Full Fee Schedule For Maine

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 505 Schedule
ADA CODE	DIAGNOSTIC	MEMBER PAYS
0120	PERIODIC ORAL EVALUATION	$17
0140	LIMITED ORAL EVALUATION-PROBLEM FOCUSED	$22
0150	COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED PATIENT	$22
0210	INTRAORAL-COMPLETE SERIES INCLUDING BITEWINGS	$52
0220	INTRAORAL-PERIAPICAL-FIRST FILM	$12
0230	INTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM	$5
0270	BITEWING-SINGLE FILM	$13
0272	BITEWINGS-TWO FILMS	$16
0273	BITEWINGS-THREE FILMS	$21
0274	BITEWINGS-FOUR FILMS	$26
0330	PANORAMIC FILM	$52
PREVENTIVE
1110	PROPHYLAXIS-ADULT	$39
1120	PROPHYLAXIS-CHILD	$32
1351	SEALANT-PER TOOTH	$25
1510	SPACE MAINTAINER-FIXED-UNILATERAL	$114
1515	SPACE MAINTAINER-FIXED-BILATERAL	$168
1520	SPACE MAINTAINER-REMOVABLE-UNILATERAL	$149
1525	SPACE MAINTAINER-REMOVABLE-BILATERAL	$190
RESTORATIVE
2140	AMALGAM-ONE SURFACE, PRIMARY OR PERMANENT	$52
2150	AMALGAM-TWO SURFACES, PRIMARY OR PERMANENT	$66
2160	AMALGAM-THREE SURFACES, PRIMARY OR PERMANENT	$78
2161	AMALGAM-FOUR OR MORE SURFACES, PRIMARY OR PERMANENT	$97
2330	RESIN-BASED COMPOSITE-ONE SURFACE, ANTERIOR	$66
2331	RESIN-BASED COMPOSITE-TWO SURFACES, ANTERIOR	$81
2332	RESIN-BASED COMPOSITE-THREE SURFACES, ANTERIOR	$101
2335	RESIN-BASED COMPOSITE-FOUR OR MORE SURFACES OR INVOLVING INCISAL ANGLE, ANTERIOR	$128
2391	RESIN-BASED COMPOSITE-ONE SURFACE, POSTERIOR	$88
2392	RESIN-BASED COMPOSITE-TWO SURFACES, POSTERIOR	$125
2393	RESIN-BASED COMPOSITE-THREE SURFACES, POSTERIOR	$167
2394	RESIN-BASED COMPOSITE-FOUR OR MORE SURFACES, POSTERIOR	$192
2750	CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL	$600
2751	CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL	$541
2752	CROWN-PORCELAIN FUSED TO NOBLE METAL	$572
2790	CROWN-FULL CAST HIGH NOBLE METAL	$578
2791	CROWN-FULL CAST PREDOMINANTLY BASE METAL	$550
2930	PREFABRICATED STAINLESS STEEL CROWN-PRIMARY	$123
2931	PREFABRICATED STAINLESS STEEL CROWN-PERMANENT	$141
2950	CORE BUILD-UP, INCLUDING ANY PINS	$123
2951	PIN RETENTION/TOOTH, IN ADDITION TO RESTORATION	$28
2952	CAST POST AND CORE IN ADDITION TO CROWN	$193
2954	PREFABRICATED POST AND CORE IN ADDITION TO CROWN	$150
ENDODONTICS
3110	PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION)	$27
3120	PULP CAP-INDIRECT (EXCLUDING FINAL RESTORATION)	$27
3220	THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION)	$66
3310	ROOT CANAL-ANTERIOR (EXCLUDING FINAL RESTORATION)	$360
3320	ROOT CANAL-BICUSPID (EXCLUDING FINAL RESTORATION)	$426
3330	ROOT CANAL-MOLAR (EXCLUDING FINAL RESTORATION)	$535
PERIODONTICS
4210	GINGIVECTOMY OR GINGIVOPLASTY-FOUR OR MORE CONTIGUOUS TEETH OR BOUNDED TEETH SPACES PER QUADRANT	$360
4341	PERIODONTAL SCALING AND ROOT PLANING-FOUR OR MORE TEETH PER QUADRANT	$120
4910	PERIODONTAL MAINTENANCE	$76
PROSTHODONTICS (REMOVABLE)
5110	COMPLETE DENTURE-MAXILLARY	$779
5120	COMPLETE DENTURE-MANDIBULAR	$779
5130	IMMEDIATE DENTURE-MAXILLARY	$828
5140	IMMEDIATE DENTURE-MANDIBULAR	$828
5211	MAXILLARY PARTIAL DENTURE-RESIN BASE (CLASP/RESTS)	$764
5212	MANDIBULAR PARTIAL DENTURE-RESIN BASE (CLASP/RESTS)	$764
5213	MAXILLARY PARTIAL DENTURE-METAL FRAME WITH RESIN BASE	$870
5214	MANDIBULAR PARTIAL DENTURE-METAL FRAME WITH RESIN BASE	$870
5410	ADJUST COMPLETE DENTURE-MAXILLARY	$41
5411	ADJUST COMPLETE DENTURE-MANDIBULAR	$41
5510	REPAIR BROKEN COMPLETE DENTURE BASE	$70
5520	REPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE (EACH TOOTH)	$66
5630	REPAIR OR REPLACE BROKEN CLASP, PARTIAL DENTURE	$81
5650	ADD TOOTH TO EXISTING PARTIAL DENTURE	$70
5660	ADD CLASP TO EXISTING PARTIAL DENTURE	$89
5730	RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)	$167
5731	RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)	$167
5740	RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)	$158
5741	RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)	$158
5750	RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)	$218
5751	RELINE COMPETE MANDIBULAR DENTURE (LABORATORY)	$218
PROSTHODONTICS (FIXED)
6240	PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL	$588
6241	PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL	$492
6242	PONTIC-PORCELAIN FUSED TO NOBLE METAL	$535
6750	CROWN-RETAINER-PORCELAIN FUSED TO HIGH NOBLE METAL	$561
6751	CROWN-RETAINER-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL	$522
6752	CROWN-RETAINER-PORCELAIN FUSED TO NOBLE METAL	$534
ORAL SURGERY
7140	EXTRACTION-ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPTS REMOVAL)	$66
7220	REMOVAL OF IMPACTED TOOTH-SOFT TISSUE	$136
7230	REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY	$179
7240	REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY	$239
7250	SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE)	$125
7310	ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS-PER QUADRANT	$114
7320	ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS-PER QUADRANT	$166
7510	INCISION AND DRAINAGE ABSCESS-INTRAORAL SOFT TISSUE	$84
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	$44
9215	LOCAL ANESTHESIA	$16
9230	ANALGESIA	$27
9951	OCCLUSAL ADJUSTMENT-LIMITED	$61
9952	OCCLUSAL ADJUSTMENT-COMPLETE	$247
*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.