Fees
How much is a full fee LEPA?
$200
What is needed to send SRP's to insurance?
FMX (within 5 years) and perio charting within 6 months
What x-rays are required for a bridge?
Current FMX/PANO within insurance freq (36 months or 60 months?)
PA's within 6 months showing the full tooth
Patient has a federal dental insurance plan, what else do you need to know from the patient?
Must know BCBS FEP medical insurance information. This must be entered as primary insurance. Need 3 digit code from medical insurance.
What does a 2X12 month frequency mean?
Rolling months not a calendar year.
EX. 12/05/2025 and 5/25/2026
Next eligible would be after 12/06/2026
What is the fee for our KFD Plan?
$378
What information is needed for a claim on a tooth that has an existing crown?
PA within 6 months- must show the entire tooth
Age of existing crown- Month and year
Commlog this info. Also enter "replacement" and date in the crown procedure line
Why is it important not to send the PANO to insurance at the sametime you take an FMX?
Insurance will either pay for a pano OR an FMX not both.
Insurance will always choose to pay for the cheaper service which would be the PANO.
What is needed for a minor to been seen?
Signed HIPPA listing a guardian and or parent.
Guardian or parent must be attached to their file as a non patient if they are not a current patient.
NO MINOR IS TO BE ON THEIR OWN IN THE FAMILY FILE
What is the doctor recommended frequency for Orthotic adjustments?
1st- 2 weeks after delivery (at no charge)
2nd- 1 month after 1st adjustment
Then patient can bring to their cleaning appt to see if they need an adjustment and we will work it into our schedule.
Are we in network with Aetna Fee Schedule?
NO!
What do we need for a bridge estimate where the patient is missing 3 teeth in the same arch?
FMX
Does the pt have an existing restoration or removable?
How old is the existing?
How long have the teeth been missing?
Commlog this info
At what age do we start taking PANO's on children?
5 Years old.
Are we in network with DHL and INO Plans?
NO!!
THESE ARE HMO PLANS
How much is whitening and explain the process?
Where do we schedule this?
$420
Pt comes in for impressions and we schedule back in 1 week for whitening deliver. Pt will receive 4 whitening tubes to whiten at home.
We schedule the 1st and 2nd step in our teamwork column
If there is no fee listed for a billable procedure in Open Dental what is the fee?
Our full fee!
What information do we need for a partial estimate?
FMX/PANO within ins freq
Are we replacing an existing partial or bridge?
Dates of existing or old partial or bridge?
When were the teeth extracted?
Commlog this info!
What is the difference between these two PA's?
PA Intraoral - Periapical first radiographic images and PAadd Intraoral- Periapical each additional radiographic image
PA intraoral is for the 1st PA set complete and the PAadd is for any additional PA's taken.
How do you determine primary and secondary?
a. Children/ b. Spouse / c. Medicare Plan
a. Birthday rule (follows the earlier month in the year between mom and dad- not year of birth!)
b. Pt's employer's plan is primary then spouses is secondary
c. No matter what Medicare is primary
How old can a PA of a tooth be to present an estimate for a crown?
Less than 6 months.
What fee schedule has dollars and cents listed as their fee?
Dentemax
What must you have for insurance to even consider anterior crown coverage?
Full PA showing entire tooth- including the incisal edge.
How old can an FMX be when presenting and estimate for SRP's?
it's determined by the insurance company.
3-5 years depending on the insurance plans frequency.
What fee schedule do you use for GXP and AXV for Aetna insurance?
What about every other provider?
GXP = DHA
AXV = Metlife
All others = Dentemax
What is required for treatment planning an implant?
Evaluation by a doctor
Implant Sheet filled out by doctor
X-Rays (PANO/FMX)
How long has the tooth been missing if the tooth is already missing?