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Fee Schedule A for 2000

UHP Dental Fee Schedule A for 2000

As performed by participating General Practitioners & Specialists

Schedule A applies to the following States:
CA, CT, DE, DC, FL, GA, HI, IL, ME, MD, MA, MI, NH, NV, NJ, NM, NY, OR, PA, PR, RI, TX, VT, VA, WA.

The Average savings for 106 procedures with UHP Schedule A compared to the ADA Mean = 46%, Click here for Specialist Codes

ADA Code

Description

UHP Sched A ADA Mean Save $ Save %
General Practitioner
Diagnostic Procedures
110 Initial oral examination No Charge Not Published
120 Periodic oral examination No Charge 21 21 100%
130 Emergency oral examination No Charge Not Published
210 Intraoral comp. series x-ray (Inc. Bit.) No Charge 62 62 100%
220 Intraoral x-ray film,single, first No Charge 12 12 100%
230 Intraoral x-ray film, each additional No Charge 8 8 100%
260 Extraoral-Additional Film No Charge Not Published
270 Bitewing x-ray film, single, first No Charge Not Published
274 Bitewing x-ray films, four No Charge 30 30 100%
330 Panoramic film No Charge 54 54 100%
460 Pulp vitality tests 15 Not Published
Preventive Procedures
1110 Prophylaxis - adult (simple cleaning) 27 45 18 40%
Prophylaxis - adult (difficult cleaning) 44 Not Published
1120 Prophylaxis - child (up to & including 16 years old) 23 33 10 30%
1201 Topical appl. of fluoride (incl. prophy child) 30 42 12 29%
1203 Topical appl. of fluoride (excl. prophy-child) 7 18 11 61%
1204 Topical appl. of fluoride (excl. prophy-adult) 8 20 12 60%
1205 Topical appl. of fluoride (incl. prophy-adult) 35 49 14 29%
1330 Oral hygiene instructions No Charge Not Published
1351 Sealant - per tooth 12 24 12 50%
1510 Space maintainer - fixed bilateral type 83 142 59 42%
1515 Space maintainer - fixed unilateral type 128 198 70 35%
Restorative Procedures
2110 Amalgam - 1 surface, primary 29 46 17 37%
2120 Amalgam - 2 surfaces, primary 38 59 21 36%
2130 Amalgam - 3 surfaces, primary 46 72 26 36%
2131 Amalgam - 4 surfaces, primary 56 Not Published
2140 Amalgam - 1 surface, permanent 33 54 21 39%
2150 Amalgam - 2 surfaces, permanent 43 68 25 37%
2160 Amalgam - 3 surfaces, permanent 54 83 29 35%
2161 Amalgam - 4 surfaces, permanent 65 99 34 34%
2330 Resin - 1 surface, anterior 38 65 27 42%
2331 Resin - 2 surfaces, anterior 52 82 30 37%
2332 Resin - 3 surfaces, anterior 66 100 34 34%
2335 Resin - 4+ surfaces or involving incisal angle 77 123 46 37%
2751 Crown - porcelain fused to base metal 390 495 105 21%
2791 Crown - full cast (base metal) 325 Not Published
2920 Recement crown 28 46 18 39%
2930 Prefab'd stainless steel crown - 1 tooth 67 113 46 41%
2931 Prefab'd stainless steel crown - 2 tooth 89 135 46 34%
2932 Prefabricated Resin Crown 78 Not Published
2940 Sedative filling 28 43 15 35%
2950 Crown buildup, including any pins 72 115 43 37%
2951 Pin retention-per tooth, in add. to restoration 20 Not Published
2952 Cast post and core, in addition to crown 123 181 58 32%
2953 Cast post as part of crown 100 Not Published
2954 Prefab'd post and core in add. to crown 95 Not Published
2970 Temporary crown (fractured tooth) 72 Not Published
Cosmetic Procedures
2962 Porcelain laminate veneer-per tooth 290 429 139 32%
3960 Bleaching (whitening) - per jaw 150 125 -25 -20%
Endodontic Procedures (Root Canal Therapy)
3110 Pulp cap-direct (exc final restoration) 15 35 20 57%
3120 Pulp cap-indirect (excl final restoration.) 15 35 20 57%
3220 Therapeutic pulpotomy (excl final restoration.) 50 74 24 32%
3310 Root canal therapy-anterior (excl final restoration.) 206 304 98 32%
3320 Root canal therapy-bicuspid (excl final restoration.) 262 368 106 29%
3330 Root canal therapy-molar (exc final restoration.) 334 462 128 28%
3340 Root canal therapy-4 or more canals (excl. final restoration) 362
Periodontic Procedures
4210 Gingivectomy or gingivoplasty - per quadrant 144 252 108 43%
4211 Gingivectomy or gingivoplasty, per tooth 44 91 47 52%
4240 Gingival flap procedure-incl root planing per quadrant 227 Not Published
4260 Osseous surgery-incl flap entry and closure per quadrant 322 429 107 25%
4270 Pedicle soft tissue graft procedure 183 Not Published
4341 Periodontal scaling and root planing, per quadrant 52 110 58 53%
