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| Dallas Independent School
District Dental Member | | | | | | | | | | | | | | | | | | | | |
Texas Dental Plan (TDP) Schedule1
| 1Select a service below | | | | SERVICES | | | | | | | | | | | | | | | | CROWNS & BRIDGES | | | | | | | ADA
Code | | Procedure | | Member
Pays |  | | D2751 | | Crown - porcelain fused to predominantly base metal* | | $321 + LAB | | | | D2791 | | Crown - full cast predominantly base metal* | | 300 + LAB | | | | D2810 | | Crown - 3/4 cast predominantly base metal* | | 300 + LAB | | | | D2950 | | Core buildup, including any pins | | 20%
Discount | | | | D6211 | | Pontic - cast predominantly base metal* | | 300 + LAB | | | | D6241 | | Pontic - porcelain fused to predominately base metal* | | 321 + LAB | | | | D6751 | | Crown - porcelain fused to predominately base metal* | | 321 + LAB | | | | D6791 | | Crown - full cast predominantly base metal* | | 300 + LAB | | | | | | **Lab fees are additional and are not subject to plan discounts | | | 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. | | 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. | | |
