Paradise Smile Fees
Diagnostic
D0120
Periodic oral evaluation
D0140
Limited oral evaluation
D0150
Comprehensive oral evaluation
D0220
Intraoral-periapical 1st radiographic image
D0230
Intraoral-periapical each additional film
D0272
Bitewings-2 radiographic images
D0274
Bitewings-4 radiographic images
D0330
Panoramic radiographic image
Paradise Smiles Fees |
|---|
$40.00 |
$40.00 |
$100.00 |
$40.00 |
$20.00 |
$40.00 |
$80.00 |
$120.00 |
Individual/Family Benefits |
|---|
100% |
100% |
30% |
30% |
30% |
30% |
30% |
0% |
Individual/Family Fees |
|---|
- |
- |
$70.00 |
$28.00 |
$14.00 |
$28.00 |
$56.00 |
$100.00 |
Corporate Benefits |
|---|
100% |
100% |
50% |
50% |
50% |
50% |
50% |
0% |
Corporate Fees |
|---|
$40.00 |
$40.00 |
$50.00 |
$20.00 |
$10.00 |
$20.00 |
$40.00 |
$100.00 |
Preventive
D1110
Periodic oral evaluation
D1110-B
Limited oral evaluation
D1120
Comprehensive oral evaluation
D1120-A
Intraoral-periapical 1st radiographic image
D1206
Intraoral-periapical each additional film
D1208
Bitewings-2 radiographic images
D1330
Bitewings-4 radiographic images
D1351
Panoramic radiographic image
D1352
Panoramic radiographic image
Paradise Smiles Fees |
|---|
$100.00 |
$150.00 |
$80.00 |
$50.00 |
$30.00 |
$30.00 |
$30.00 |
$30.00 |
$60.00 |
Individual/Family Benefits |
|---|
30% |
30% |
30% |
30% |
30% |
30% |
30% |
30% |
30% |
Individual/Family Fees |
|---|
$70.00 |
$105.00 |
$56.00 |
$35.00 |
$21.00 |
$21.00 |
$21.00 |
$21.00 |
$42.00 |
Corporate Benefits |
|---|
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
Corporate Fees |
|---|
$50.00 |
$75.00 |
$40.00 |
$25.00 |
$15.00 |
$15.00 |
$15.00 |
$15.00 |
$30.00 |
Restorative
D2140
Amalgam-1 Surface (Primary/Permanent)
D2150
Amalgam-2 Surfaces (Primary/Permanent)
D2160
Amalgam-3 Surfaces (Primary/Permanent)
D2161
Amalgam-4 or more Surfaces (Primary/Permanent)
D2330
Resin-based composite-1 surface; Anterior (Permanent)
D2331
Resin-based composite-2 surfaces; Anterior (Permanent)
D2332
Resin-based composite-3 surfaces; Anterior (Permanent)
D2335
Resin-based composite-4 or more surfaces involving incisal angle; Anterior (Permanent)
D2391
Resin-based composite-1 surface; (Posterior)(Permanent)
D2392
Resin-based composite-2 surfaces; (Posterior)(Permanent)
D2393
Resin-based composite-3 surfaces; (Posterior)(Permanent)
D2394
Resin-based composite-4 surfaces; (Posterior)(Permanent)
D2954
Metal/Fiber Post (Permanent)
Paradise Smiles Fees |
|---|
$100.00 |
$150.00 |
$200.00 |
$250.00 |
$300.00 |
$350.00 |
$400.00 |
$450.00 |
$300.00 |
$350.00 |
$400.00 |
$450.00 |
$200.00 |
Benefits |
|---|
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
Fees |
|---|
$75.00 |
$112.00 |
$150.00 |
$187.50 |
$225.00 |
$262.50 |
$300.00 |
$337.50 |
$225.00 |
$262.50 |
$300.00 |
$337.50 |
$150.00 |
Corporate Benefits |
|---|
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
Corporate Fees |
|---|
$50.00 |
$75.00 |
$100.00 |
$125.00 |
$150.00 |
$175.00 |
$200.00 |
$225.00 |
$150.00 |
$175.00 |
$200.00 |
$225.00 |
$100.00 |
Oral Surgery
D7111
Extraction, coronal remnants- Primary tooth
D7250
Surgical removal of residual tooth roots (cutting procedure)
D7140
Extraction, erupted tooth or exposed root
D7140B
Extraction, erupted tooth (Braces Patients)
D7140A
Extraction, Erupted Wisdom tooth or exposed root
D7210
Surgical removal of erupted tooth
D7220
Removal of impacted tooth- soft tissue
D7230
Removal of impacted tooth- partially bony
D7240
Removal of impacted tooth- completely bony
D7953
Bone replacement graft for ridge preservation-per site
Paradise Smiles Fees |
|---|
