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| Dallas Independent School
District Dental Member | | | | | | | | | | | | | | | | | | | | |
Texas Dental Plan (TDP) Schedule1
| 1Select a service below | | | | SERVICES | | | | | | | | | | | | | | | | ORTHODONTIC DENTISTRY (Braces by a General Dentist) | | | | | | | ADA
Code | | Procedure | | Member
Pays |  | | | | | | | | D8660 | | Pre - orthodontic treatment visit | | 120 | | | | D9310 | | Consultation (diagnostic service provided by dentist or physician other than practitioner providing treatment) | | 15/10-Ortho | | | | | | Orthodontic Treatment (Braces) | | | | D8080 | | Comprehensive orthodontic treatment of the adolescent dentition | | 2,150 | | | | D8090 | | Comprehensive orthodontic treatment of the adult dentition | | 2,350 | | | | | | The above orthodontic charges are our reduced fees for full banded Class I malocclusion cases. Any orthodontic treatment that requires surgery, headgear, unusual or ancillary services or is extended because of lack of patient cooperation will have an additional charge. At the orthodontic consultation appointment, the general dentist will explain the length of treatment, all fees, and the payment schedule. Orthodontic services are offered on a space and time available basis only and are not available to any person that is currently in treatment or has had treatment planned by any dentist in the past 6 months. Broken or lost appliances will be and additional charge. | | | 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. | | | |
