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Dallas
Independent School
District Dental Member |
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Texas Dental Plan (TDP) Schedule1
| 1Select a service
below |
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| SERVICES |
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ORAL SURGERY |
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ADA
Code |
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Procedure |
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Member
Pays |
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D7110 |
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Extraction, single tooth |
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$35 |
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D7210 |
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Surgical removal of erupted tooth requiring elevation of mucoperiostial flap
and removal of bone and/or section of tooth |
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65 |
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D7220 |
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Removal of impacted tooth - soft tissue |
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99 |
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D7230 |
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Removal of impacted tooth - partially bony |
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120 |
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D7240 |
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Removal of impacted tooth - completely bony |
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142 |
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D7510 |
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Incision and drainage of abscess - intraoral soft tissue |
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32 |
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Any tooth that presents unusual difficulties and circumstances may incur an
additional charge. Please discuss all fees with the dentist prior to
treatment |
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All of the listed charges are reduced fees for services
performed by a participating general dentist. Fees are
subject to change without notice.
Any procedure not listed is available on a fee for service basis at
a 20% discount. Consult with your participating general dentist
prior to beginning any treatment. |
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Specialist Services
Any treatment provided by a participating specialist, if available,
in Endodontics (root canal), Pediatric Dentistry (children's
dentistry), Prosthodontics (Dentures), Orthodontics (teeth
straightening), Periodontics (gum disease treatment) or Oral
Surgery, will be charged at a 20% reduction of participating
specialist's fees for that particular case. Some specialists may
require a consultation visit before treatment is initiated. Discuss
each case with the specialist prior to beginning any treatment. |
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