$80.00 |
$150.00 |
$120.00 |
$200.00 |
$500.00 |
$150.00 |
$600.00 |
$700.00 |
$1,000.00 |
$500.00 |
Benefits |
|---|
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
25% |
Fees |
|---|
$60.00 |
$112.50 |
$90.00 |
$150.00 |
$375.00 |
$112.50 |
$450.00 |
$525.00 |
$750.00 |
$375.00 |
Corporate Benefit |
|---|
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
Corporate Fees |
|---|
$40.00 |
$75.00 |
$60.00 |
$100.00 |
$250.00 |
$75.00 |
$300.00 |
$350.00 |
$500.00 |
$250.00 |
D4210
Gingivectomy or gingivoplasty
D4249
Crown Lengthening
D4260
Osseous Surgery (including flap entry and closure)
D4263
Bone replacement graft
D4270
Pedicle soft tissue graft
Periodontics
Paradise Smiles Fees |
|---|
$500.00 |
$500.00 |
$500.00 |
$500.00 |
$300.00 |
$50.00 |
$40.00 |
$320.00 |
Benefits |
|---|
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
Fees |
|---|
$400.00 |
$400.00 |
$400.00 |
$400.00 |
$240.00 |
$40.00 |
$32.00 |
$256.00 |
Corporate Benefit |
|---|
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
Corporate Fees |
|---|
$250.00 |
$250.00 |
$250.00 |
$250.00 |
$150.00 |
$25.00 |
$20.00 |
$160.00 |
D4341
Periodontal scaling and root planing-4 or more teeth per quad.
D4342
Periodontal scaling and root planing-1 to 3 teeth per quad.
D4355
Full mouth debridement
Prosthodontics/Dentures
D5110
Complete Denture- Max (Top)
D5120
Complete Denture-Man (Bottom)
D5510
Denture Repair
Paradise Smiles Fees |
|---|
$900.00 |
$900.00 |
$200.00 |
Benefits |
|---|
15% |
15% |
15% |
Fees |
|---|
$765.00 |
$765.00 |
$170.00 |
Corporate Benefit |
|---|
20% |
20% |
20% |
Corporate Fees |
|---|
$720.00 |
$720.00 |
$160.00 |
Prosthodontics/Partial Dentures/Implants
Paradise Smiles Fees |
|---|
$900.00 |
$900.00 |
$600.00 |
$600.00 |
$1000.00 |
$1000.00 |
$1000.00 |
$1000.00 |
$300.00 |
$300.00 |
$1500.00 |
$250.00 |
$500.00 |
$1,500.00 |
$1,000.00 |
$1,000.00 |
$900.00 |
Benefits |
|---|
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
Fees |
|---|
$765.00 |
$765.00 |
$510.00 |
$510.00 |
$850.00 |
$850.00 |
$850.00 |
$850.00 |
$255.00 |
$255.00 |
$1275.00 |
$212.50 |
$425.00 |
$1,275.00 |
$850.00 |
$850.00 |
$765.00 |
Corporate Benefit |
|---|
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
Corporate Fees |
|---|
$720.00 |
$720.00 |
$480.00 |
$480.00 |
$800.00 |
$800.00 |
$800.00 |
$800.00 |
$240.00 |
$240.00 |
$1,200.00 |
$200.00 |
$400.00 |
$1,200.00 |
$800.00 |
$800.00 |
$720.00 |
D5211
Maxillary partial denture-Acrylic resin base
(>4 teeth)
D5212
Mandibular partial denture-Acrylic resin base
(>4 teeth)
D5211A
Maxillary partial denture-Acrylic resin base (1-3 teeth)(Flipper)
D5212A
Mandibular partial denture-Acrylic resin base(1-3 teeth)(Flipper)
D5225
Valplast Partial Denture Max (Top)
D5226
Valplast Partial Denture Man (Bottom)
D5213
Maxillary partial
denture-cast metal framework
D5214
Mandibular partial denture-cast metal framework
D5221
Immediate Maxillary Partial Denture - Resin Base
D5222
Immediate Mandibular Partial Denture - Resin Base
D6010
Surgical placement of implant body: endosteal implant
D6056
Prefabricated abutment
D6057
Custom fabricated abutment
D6059
Abutment supported porcelain fused to metal crown (high noble)
D6240
Pontic- porcelain fused to high noble metal
D6750
Crown-porcelain fused to high noble metal
D6752
Crown- porcelain fused to noble metal
D5211
Crown-porcelain/ceramic substrate (Zirconia Crowns)
D5212
Crown-porcelain/ceramic substrate (E-Max Crowns)
D2710
Crown-Composite substrate
D2750
Crown-porcelain crown fused to high noble metal
D2751
