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Dental Fees For City Club Naples (CCN) Members 2007
Providers:
Central Dental (CD) 262-1913
Gulfshore Dental (GS)
948-5666
R. Koslen D.D.S(RK)
594-8108 |
Procedures Not Available from Providers Noted
(See Note at Bottom)
|
Usual
Fees $ |
CCN
Member Pays $ |
CNN
Member Saves $ |
Percent Savings |
| Diagnostic & Preventive Procedures |
| 0120 Periodic Oral Evaluation |
|
52 |
28 |
24 |
46.23% |
0140 Limited Oral Eval-
Problem Focused |
|
77 |
31 |
46 |
59.73% |
| 0150 Comprehensive Exam |
|
94 |
42 |
52 |
55.30% |
|
0210 Complete Series of
X-Rays |
|
129 |
70 |
59 |
45.76% |
|
0220 Intraoral Periapical
First Exam |
|
27 |
16 |
11 |
41.11% |
|
0230 Intaoral Periapical
Additional Film |
|
23 |
8 |
15 |
64.66% |
|
0270 Bitewing-Single |
|
28 |
16 |
12 |
43.46% |
|
0272 Bitewing-Double |
|
46 |
30 |
16 |
35.36% |
|
0274 Bitewing-Four |
|
66 |
34 |
32 |
48.21% |
|
0330 Panoramic Film |
CD |
109 |
57 |
52 |
47.55% |
|
0470 Diagnostic Cast |
|
110 |
58 |
52 |
47.18% |
|
1110 Adult Prophlaxis
(Cleaning) |
|
93 |
69 |
24 |
25.67% |
|
1120 Child Prophlaxis
(Cleaning) |
|
69 |
40 |
29 |
42.07% |
|
1201 Child Prophlaxis with
Fluoride |
|
93 |
50 |
43 |
46.13% |
|
1205 Adult Prophlaxis with
Fluoride |
|
118 |
64 |
54 |
45.64% |
|
1351 Sealant |
|
55 |
27 |
28 |
51.32% |
|
RESTORATIVE PROCEDURES |
|
2330 Resin One Surface
Anterior |
|
158 |
95 |
63 |
40.06% |
|
2331 Resin Two Surface
Anterior |
|
199 |
110 |
89 |
44.79% |
|
2332 Resin Three Surface
Anterior |
|
245 |
145 |
100 |
40.70% |
|
| 2335 Resin Four Surface/Incisal Edge Anterior |
|
311 |
170 |
141 |
45.39% |
|
2960 Labial Veneer (Laminate)
Chairside |
|
453 |
210 |
243 |
53.62% |
|
2962 Labial Veneer (Porcelain Laminate) Laboratory |
|
1,047 |
550 |
497 |
47.47% |
|
2391 Resin One Surface
Posterior |
|
174 |
105 |
69 |
39.77% |
| 2392 Resin Two Surface Posterior |
|
229 |
135 |
94 |
40.96% |
| 2393 Resin Three Surface Posterior |
|
291 |
175 |
116 |
39.85% |
|
2394 Resin Four Surface Posterior |
|
340 |
215 |
125 |
36.69% |
|
2644 Onlay Porcelain |
|
1,058 |
650 |
408 |
38.56% |
|
2740 Crown all Porcelain |
|
1,082 |
750 |
332 |
30.70% |
|
2750 Crown Porcelain Fused To Gold |
|
977 |
795 |
182 |
18.62% |
|
2790 Crown all Gold |
|
970 |
775 |
195 |
20.11% |
|
2799 Provisional Crown |
|
434 |
125 |
309 |
71.17% |
|
2910 Recement Inlay |
|
109 |
75 |
34 |
30.98% |
|
2920 Recement Crown |
|
109 |
75 |
34 |
30.98% |
|
2940 Sedative Filing |
|
119 |
75 |
44 |
36.90% |
|
2950 Core Buildup including Pins |
|
281 |
125 |
156 |
55.47% |
|
2951 Pin Retention-Per Tooth with Restoration |
|
89 |
25 |
64 |
72.04% |
| 2952 Cast Post and Core |
|
458 |
185 |
273 |
59.65% |
| 2954 Prefabricated Post and Core |
|
342 |
170 |
172 |
50.27% |
| Procedure |
Procedures Not Available from Providers Noted(See Note at Bottom)
|
Usual
Fees $ |
CCN
Member Pays $ |
|
CNN
Member Saves $ |
Percent Savings |
| ENDODONTICS |
| 3220 Pulpotomy |
|
212 |
80 |
|
132 |
62.21% |
| 3310 Anterior |
|
706 |
375 |
|
331 |
46.91% |
| 3320 Biscuspid |
|
804 |
525 |
|
279 |
34.68% |
|
3330 Molar |
|
985 |
625 |
|
360 |
36.54% |
|
3346 Retreat Anterior |
|
831 |
475 |
|
356 |
42.83% |
|
3347 Retreat Biscuspid |
|
934 |
575 |
|
359 |
38.43% |
|
3348 Retreat Molar |
|
1081 |
675 |
|
406 |
37.56% |
| 3920 Hemisection |
GS |
516 |
300 |
|
216 |
41.88% |
|
3950 Canal Preparation For Post |
|
274 |
50 |
|
224 |
81.75% |
|
PERIODONTICS |
| 4263 Bone Replacement First Tooth |
CD, GS |
869 |
305 |
|
564 |
64.92% |
|
4264 Bone Replace Additional Tooth Same Quadrant |
CD, GS |
655 |
150 |
|
505 |
77.11% |
|
4320 Splinting Per Tooth (Up to Six Teeth) |