4345 Periodontal scaling in the presence of gingival inflammation 44 Not Published
4910 Periodontal maintenance procedures (follow active therapy) 44 Not Published
Prosthodontics, Removable
5110 Complete upper denture, incl 6 months post-inseration care 445 703 258 37%
5120 Complete lower denture, incl 6 months post-inseration care 445 706 261 37%
5130 Immediate upper denture,incl 6 months post -inseration care; does not include required future rebasing/relining procedure(s) or a complete new denture 468 734 266 36%
5140 Immediate lower denture,incl 6 months post-inseration care; does not include required future rebasing/relining procedure(s) or a complete new denture 468 737 269 36%
5211 Upper partial denture - acrylic base, including any conventional clasps and rest 329 518 189 36%
5212 Lower partial denture - acrylic base, including any conventional clasps and rest 329 521 192 37%
5213 Upper partial denture - predominantly base cast base with acrylic saddles incl any conventional clasps and rests 507 777 270 35%
5214 Lower partial denture - predominantly base case base with acrylic saddles incl any conventional clasps and rests 507 776 269 35%
5410 Adjust complete denture-upper (after 6 mos) 20 Not Published
5411 Adjust complete denture-lower (after 6 mos) 20 Not Published
5421 Adjust partial denture-upper (after 6 mos) 20 Not Published
5422 Adjust partial denture-lower (after 6 mos) 20 Not Published
5510 Repair broken complete denture base 50 86 36 42%
5520 Replace missing or broken teeth, complete denture (each tooth) 45 71 26 37%
5610 Repair partial denture resin saddle or base 46 82 36 44%
5630 Repair or replace partial denture broken 59 104 45 43%
5640 Replace broken teeth-partial denture-per tooth 45 70 25 36%
5650 Add tooth to existing partial denture 60 88 28 32%
5660 Add clasp to existing partial denture 72 112 40 36%
5710 Rebase complete upper denture (LAB) 153 241 88 37%
5711 Rebase complete lower denture (LAB) 153 Not Published
5720 Rebase partial upper denture (LAB) 153 Not Published
5721 Rebase partial lower denture (LAB) 153 Not Published
5730 Reline complete upper denture (chairside) 90 144 54 38%
5731 Reline complete lower denture (chairside) 90 143 53 37%
5740 Reline upper partial denture (chairside) 90 Not Published
5741 Reline lower partial denture (chairside) 90 Not Published
5810 Temporary complete denture (upper) 248 Not Published
5811 Temporary complete denture (lower) 248 Not Published
5820 Temporary partial - stayplate denture (upper) 224 Not Published
5821 Temporary partial - stayplate denture (lower) 224 Not Published
Prosthodontics, Fixed Bridges
6241 Pontic, porcelain fused to base metal 390 494 104 21%
6545 Cast metal retainer for acid etch bridge 167 305 138 45%
6751 Crown (abutment)-porcelain fused to base metal 390 501 111 22%
6791 Crown (abutment)- full cast base metal 325 Not Published
6930 Recement bridge 35 69 34 49%
6940 Stress breaker 124 Not Published
6950 Precision attachment (each) 250 Not Published
6970 Cast post & core in addition to bridge retainer 123 Not Published
6971 Cast post & core as part of bridge retainer 100 Not Published
6972 Prefabricated post & core in addition to bridge retainer 95 Not Published
Oral Surgery
7110 Extraction (simple) - single tooth 41 65 24 37%
7120 Extraction (simple) - each additional tooth 37 60 23 38%
7130 Extraction, root removal-exposed root 49 74 25 34%
7210 Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and/or section of tooth-each tooth 69 118 49 42%
7220 Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth 89 137 48 35%
7230 Removal of impacted tooth, soft tissue 123 178 55 31%
7240 Removal of impacted tooth, partially bony 172 221 49 22%
7241 Removal of impacted tooth-completely bony 207 249 42 17%
7250 Removal of impacted tooth, completely bony, with unusual surgical complications 72 129 57 44%
7281 Surgical removal of residual tooth roots (cutting procedure) 120 119 -1 -1%
7310 Surg exposure of impacted/unerupted tooth(ortho attach) 61 114 53 46%
7320 Surgical exposure of impacted or unerupted tooth to aid eruption 89 155 66 43%
7960 Frenclectomy (frenectomy or frenotomy), seperate procedure 102 155 53 34%
7970 Excision of hyperplastic tissue, per arch 78 161 83 52%
