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| Dallas Independent School
District Dental Member | | | | | | | | | | | | | | | | | | | | |
Texas Dental Plan (TDP) Schedule1
| 1Select a service below | | | | SERVICES | | | | | | | | | | | | | | | | GENERAL | | | | | | | ADA
Code | | Procedure | | Member
Pays |  | | D9110 | | Palliative (emergency) treatment of dental plan | | 20%
Discount | | | | D9430 | | Office visit for observation (during regularly scheduled hours) | | 12 | | | | D9440 | | Office visit for observation (after regularly scheduled hours) | | UCR* | | | | D9999 | | Broken appointments without 24 hours advanced notice | | 25 | | | | | | * UCR = Usual and Customary Charges | | | | 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. | | | |
