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| Dallas Independent School
District Dental Member | | | | | | | | | | | | | | | | | | | | |
Texas Dental Plan (TDP) Schedule1
| 1Select a service below | | | | SERVICES | | | | | | | | | | | | | | | ENDODONTIC DENTISTRY
(Root Canal Treatment) | | | | | | | ADA
Code | | Procedure | | Member
Pays |  | | D3110 | | Pulp cap-direct (excluding final restoration) | | $19 | | | | D3120 | | Pulp cap-indirect (excluding final restoration) | | 19 | | | | D3220 | | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament | | 43 | | | | | | Root canals | | | | | | | | D3310 | | Root canal therapy - anterior (excluding final restoration) | | 199 | | | | D3320 | | Root canal therapy - bicuspid (excluding final restoration) | | 236 | | | | D3330 | | Root canal therapy - molar (excluding final restoration) | | 279 | | | | | | Any Root Canal treatment or retreatment that presents unusual difficulties and circumstances may have an additional charge. Please discuss all fees with the general dentist prior to treatment. | | | 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. | | | |
