Careington Dental Plan Information

Full Fee Schedule For Alaska

We are proud to be the only major discount dental plan and dental insurance alternative that will show you a full fee schedule before you become a member. We want you to know how much you can save at Careington providers.

CAREINGTON Discount Dental Plan 500 Series
Plan 506 Schedule
ADA CODE DIAGNOSTIC MEMBER PAYS
0120 PERIODIC ORAL EVALUATION $20
0140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED $24
0150 COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED PATIENT $24
0210 INTRAORAL-COMPLETE SERIES INCLUDING BITEWINGS $60
0220 INTRAORAL-PERIAPICAL-FIRST FILM $14
0230 INTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM $7
0270 BITEWING-SINGLE FILM $14
0272 BITEWINGS-TWO FILMS $17
0273 BITEWINGS-THREE FILMS $22
0274 BITEWINGS-FOUR FILMS $26
0330 PANORAMIC FILM $60
PREVENTIVE
1110 PROPHYLAXIS-ADULT $44
1120 PROPHYLAXIS-CHILD $36
1351 SEALANT-PER TOOTH $31
1510 SPACE MAINTAINER-FIXED-UNILATERAL $131
1515 SPACE MAINTAINER-FIXED-BILATERAL $193
1520 SPACE MAINTAINER-REMOVABLE-UNILATERAL $170
1525 SPACE MAINTAINER-REMOVABLE-BILATERAL $217
RESTORATIVE
2140 AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT $60
2150 AMALGAM-TWO SURFACES, PRIMARY OR PERMANENT $76
2160 AMALGAM-THREE SURFACES, PRIMARY OR PERMANENT $90
2161 AMALGAM-FOUR OR MORE SURFACES, PRIMARY OR PERMANENT $110
2330 RESIN-BASED COMPOSITE-ONE SURFACE, ANTERIOR $76
2331 RESIN-BASED COMPOSITE-TWO SURFACES, ANTERIOR $93
2332 RESIN-BASED COMPOSITE-THREE SURFACES, ANTERIOR $117
2335 RESIN-BASED COMPOSITE-FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE, ANTERIOR $147
2391 RESIN-BASED COMPOSITE-ONE SURFACE, POSTERIOR $98
2392 RESIN-BASED COMPOSITE-TWO SURFACES, POSTERIOR $143
2393 RESIN-BASED COMPOSITE-THREE SURFACES, POSTERIOR $181
2394 RESIN-BASED COMPOSITE-FOUR OR MORE SURFACES, POSTERIOR $207
2750 CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL $670
2751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $654
2752 CROWN-PORCELAIN FUSED TO NOBLE METAL $663
2790 CROWN-FULL CAST HIGH NOBLE METAL $685
2791 CROWN-FULL CAST PREDOMINANTLY BASE METAL $649
2930 PREFABRICATED STAINLESS STEEL CROWN-PRIMARY $134
2931 PREFABRICATED STAINLESS STEEL CROWN-PERMANENT $150
2950 CORE BUILD-UP, INCLUDING ANY PINS $131
2951 PIN RETENTION/TOOTH, IN ADDITION TO RESTORATION $33
2952 CAST POST AND CORE IN ADDITION TO CROWN $217
2954 PREFABRICATED POST AND CORE IN ADDITION TO CROWN $164
ENDODONTICS
3110 PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION) $33
3120 PULP CAP-INDIRECT (EXCLUDING FINAL RESTORATION) $31
3220 THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) $76
3310 ROOT CANAL-ANTERIOR (EXCLUDING FINAL RESTORATION) $411
3320 ROOT CANAL-BICUSPID (EXCLUDING FINAL RESTORATION) $487
3330 ROOT CANAL-MOLAR (EXCLUDING FINAL RESTORATION) $611
PERIODONTICS
4210 GINGIVECTOMY OR GINGIVOPLASTY-FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT $424
4341 PERIODONTAL SCALING AND ROOT PLANING-FOUR OR MORE TEETH PER QUADRANT $138
4910 PERIODONTAL MAINTENANCE $86
PROSTHODONTICS (REMOVABLE)
5110 COMPLETE DENTURE-MAXILLARY $888
5120 COMPLETE DENTURE-MANDIBULAR $888
5130 IMMEDIATE DENTURE-MAXILLARY $935
5140 IMMEDIATE DENTURE-MANDIBULAR $935
5211 MAXILLARY PARTIAL DENTURE-RESIN BASE (CLASP/RESTS) $873
5212 MANDIBULAR PARTIAL DENTURE-RESIN BASE (CLASP/RESTS) $873
5213 MAXILLARY PARTIAL DENTURE-METAL FRAME WITH RESIN BASE $997
5214 MANDIBULAR PARTIAL DENTURE-METAL FRAME WITH RESIN BASE $997
5410 ADJUST COMPLETE DENTURE-MAXILLARY $47
5411 ADJUST COMPLETE DENTURE-MANDIBULAR $47
5510 REPAIR BROKEN COMPLETE DENTURE BASE $81
5520 REPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE (EACH TOOTH) $76
5630 REPAIR OR REPLACE BROKEN CLASP, PARTIAL DENTURE $93
5650 ADD TOOTH TO EXISTING PARTIAL DENTURE $81
5660 ADD CLASP TO EXISTING PARTIAL DENTURE $102
5730 RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE) $185
5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) $185
5740 RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) $174
