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| Dallas Independent School
District Dental Member | | | | | | | | | | | | | | | | | | | | |
Texas Dental Plan (TDP) Schedule1
| 1Select a service below | | | | SERVICES | | | | | | | | | | | | | | | | ORAL SURGERY | | | | | | | ADA
Code | | Procedure | | Member
Pays |  | | D7110 | | Extraction, single tooth | | $35 | | | | D7210 | | Surgical removal of erupted tooth requiring elevation of mucoperiostial flap and removal of bone and/or section of tooth | | 65 | | | | D7220 | | Removal of impacted tooth - soft tissue | | 99 | | | | D7230 | | Removal of impacted tooth - partially bony | | 120 | | | | D7240 | | Removal of impacted tooth - completely bony | | 142 | | | | D7510 | | Incision and drainage of abscess - intraoral soft tissue | | 32 | | | | | | Any tooth that presents unusual difficulties and circumstances may incur an additional charge. Please discuss all fees with the 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. | | | |
