Fees / Insurance

What are the initial fees?

We are a family practice and indeed we do see children.  We are currently scheduling appointments for  new patients.

Our initial exam fee for adults is $300.00 and for children is $120.00.  The adult exam is extremely comprehensive and typically lasts at least two hours or longer and includes a consultation.  Both the adult and child exams include digital photographs, at no extra charge,  in addition to x-rays.  This allows you to see everything we see and makes your participation in  treatment planning much easier.  We have been told this is an incredible value and provides an invaluable opportunity for patients to understand their dental condition.

These charges do not include “routine cleanings” which for adults are an additional $ 90 and for children are an additional  $ 45.  It is important to remember that, statistically,    80 % of adults have some level of periodontal / gum disease.  If this is the case, you will be informed of that and the fact that a “routine recall cleaning” will not address your circumstances.  You will be provided a treatment plan to address this condition (which has systemic consequences) which will estimate the number of visits projected to be required and the cost.  Under those circumstances, you would not receive a “routine cleaning” at this visit.

If x-rays are needed (typically every 3 to 5 years for a complete series on all your teeth, and every year for limited bite-wings to detect decay), there is an additional charge.    The complete  and comprehensive x-ray series cost is $ 120.  The more limited “annual” x-rays for children or adults  is typically between $42.00 and $60.00   The need to take x-rays, as well as the cost,  can vary depending on the individual circumstances.

We utilize digital x-rays which expose patients to minimal radiation.  These x-rays can be sent via e-mail to others who may have a need to see them.  If you have current x-rays at another office, and if they are digital, taken on computer sensors, you can request to have them e-mailed to us.   If they are  the [“older”] film based x-rays, duplicate copies can be made and forwarded or they may be given to you to transport.  Typically, you will be asked to provide a written authorization to transfer the x-rays.  Generally, this can be done via e-mail or fax, sometimes by phone, as opposed to physically signing for them, however, this may vary depending on an office’s policies.  You should anticipate an office to assist you in acquiring your x-rays professionally and in a timely manner.

Occasionally, an office may not have the capability to transfer or copy the x-rays and instead may  make paper copies.  These often may have lower quality diagnostic value and it is in your interest to request the digital transfer or film based copies.

How much does it cost to have a mercury  amalgam filling replaced?

Tooth colored posterior composite fillings range in price from $ 205 to $ 455 depending on size.  If a tooth has extensive decay or is cracked from the amalgam filling and /or heavy biting forces, a porcelain / ceramic onlay may be recommended to increase durability.  You may still choose to have another composite filling placed, even if the porcelain is recommended.   While the porcelain / ceramic onlay (or crown)  may be expected to last much longer than a composite  filling, you may still get a number of years of service from the composite filling.  If you choose to have a composite filling placed now (even though an onlay may be recommended) and in the [near] future if it should break and there be no alternative than the porcelain filling,  you will incur the initial charge for the composite filling now and, later, the charge for the onlay, essentially, paying for both, as opposed to paying for just the porcelain onlay if it is done intially.

However, some patients who may want their amalgam fillings replaced timely, may elect to have all the mercury amalgams replaced with composites in the short term.  Then they can  plan, over the next several years, to have the [new] composites replaced with any necessary porcelain restorations as their budget allows.  If they chose to both replace the existing fillings with porcelain / ceramic AND to maximize their insurance benefits, they might extend the process, and the exposure to the mercury fillings,  over a number of years.

Insurance coverage.

Due to the additional technique sensitivity / difficulty in placement of composite fillings there is usually a higher fee charged than for mercury amalgam fillings.  Often, insurance companies reduce the fee charged for a posterior composite filling to that allowed for a mercury filling.

For example,  a $ 325  filling charge may be reduced to $ 240 (just a guess) and THEN the insurance company pays their per centage (whether 50 %, 70 % or 80 %, depending on your contract).  You then also, in addition to your co-payment, pay the amount above their allowed [reduced] amount for that procedure, in this exmple, $ 325 – $ 240 =  $ 85 ( plus your co-payment on the $ 240).

Typically, insurance companies pay from $ 1000 to $ 1500 per calendar year, depending on your contract.  Let’s assume, for the sake of example, that your annual dental benefit is $ 1000.  Lets also assume that your carrier will not reduce the fee allowed for composites to the amalgam fee (although they almost always do).   Then you could have  $ 1250 worth of dental fillings done and at 80 % benefit, your carrier would pay $ 1000 and you would pay $ 250.

The above example does not, however, take into account exams, x-rays, and cleanings that you might also have.  These procedures are usually paid at 100 %.   If in addition to fillings, you wish to have the typical  two exams, two cleanings,  and several x-rays in one calendar year you might incur a $ 300 charge.  This would then decrease from $ 1000 per year to  $ 700 per year the amount that remains to do fillings.  Additionally, this   $  700 would be used to pay 80 % of charges on fillings, in this example.

Fillings that are not damaged or decayed may not be covered by insurance whether the choice to remove them is strictly for cosmetic reasons,  for mercury content or the desire to not have metal in the mouth.  These would be “out of pocket” expenses for an insured patient.

What if I need an onlay ( or crown)?

If you have a very large filling or a cracked tooth, a porcelain onlay (or crown if the damage is very extensive) may be recommended.  This requires not only removal of the existing filling and decay, but additional shaping and preparation of the tooth.  This will provide room for the thickness of the porcelain that will be bonded over the top to protect and strengthen the tooth.

You can expect to pay $ 1000 for the porcelain onlay or crown.  If you have insurance you can, generally, expect it to pay 50 %, 70 % , 80 %, more or less, or whatever the contract language specifies.

The tooth is prepared for the onlay or crown at one appointment and an impression (model) is then made and a temporary onlay or crown is placed on your tooth.   The model is sent to a dental lab to make your onlay or crown and you will be re-scheduled to return about two weeks later to cement the finished restoration.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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