5741 RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) $174
5750 RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) $240
5751 RELINE COMPETE MANDIBULAR DENTURE (LABORATORY) $240
PROSTHODONTICS (FIXED)
6240 PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL $614
6241 PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $567
6242 PONTIC-PORCELAIN FUSED TO NOBLE METAL $586
6750 CROWN-RETAINER-PORCELAIN FUSED TO HIGH NOBLE METAL $654
6751 CROWN-RETAINER-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $616
6752 CROWN-RETAINER-PORCELAIN FUSED TO NOBLE METAL $640
ORAL SURGERY
7140 EXTRACTION-ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPTS REMOVAL) $76
7220 REMOVAL OF IMPACTED TOOTH-SOFT TISSUE $157
7230 REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY $204
7240 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY $267
7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) $147
7310 ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS-PER QUADRANT $131
7320 ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS-PER QUADRANT $189
7510 INCISION AND DRAINAGE ABSCESS-INTRAORAL SOFT TISSUE $97
ORTHODONTICS
8070 COMPLETE ORTHODONTIC TREATMENT-TRANSITIONAL DENTITION 20% Discount
8080 COMPLETE ORTHODONTIC TREATMENT-ADOLESCENT DENTITION 20% Discount
8090 COMPLETE ORHTODONTIC TREATMENT-ADULT DENTITION 20% Discount
ADJUNCTIVE SERVICES
9110 PALLIATIVE (EMERGENCY) TREATMENT-DENTAL PAIN-MINOR PROCEDURE $50
9215 LOCAL ANESTHESIA $20
9230 ANALGESIA $33
9951 OCCLUSAL ADJUSTMENT-LIMITED $70
9952 OCCLUSAL ADJUSTMENT-COMPLETE $283
This schedule applies to services provided by a participating CAREINGTON General Dentist. The purpose of this schedule is to establish the fee that a General Dentist will charge for each procedure. Member is responsible for all charges at the time of service. Participating Specialists (Board Certified or Advanced Degree) do not charge according to a fee schedule. Participating Specialists will give up to a 20% discount off of their normal fees. Fee schedules are subject to change without prior notification to members.
It is the Member’s responsibility to verify that the dentist is a participating Provider before seeking any treatment. Any dental procedures performed by a non-participating dentist are not discounted and are charged at the dentist's normal fees.
The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment - many treatments may require more than one dental procedure. Please consult your CAREINGTON provider for a detailed treatment plan prior to beginning any work.
Procedures not listed on this schedule will be discounted at 20% off of the General Dentist's normal fee.
Implants and some whitening procedures will not be discounted by all participating CAREINGTON providers. Implants and some whitening procedures will only be discounted if the participating CAREINGTON provider has agreed to discount these procedures as part of their contract. These services will be offered, when applicable, at a 15% discount off of the provider's normal fee.
If the General Dentist's normal fee for any procedure is less than the fee listed on this schedule, the dentist will charge 20% off of their normal fee for that procedure.
Work in progress prior to signing up on the dental plan must be completed by the dentist who started the work and is subject to no discount.
CAREINGTON can not guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating CAREINGTON provider. Not all types of dentists may be available in your area.
Any procedure involving lab fees will incur additional costs. All applicable lab fees are the responsibility of the member.
While all participating CAREINGTON providers are professionally licensed in the state in which they practice, CAREINGTON does not guarantee the quality of service of the providers. Any quality of care concerns involving any participating CAREINGTON provider should be directed in writing to: CAREINGTON International, Attn. Provider Relations, PO Box 2568, Frisco, Texas 75034.

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