Orthodontics - Comprehensive Case, Class 1, 11, 111
4 month limited Orthodontic treatment of the transitional dentition codes 8020, 8060, 8070,8660 (to age 16) 2500 4294 1794 42%
8010 Orthodontic records, treatment plan and consultation 75 Not Published
Initial ortho, applicance, construction and installation 355 Not Published
Active treatment phase - up to 24 months 1965 Not Published
Retention phase including a retainer 105 Not Published
Adjunctive Services Unclassified Treatment
9110 Palliative (emergency) treatment of dental pain, minor procedure, during regular office hours 27 49 22 45%
9440 Office visit after regularly scheduled hours 54 59 5 8%
Specialist Codes
Oral Surgery
7110 Extraction (simple)-single tooth 65 80 15 19%
7120 Extraction (simple)-each additional tooth 47 71 24 34%
7130 Extraction, root removal-exposed roots 65 106 41 39%
7210 Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and/or section of tooth-each tooth 90 132 42 32%
7220 Removal of impacted tooth-soft tissue 130 163 33 20%
7230 Removal of impacted tooth-partially bony 158 209 51 24%
7240 Removal of impacted tooth-completely bony 195 246 51 21%
7241 Removal of impacted tooth-competely bony wth unusual surgical complications 245 298 53 18%
7250 Surgical removal of residual tooth roots (cutting procedure) 110 153 43 28%
7281 Surgical exposure of impacted or unerupted tooth to aid eruption 158 257 99 39%
7310 Alveolectomy or plasty in conjunction with extractions-per quadrant 88 134 46 34%
7320 Alveolectomy or plasty not in conjunction with extractions-per quadrant 125 192 67 35%
7960 Frenulectomy (frenectomy or frenotomy), separate procedures 150 87 -63 -72%
7970 Excision of hyperplastic tissue-per arch 175 164 -11 -7%
7971 Excision of pericoronal gingiva 94 Not Published
Periodontics
4210 Gingivectomy or gingivoplasty-per quadrant 225 450 225 50%
4211 Gingivectomy or gingivoplasty-per tooth 75 148 73 49%
4240 Gingival flap procedure-incl root planing,per quadrant 325 Not Published
4260 Osseous surgery,incl flap entry and closure, per quadrant 448 693 245 35%
4270 Pedicle soft tissue graft procedure 250 Not Published
4341 Periodontal scaling and root planing, per quadrant 92 157 65 41%
4345 Scaling in the presence of gingival inflammation 65 Not Published
4910 Periodontal maintenance procedures following active therapy 59 Not Published
Endodontics
3310 Root canal therapy-anterior tooth (excl. final restoration) 280 441 161 37%
3320 Root canal therapy-bicuspid (excl. final restoration) 353 518 165 32%
3330 Root canal therapy-molar (excl. final restoration) 459 632 173 27%
3340 Root canal therapy-4 or more canals (excl. final restoration) 496 Not Published
3410 Apicoectomy (per tooth) first root 254 493 239 48%
3411 Apicoectomy (per tooth) each additional root 98 Not Published
3430 Retorgrade filling-per root 88 Not Published
3450 Root amputation-per root 135 Not Published
3920 Hemisection (incl. root removal; excl. root canal therapy)) 148 Not Published
Implantology
All implants - Stage 1 & 2** 1325 Not Published
Adjunctive General Services-Unclassified Treatment
16 Failed appointment (without 24 hour notice), per 15 minutes 15 Not Published

Glossary:

ADA Mean - Mean price published in the most recent "Survey of Dental Fees" by The American Dental Association.

Not Published - Not Available, this procedure mean price was not published.

No Charge* - One initial oral examination or one periodic examination available once each year when provided by general practitioners listed in the UHP dental directory; one full series of x-rays or panoramic film taken in conjunction with an initial or periodic oral examination available one in a three year period; a partial series of x-ray films taken in conjunction with an initial or periodic oral examination available once per year.

The dental services appearing in this schedule are available from general practitioners and specialists listed in the Dental Directory. Other services are available at 25% discount from the usual and customary fees charged by participating practitioners and specialists.


Copyright 1999 United Health Programs of America
Last modified: March 12, 1999


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