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 |
D2954 |
Prefabricated post and core in addition to crown |
$115 |
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 |
