Dental coverage is now available for adults! Save time and money while helping the environment by electronically submitting your encounter forms to DeltaCare USA. MEMBER FEE SCHEDULE MEMBER PAYS DENTAL SERVICE (Maximum Charge) Delta Dental of Illinois DDIL.PD.FS.0802 Diagnostic Services D 0120 Periodic oral evaluation $23 D 0140 Limited oral evaluation-problem focused $34 . Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas, Utah and U.S. Virgin Islands: E-mail:ProfessionalServices@ddic.delta.org Contact your company's human resources department. Duplicate radiographs or radiographic image copies of diagnostic quality, including paper copies of digitized images, are acceptable. The NPI contains no embedded intelligence no coding that would identify the dentists state or license number, for example. ZIP Code Lookup | USPS No data found. Our Dental Care Cost Estimator tool provides estimated cost ranges for common dental care needs. Saving time by submitting electronic encounter forms daily, which can eliminate the need to spend more time running monthly reports. My Contracted Fees 1. This brochure describes the benefits of Delta Dental's Federal Employees Dental Program under Delta Dental of California contract OPM02-FEDVIP-02AP-05 with OPM, as authorized by the FEDVIP law. If the member has two plans through current employment at two jobs, then the plan that has been in effect the longest is usually primary. Periapical radiographs pre- and post-operative, Chart notes including periodontal case type and diagnosis, Narrative including necessity of treatment and mobility of teeth, Periapical or bitewing radiographs documenting bone loss, Narrative including necessity of treatment, Periapical or panoramic radiographs - current, Narrative including diagnosis, orthodontia type, and treatment length, Narrative for any exceptional cases and/or unspecified codes in all categories of service (D##99). Delta Dental will process the primary benefits, even if processing the secondary coverage must be delayed (for lack of eligibility data, for example). This website is the home of Delta Dental of California; Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; Delta Dental of West Virginia, Inc. and their affiliated companies. Dental Curing Lights - LED Curing Lights | Find the one thats right for you. PDF Minneapolis, MN 55440-9304 Confidential Filed Fee Schedule Select the patient, then select the Submit Claim icon in the Actions menu. View plans, sample savings & pricing, patient reviews & practice information. Please input information for either ZIP code or address but not both, Please enable your browser to allow this site to use your location. Review Sample Pricing with a Savings Plan Below. Dental Equipment Sales & Services | Indicate a quantity (the number of x-rays, for example) in the field on the claim specifically for this purpose. Listerine Ultra Clean Floss | Faxes are not accepted. Daniel Ribeiro , has not yet specified details about his residency. Dentist Frequently Asked Questions - Delta Dental Mass Please refer to the specific procedure code below for more details regarding the description of procedures. Fee Schedules - General Information | CMS - Home - Centers for Medicare When you submit claims as soon as possible after treatment is completed, you help us process claims more efficiently, using the patients most current eligibility and benefits to determine payment. These listings are updated on a regular basis, and every effort has been made to ensure that only participating active providers are listed. Daniel Ribeiro , Dentist has not yet specified details about his education and training. In joint custody cases, the parent Dental Products - Professional Services | Please do not submit original radiographic images if they are the only diagnostic record for your patient. Equipment & Technology Financing & Leasing, Henry Schein Thrive Rewards Terms & Conditions, Articulating Paper for Occlusal Contacts & Forces, Cosmetic Dentistry: Teeth Whitening & Alignment, Dental Adhesives: Dental Cements & Dental Liners, Dental Alloy: Dental Amalgam & Dental Refining, Dental Cements - Temporary & Permanent - Dental Liners, Dental CAD/CAM: Dental CAD/CAM Milling Machine, Dental Continuing Education Seminars & Resources, Dental Digital Radiography & Digital X-Ray Equipment, Dental Equipment Parts - Dental Repair Parts, Dental Handpieces & Dental Handpiece Repair, Dental Infection Control Supplies & Products, Dental Tools & Instruments - Hand & Surgical Instruments, Dental Materials: Dental Equipment & Technology, Dental Office Dcor Reception Room Furniture, Dental Office Forms - Perio Charting Forms, Dental Patient Education | Dental Patient Communications, Dental Patient Financing | Dental Financing, Dental Polishing: Finishing Strips, Polish & Brushes, Dental & Porcelain Veneers: Dental Laminates, Dental Practice Marketing & Office Supplies, Dental Reminder Postcards and Filing Office Supplies, Dental Restoration: Dental Bridges, Crowns & Posts, Dental Scalers, Power Scaler & Dental Curettes, Dental Sleep Medicine - Sleep Apnea Prevention, Dental Scrubs & Uniforms - Fashion Seal Scrubs, Disposable Dental Supplies - Single Use Products, National Dental Supply and Dental Products Manufacturers, Online Dental Supply Company | Dental Supply Store | Dental Companies, Oral Cancer Screening Light Tool | Identafi, Oral Surgery Instruments, Anesthetic & Supplies, Preventive Products: GC MI Paste Plus, Colgate PreviDent, PreviDent, Sharps Disposal Containers - Small & Large Sizes, TechCentral - Advanced Technology Solutions and Dental IT Support, Vinyl Polysiloxane (VPS) Dental Impression Material. %%EOF The address for our administrative office is: Delta Dental of California . Dental Scrubs & Uniforms - Fashion Seal Scrubs | For full time students, enter the name of the school and the city in which it is located on the claim. Delta Dental and its affiliate companies use MetaVance Benefit Administration Software as the claims editing software product to provide timely and efficient adjudication for dental claims. Estimate Costs Step 2 / Dental - FAIR Health This is a10-digit random number unique to each health care provider or organization. You'll be receiving an email with the information you've requested shortly. Some Delta Dental groups that are not subject to the provisions of California Health and Safety Code 1374.19 have a non-duplication of benefits clause in their contract. Need to make an adjustment on a claim? Please contact the Delta Dental company below for more information. How maximum contract allowances are determined, How maximum contract allowances are updated. All Rights Reserved. In the following states, you can change your dentist any time without contacting Delta Dental: AK, CT, LA, ME, MS, MT, NC, ND, NH, OK, SD, VT, WY. The benefit is based on theapproved fee for conventional orthodontics. The amount that would have been payable by Delta Dental may not be charged to the patient. DentalPlans detailed profile of Daniel Ribeiro , DDS - Dentist in 20152. Delaware, District of Columbia, Maryland, New York, Pennsylvania and West Virginia: E-mail:ddpdentist_services@deltadentalpa.org Estimates should not be construed as financial or medical advice. a patients eligibility and benefits will only be determined at the time of a claim The Henry Schein Fee Analysis provides dentists and dental professionals with the latest UCR (Usual, Customary, and Reasonable) fees for the zip code of your choice. (Note: Fee filings are not used in Texas or by any states administered by Delta Dental of Pennsylvania.). Copyright 2023 Delta Dental Plans Association. Preventive services are included in this tool. KY Medicaid Dental Fee Schedule 2022 Revised 3/17/2022 Proc Code Procedure Description UNDER AGE 21 Rate 21 and OVER Rate Notes D2161 AMALGAM-FOUR/MORE SURFACES, PRIMARY OR PERMANENT $93.60 $72.00 D2330 RESIN-ONE SURFACE, ANTERIOR $57.20 $44.00 D2331 RESIN-TWO SURFACES, ANTERIOR $71.50 $55.00 D2332 RESIN-THREE SURFACES, ANTERIOR $85.80 $66.00 Dental Adhesives: Dental Cements & Dental Liners | *Not sure where your company is headquartered? The sample table above is a small selection of common procedures discounted by these discount dental plans and programs. Mailed applications may require up to 20 days to process. With electronic claims submission, your claims are automatically edited for missing or invalid information before they are sent to carriers. Delta Dental PPOSM, PF, 1500A, 100*/90/50, 50 Calendar year costs Deductible $50 per person / $150 family Out-of-pocket maximum (under age 19) $375 for one member / $750 for two or more members (in-network only) Annual maximum (age 19+) $1,500 Class 1 does not apply to max Minimum number of subscribers N/A Class 1 D7410D7415, D7440D7461, D7465, Description of service: Its just not a payable claim under the terms of the dental benefit