This is a Cooperative Dental Plan. If your membership fee is not returned thru Plan Savings, we are not meeting our minimum goal. We seek member feedback on dental fees and all aspects of the plan. Savings shown for Diagnostic and Preventive visits alone should cover all or most of membership cost. Utilization of additional Dental Services or Coordination of Benefits with conventional dental insurance plans should result in greater savings.
To track plan utilization and member savings, NYDN may ask participating dentists to document NYDN fees actually charged, compared to usual and customary fees. NYDN may remit an administrative fee to dentists for this service, where applicable. Results of this fee survey will be made available to dentists and members to illustrate the cost effectiveness of this plan. For reasons of confidentiality, NYDN never collects or distributes medical or dental information; we are concerned only with fee information.
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| Note: For some procedures listed on this schedule we have posted an alternate, higher fee that may apply at certain Manhattan practice locations only. Please consult with your dentist about this. |
Dentists: Please Verify Member Status at each member visit.
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Endodontic Rates & Procedures Services are provided by an Endodontist,
a Specialist with additional training in this field. |
Regional Fee
|
Network Fee
|
Typical Network Savings |
Typical % Savings |
| Comprehensive Oral Exam |
$90 |
$50 |
$40 |
44% |
| Consultation - Extended, may include x-rays |
$200 |
$100 |
$100 |
50% |
| First Periapical X-ray |
$25 |
$15 |
$10 |
40% |
| Each Additional Periapical X-ray |
$20 |
$10 |
$10 |
50% |
| X-Ray Bite Wings (complete) |
$80 |
$45 |
$35 |
31% |
| X-Ray Full Mouth |
$140 |
$80 |
$60 |
43% |
| X-Ray Panorex |
$125 |
$85 |
$40 |
32% |
| X-Ray Full Mouth, Including Bitewings (complete) |
$115 - $165 |
$85 |
$60 |
39% |
| Pulp Test |
$75 |
$50 |
$25 |
33% |
| Pulpotomy |
$325 |
$225 |
$100 |
31% |
| Pulpectomy |
$450 |
$300 |
$150 |
33% |
| Note: Fees for Root Canal Therapy and Retreatments vary based upon degree of difficulty, time, and individual professional considerations. The dentist will confirm UCR fee and in this way you can determine the amount and the percentage of network savings. |
- |
- |
- |
- |
| Root canal therapy - anterior |
$850 - $1050 |
$650 |
$300 |
32% |
Root canal therapy - anterior Alternate Fee - Certain Manhattan Locations Only - Please consult with your dentist. |
$850 - $1150 |
$750 |
$250 |
25% |
| Root canal therapy - bicuspid |
$1050 - $1150 |
$825 |
$275 |
25% |
Root canal therapy - bicuspid Alternate Fee - Certain Manhattan Locations Only - Please consult with your dentist. |
$1050 - $1250 |
$900 |
$150 |
22% |
| Root canal therapy - molar |
$1100 - $1350 |
$900 |
$325 |
27% |
Root canal therapy - anterior Alternate Fee - Certain Manhattan Locations Only - Please consult with your dentist. |
$1250 - $1650 |
$1150 |
$300 |
21% |
Root Canal Retreatment* (upon referral)
*Generally, more complicated than initial root canal therapy, when indicated. |
- |
- |
- |
- |
| Retreatment, anterior |
$900 - $1150 |
$750 |
$275 |
27% |
Retreatment, anterior Alternate Fee - Certain Manhattan Locations Only - Please consult with your dentist. |
$1000 - $1250 |
$850 |
$275 |
24% |
| Retreatment, bicuspid |
$1000 - $1300 |
$925 |
$225 |
20% |
Retreatment, bicuspid Alternate Fee - Certain Manhattan Locations Only - Please consult with your dentist. |
$1050 - $1350 |
$1000 |
$200 |
17% |
| Retreatment, molar |
$1200 - $1600 |
$1000 |
$400 |
29% |
Retreatment, molar Alternate Fee - Certain Manhattan Locations Only - Please consult with your dentist. |
$1350 - $1750 |
$1200 |
$350 |
23% |
| Perforation Repair (MTA) Mineral Trioxide Aggregate |
$450 |
$350 |
$100 |
23% |
| Root Canal Retreatment - Removal of Post |
$375 |
$225 |
$150 |
40% |
| Apicoectomy (Surgical Root Canal) |
- |
- |
- |
- |
| Apicoectomy - Anterior (does not include retrograde filling) |
$675 - $750 |
$550 |
$162 |
23% |
| Apicoectomy - Bicuspid (does not include retrograde filling) |
$775 - $825 |
$650 |
$150 |
19% |
| Apicoectomy - Molar (does not include retrograde filling) |
$850 - $900 |
$700 |
$175 |
20% |
| Retrograde Filling (apicoectomy - per root) |
$325 |
$200 |
$125 |
38% |
| Additional Root (apicoectomy - per additional root) |
$450 |
$300 |
$150 |
33% |
| Hemisection (per root) |
$425 |
$300 |
$125 |
29% |
| Intra-Oral Incision and Drainage of Abcess |
$300 - $400 |
$200 - $250 |
$125 |
36% |
| Bone Replacement (Grafting) |
$600 |
$400 |
$200 |
33% |
| Anesthesia and Analgesia - In some cases, the cost of Inhalation Analgesia (nitrous oxide) may be included in cost of the procedure. In other cases, a separate fee, as shown on this schedule, may apply. In general, fees for Analgesia and for IV Sedation are based upon time required for each procedure. In some dental procedures, conventional medical insurance may cover a portion of the surgical or anesthesia fees. Consult with your dentist about his/her fees for Analgesia and Anesthesia to determine network savings. |
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|
|
|
| Inhalation Analgesia (Nitrous Oxide) |
$65 - $95 |
$45 |
$35 |
44% |
| IV Conscious Sedation (first 30 minutes) |
$350 - $500 |
$250 |
$175 |
41% |
| IV Conscious Sedation (additional 15 minutes) |
$180 - $220 |
$100 |
$100 |
50% |