Corrections to Preferred Dental Fee Increases

On January 1, 2013, the fee increases listed below took effect for the EmblemHealth Preferred Dental plan.

Please note: A January 2013 letter about this policy update listed incorrect fees for codes D2952 and D2954. The correct fee for each code appears in red below:

Code

Descriptor

Fee as of 1/1/2013

D0120

Periodic oral exam

$20

D1110

Prophylaxis - adult

$39

D2951

Pin retention per tooth in addition to restoration

$24

D2952

Cast post and core in addition to crown, indirectly fabricated

$115
$110

D2954

Prefabricated post and core in addition to crown

$115
$110

D3310

Endodontic therapy - anterior tooth (excluding final restoration)

$315

D3320

Endodontic therapy - bicuspid tooth (excluding final restoration)

$390

D3330

Endodontic therapy - molar (excluding final restoration)

$470

D5213

Upper partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)

$620

D5214

Lower partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)

$620

D7140

Extraction, erupted or exposed root (elevation and/or forceps removal)

$42