Crown-porcelain crown fused to predominantly base metal
Crown & Bridge
Paradise Smiles Fees |
|---|
$1,200.00 |
$1,200.00 |
$600.00 |
$1,000.00 |
$900.00 |
$1,200.00 |
$150.00 |
$150.00 |
$600.00 |
$1,200.00 |
$120.00 |
Benefits |
|---|
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
15% |
Fees |
|---|
$1,020.00 |
$1,020.00 |
$510.00 |
$850.00 |
$765.00 |
$1,020.00 |
$127.50 |
$127.50 |
$510.00 |
$1,020.00 |
$102.00 |
Corporate Benefit |
|---|
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
20% |
Corporate Fees |
|---|
$960.00 |
$960.00 |
$480.00 |
$800.00 |
$720.00 |
$960.00 |
$120.00 |
$120.00 |
$480.00 |
$960.00 |
$96.00 |
D2790
Crown-full cast high noble metal
D2950
Crown Recement
D2930
Prefabricated stainless steel crown-primary tooth
D2961
Labial Veneer (Resin Laminate) - Laboratory
D2962
Labial Veneer (Porcelain Laminate) - Laboratory
D2932
Prefabricated Resin Crown
D3220
Therapeutic pulpotomy (excluding final restoration)
D3310
Endodontic therapy; anterior tooth (excluding final restoration)
D3320
Endodontic therapy; bicuspid tooth (excluding final restoration)
D3330
Endontic therapy; molar (excluding final restoration)
D3346
Retreatment of previous root canal therapy-anterior
Endodontics
Paradise Smiles Fees |
|---|
$250.00 |
$500.00 |
$550.00 |
$600.00 |
$600.00 |
$650.00 |
$700.00 |
Benefits |
|---|
15% |
15% |
15% |
15% |
15% |
15% |
15% |
Fees |
|---|
$212.50 |
$425.00 |
$467.50 |
$510.00 |
$510.00 |
$552.50 |
$595.00 |
Corporate Benefit |
|---|
20% |
20% |
20% |
20% |
20% |
20% |
20% |
Corporate Fees |
|---|
$200.00 |
$400.00 |
$440.00 |
$480.00 |
$480.00 |
$520.00 |
$560.00 |
D3347
Retreatment of previous root canal therapy-bicuspid
D3348
Retreatment of previous root canal therapy-molar
D8080
Comprehensive Orthodontic Treatment of the Adolescent Dentition
D8080A
Comprehensive Orthodontic Treatment of the Adolescent Dentition (Initial Payment)
D8090
Comprehensive Orthodontic Treatment of the Adult Dentition
D8090A
Comprehensive Orthodontic Treatment of the Adult Dentition (Initial Payment)
D8670
Periodic Orthodontic Treatment Visit (Monthly Payment)
Orthodontics
Paradise Smiles Fees |
|---|
$5,000.00 |
$1,000.00 |
$5,000.00 |
$1,000.00 |
$200.00 |
$50.00 |
$300.00 |
$500.00 |
$200.00 |
Benefits |
|---|
15% |
0% |
15% |
0% |
0% |
0% |
15% |
100% |
100% |
Fees |
|---|
$4,250.00 |
$1,000.00 |
$4,250.00 |
$1,000.00 |
$200.00 |
$50.00 |
$255.00 |
- |
- |
Corporate Benefit |
|---|
20% |
0% |
20% |
0% |
0% |
0% |
20% |
100% |
100% |
Corporate Fees |
|---|
$4,000.00 |
$1,000.00 |
$4,000.00 |
$1,000.00 |
$200.00 |
$50.00 |
$240.00 |
- |
- |
D8693
Re-Cement or Re-Bond Fixed Retainer (Bracket Recementation)
D8694
Repair of Fixed Retainers (Ortho Wire Retainer; 2-6 Teeth)
D8680
Orthodontic Retention (Ortho Clear Retainer; Per Arch)
D8695
Removal of Fixed Orthodontic Appliances (Removal of Braces)
General Services
D9110
Palliative (emergency) treatment of dental
pain- minor procedure
D9230
Inhalation of nitrous oxide/anxiolysis, analgesia
D9910
Application of desensitizing medicament
D9940
Occlusal guard
D9951
Retreatment of previous root canal therapy-anterior
Dental Prosthesis Insurance
D9972
Spa Whitening (External Bleaching)
Paradise Smiles Fees |
|---|
$500.00 |
$250.00 |
$100.00 |
$250.00 |
$50.00 |
$250.00 |
$500.00 |
Benefits |
|---|
15% |
15% |
15% |
15% |
0% |
0% |
20% |
Fees |
|---|
$425.00 |
$212.50 |
$85.00 |
$212.50 |
$50.00 |
$250.00 |
$400.00 |
Corporate Benefit |
|---|
20% |
20% |
20% |
20% |
0% |
0% |
0% |
Corporate Fees |
|---|
$400.00 |
$200.00 |
$80.00 |
$200.00 |
$50.00 |
$250.00 |
$250.00 |