|
572 |
80 |
|
492 |
86.01% |
|
4341 Scaling and Root Planning |
|
245 |
95 |
|
150 |
61.22% |
| 4355 Full Mouth Debridement |
|
200 |
75 |
|
125 |
62.57% |
|
4381 Delivery Chemo Agent per Tooth |
|
217 |
45 |
|
172 |
79.30% |
|
4910 Peridontal Maintenance |
CD |
145 |
65 |
|
80 |
55.14% |
|
REMOVABLE |
|
5110 Upper Denture |
RK |
1,665 |
750 |
|
915 |
54.96% |
|
5120 Lower Denture |
RK |
1,710 |
750 |
|
960 |
56.15% |
|
5130 Immediate Upper Denture |
RK |
1,816 |
850 |
|
966 |
53.19% |
|
5140 Immediate Lower Denture |
RK |
1,792 |
850 |
|
942 |
5x2.57% |
|
5213 Upper Partial Denture |
RK |
1,765 |
800 |
|
965 |
54.67% |
|
5214 Lower Partial Denture |
RK |
1,760 |
800 |
|
960 |
54.55% |
|
5850 Tissue Conditioning Upper |
|
231 |
100 |
|
131 |
56.70% |
|
5851 Tissue Conditioning Lower |
|
241 |
100 |
|
141 |
58.53% |
|
5860 Overdenture Complete |
RK |
2,172 |
800 |
|
1,372 |
63.17% |
|
5861 Overdenture Partial |
RK |
2,172 |
800 |
|
1,372 |
63.17% |
|
5862 Precision Attachment |
RK |
812 |
250 |
|
562 |
69.20% |
|
PROSTHODONTICS BRIDGES/IMPLANTS |
| 6010 Implant |
CD, GS |
2,283 |
1200 |
|
1,083 |
47.44% |
| 6020 Abutment Placement |
|
1,393 |
900 |
|
493 |
35.41% |
| 6058 Porcelain Ceramic Crown |
|
1,691 |
900 |
|
791 |
46.78% |
| 6059 Implant Crown (not including post) |
|
1,544 |
900 |
|
644 |
41.71% |
|
6078 Implant Denture |
|
5,631 |
2,500 |
|
3,131 |
55.60% |
|
6210 Pontic All Gold |
|
1,048 |
550 |
|
498 |
47.53% |
|
6240 Pontic Porcelain |
|
1,081 |
550 |
|
531 |
49.12% |
|
6245 Pontic Porcelain/Ceramic |
|
1,086 |
725 |
|
361 |
33.22% |
| 6740 Crown Porcelain/Ceramic |
|
1,103 |
725 |
|
378 |
34.24% |
|
6750 Crown Porcelain |
RK |
1,079 |
550 |
|
529 |
49.02% |
|
6790 Crown All Gold |
RK |
1,058 |
550 |
|
508 |
48.04% |
|
6930 Recement Bridge |
RK |
174 |
61 |
|
113 |
65.01% |
|
6940 Stress Breaker |
|
489 |
168 |
|
321 |
65.65% |
|
6950 Precision Attachment |
RK |
734 |
250 |
|
484 |
65.92% |
| 6970 Cast Post and Core |
|
489 |
185 |
|
304 |
62.17% |
| 6972 Prefabricated Post and Core |
RK |
352 |
125 |
|
227 |
64.49% |
|
6973 Core Build Up Including Pins |
|
277 |
135 |
|
142 |
51.32% |
| 6975 Coping Metal |
RK |
749 |
300 |
|
449 |
59.97% |
| Procedure |
Procedures Not Available from Providers Noted
(See Note at Bottom)
|
Usual
Fees $ |
CCN
Member Pays $ |
CNN
Member Saves $ |
Percent Savings |
| ORAL SURGERY |
| 7140 Extraction Simple |
|
163 |
80 |
83 |
50.92% |
|
7210 Surgical Extraction |
|
278 |
230 |
48 |
17.41% |
|
7230 Removal of Wisdom Tooth |
|
408 |
200 |
208 |
50.92% |
|
7250 Root Removal Residual |
|
326 |
150 |
176 |
53.99% |
|
7310 Aveoloplasty With Extract Per Quad |
RK |
326 |
115 |
211 |
64.73% |
|
7510 Incision and Drainage |
|
245 |
125 |
120 |
48,88% |
| 7970 Excision Hyperplastic Tissue |
GS |
604 |
250 |
354 |
58.64% |
| ADJUNCTIVE GENERAL SERVICES |
| 5986 Fluoride Gel Carrier (per arch) |
|
299 |
125 |
174 |
58.17% |
| 9110 Palliative Treatment |
|
118 |
50 |
68 |
57.53% |
| 9310 Consultation |
|
151 |
40 |
111 |
73.43% |
| 9440 Office Visit After Hours |
RK |
182 |
75 |
107 |
58.85% |
| 9910 Application of Desensitizing Medicine |
|
76 |
20 |
56 |
73.63% |
| 9940 Occlusal Guard |
RK |
657 |
250 |
407 |
61.92% |
|
9951 Occlusal Adjustment Limited |
|
2209 |
60 |
149 |
71.35% |
| 9972 Teeth Whitening (both arches) |
RK |
864 |
300 |
564 |
65.27% |
* Based on Compliation by National Dental Advisory Service for 2003 indexed to 2006 for increase in CPI for Medical Care.
~Note: These Procedures May Be Available but Not at the Listed Fees. Contact the Specified Dental Office for Particulars.
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