Using Your Insurance
Before you call your dental insurance company, please go over a short list of ASK Dental Clinic’s fee schedule and make a list of the treatments you may need.
Have the following information ready:
- Insurance company’s name and telephone number:
- Subscriber’s name:
- Subscriber’s date of birth:
- Group (Policy) No:
- Certification No:
- Patient’s name:
After collecting general coverage information about your dental benefits, you can further ask your insurance company about fees for certain treatment procedures.
Examples of common procedures and their fees at ASK Dental Clinic and most insurance companies
Example 1: If you have not had a dental exam in over 2 years, we recommend a complete exam, full mouth X-rays, and teeth cleaning:
|
Description |
Procedure Code |
Fee at ASK Dental Clinic |
Fee at your Dental Insurance |
|
Adult complete exam |
01103 |
$91.00 |
|
|
Full mouth X-ray films |
02102 |
$156.30 |
|
|
Panoramic |
02601 |
$70.70 |
|
|
4 units scaling |
11114 |
$231.70 |
|
|
1 unit polish |
11101 |
$55.00 |
|
|
Fluoride treatment |
12101 |
$26.50 |
|
|
Total |
|
$631.20 |
|
|
Fee difference between ASK Dental Clinic and your insurance company: |
|
|
|
Example 2. If you regularly visit a dental office and have had teeth cleaning done in the past 6 to 9 months, we recommend a recall exam, limited X-ray films, and teeth cleaning:
|
Description |
Procedure code |
Fee at ASK Dental Clinic |
Your Insurance fee |
|
Recall exam |
01202 |
$58.00 |
|
|
4 bitewing X-ray films |
02144 |
$62.30 |
|
|
2 units scaling |
11112 |
$114.30 |
|
|
1 unit polish |
11101 |
$55.00 |
|
|
Fluoride treatment |
12101 |
$26.50 |
|
|
Total |
|
$316.10 |
|
|
Fee difference between ASK Dental Clinic and your insurance company: |
|
|
|
Example 3. If you notice that you have a specific problem, such as a toothache, new cavity, lost filling, broken tooth, swelling gums, or a loose tooth, you may need a limited exam and at least one periapical (PA) X-ray film. You may also need treatment (such as a filling, root canal treatment, extraction of a tooth, etc). We will present you with a treatment plan and estimated fee after a dentist finishes your exam and makes a diagnosis.
|
Description |
Procedure code |
Fee at ASK Dental Clinic |
Your Insurance fee |
|
Limited exam (same fee for specific exam and emergency exam) |
01204, or 01201 |
$58.00 |
|
|
1 PA X-ray film |
02111 |
$23.80 |
|
|
Total |
|
$81.80 |
|
|
Fee difference between ASK Dental Clinic and insurance company: |
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|
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