Northeast Specialist
Fee Schedule
Last Printing April 2002
| ENDODONTIST | NDPA FEE | USUAL FEE |
| Initial Consultation | $40.00 | $90.00 |
| Pulp Capping | $80.00 | $135.00 |
| Pulpotomy | $110.00 | $180.00 |
|
Root Canal Therapy (excluding final restoration) |
||
| Anterior | $445.00 | $675.00 |
| Bicuspid | $535.00 | $790.00 |
| Molar | $645.00 | $960.00 |
| Apicoectomy - (first root-per tooth) | $350.00 | $580.00 |
| Each additional root | $215.00 | $310.00 |
| Retrograde filling per-root | $150.00 | $235.00 |
| Root Resection - per root (HEMISECTION) | $285.00 | $390.00 |
| Incision and Drainage | $135.00 | $220.00 |
| *Root canal
treatment fees include filling the canals. It does not include final
restorations ( which are sometimes called fillings) *Retreatment of a Root Canal is performed at 25% courtesy fee |
||
| ORAL SURGEON | NDPA FEE | USUAL FEE |
| Initial Consultation | $40.00 | $85.00 |
| Simple Extraction (single tooth) | $80.00 | $145.00 |
| Simple Extraction (each additional tooth) | $65.00 | $117.00 |
| Surgical Extraction | $130.00 | $215.00 |
| Soft Tissue Impaction | $160.00 | $255.00 |
| Partial Bony Impaction | $230.00 | $335.00 |
| Full Bony Impaction | $325.00 | $440.00 |
| Full Bony
Impaction with unusual surgical complications |
$395.00 | $825.00 |
| Panarex | $50.00 | $100.00 |
| General Anesthesia - first unit | $95.00 | $205.00 |
| (additional 15minutes) | $55.00 | $170.00 |
| ORTHODONTIST | NDPA FEE | USUAL FEE |
| initial Consultation | $40.00 | $90.00 |
|
Diagnosis/Records Work-up, including full mouth series, Models, Photographs and a second visit for discussion and presentation |
$140.00 | $280.00 |
|
Class I Malocclusion (comprehensive dentition) |
$3100.00 | $4550.00 |
|
Class II Malocclusion (comprehensive dentition) |
$3450.00 | $4850.00 |
| Class III - available at 15% off Dentist's usual fee | ||
| Post-Treatment Stabilization - each retainer | $200.00 | $300.00 |
| Partial Case - Evaluated on an individual basis | ||
| **Specialist's Initial Consultation fee will be applied towards Diagnosis/Records unless performed as a separate visit | ||
| PERIODONTIST | NDPA FEE | USUAL FEE |
| initial Consultation | $40.00 | $90.00 |
| Diagnosis/Records/Charting | ||
| including 5 or more x-rays | $130.00 | $245.00 |
| including 4 x-rays or less | $115.00 | $185.00 |
| Periodontal
Scaling/per quadrant (root planing - curettage) |
$155.00 | $210.00 |
| Scaling (full mouth) | $115.00 | $160.00 |
| Gingivectomy or gingivoplasty - per tooth | $140.00 | $190.00 |
| Gingivectomy or gingivoplasty - per quadrant | $415.00 | $550.00 |
| Gingival
flap procedure (including root planing - per quadrant) |
$490.00 | $640.00 |
| Osseous
Surgery (including flap entry and closure) per quadrant |
$675.00 | $880.00 |
| Pedicle soft tissue graft procedure | $435.00 | 670.00 |
| Free Soft
Tissue Graft Procedure (including donor site) |
$455.00 | $690.00 |
| Apically repositioned flap procedure | $500.00 | $690.00 |
| Occlusal Equilibration: | ||
| A. As part of a full surgical case | No Charge | No Charge |
| B. As a
seperate procedure, not to exceed 3 visits |
$125.00 | $210.00 |
| Perio
Maintenence Procedure, includes exam (following active therapy) |
$105.00 | $160.00 |
| Full Surgical Case: | ||
| Includes 4
Quadrants of osseous surgery, occlusal adjustment, 4 quadrants of periodontal scaling (not to exceed) |
$3325.00 | $4395.00 |
|
Partial Cases: Are based upon above fee schedule. **Specialist's Initial Consultation fee will be applied towards Diagnosis/Records/Charting unless perfomed as a separate visit |
||
| PROSTHODONTIST | ||
| Participating Prosthodontists will provide a 30% discount off their usual rates for all NDPA members |
| PEDODONTIST | ||
| All Pedodontists will provide a 20% discount off their usual rates for all NDPA members |
| TMJ SPECIALIST | ||
| (Temporomandibular Joint Syndrome) | ||
| Providers who treat TMJ will provide a 20% discount off their usual rates for all NDPA members. |
 | Please Note: Rates are Subject to Periodic Change Without Prior Notification |