contract. Look Up a ZIP Code . Daniel Ribeiro , Dentist has not yet specified details about his experience and accolades. Already have a dentist? Oral Cancer Screening Light Tool | Identafi | PDF 2022 Delta Dental's Federal Employees Dental Program - BENEFEDS Keep in mind, a pre-treatment estimate is not a guarantee of payment and it does not check the patients: At any time, you can review the patients current eligibility and benefits information, including remaining maximum and deductible amounts. Delta Dental has the largest network of dentists nationwide. Connect with your Delta Dental company to learn more. We have dental insurance that empowers you to protect the oral health of you and your loved ones. simple just enter your dental service providers office zip code, then click on Get started here. Dental Financing and Related Services | Click the ">" to move your selection to the box on the right side. Any additional fee for the nontraditionalmethod is not billable to the patient. Articulating Paper for Occlusal Contacts & Forces | A retiree plan and a spouses active plan: Usually, the patients retiree plan is primary (a persons own coverage is primary for himself/herself); however, check the Evidence of Coverage for the retiree plan there may be a provision making it secondary to an active plan. PDF 2023 FEE SCHEDULE - Coast Dental You have entered an Invalid User ID and/or Password. Dental Burs & Diamond Burs | This cost estimator is intended for use in the 50 states, Puerto Rico and other U.S. territories. Every 12 months you may submit separate Delta Dental Premierfee updates for each practice location, specialty and TIN. Delta Dental. D6055-D6077, D6082-D6088, D6094, D6097-D6099, D6110-D6123, D6194-D6195, Description of service: It is simply a random number that does not expire. If you receive notification that no payment was made because of late submission: Amounts due from Delta Dental may be paid to your professional corporation, partnership or association. Call and make sure that your provider accepts Medicaid coverage so you can receive quality services at no cost. Dental Diagnostic Equipment | By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. Estimates may vary depending on your benefit plan and the state you live in. Register on DPVerify.com to confirm eligibility of your current or future patients. The Estimates should not be construed as financial or medical advice. PDF Delta Dental Patient Direct Member Fee Schedule only. M-T 8:30a-10p | F 8:30a-9p | Sat 9a-6p | Sun 10a-4p EST. Dental Restoration: Dental Bridges, Crowns & Posts | Estimated fees for Zip Code Dental Procedure Cost Estimator | Delta Dental Affordable Care Act. Please dont send claims for monthly orthodontic visits. U. S. Mail: Delta Dental of California,ATTN: Provider Onboarding,P.O. Oral surgery (surgical incision/excision), Description of service: DeltaCare USA's payer identification number for encounter forms is DDCA3. Dentists are encouraged to seek their own legal advice about how the NPI pertains to their practices and circumstances. P.O. Look at you smiling. Vinyl Polysiloxane (VPS) Dental Impression Material | Delta Dental had "allowed" $41 for full reimbursement for a two-surface amalgam (D2150). Dental Infection Control Supplies & Products | For more detailed information on your actual dental care costs, please consult your dentist or your Delta Dental. Oral surgery (impacted tooth), Description of service: Box 2105 If late submission occurred because of extenuating circumstances (for example, the patient did not advise you sooner of the existence of coverage), you may request reevaluation of the decision to disallow payment. Dental Patient Education | Dental Patient Communications | CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. Once you're a member, you will be provided with a complete fee schedule (applicable for most plans) with discounted fees for nearly every dental procedure. We make it easy to protect your smile and keep it healthy, with the largest network of dentists nationwide, quick answers and personalized service. Coordination of benefitsis the process insurance companies follow to ensure that the combined benefits from all group dental plans do not exceed 100% of the dentists fee. Simplylog in to Provider Toolsand select "My claims." PO Box 1809 The fee schedules are typically part of the participating provider agreement - a legal contract between the dentist and the third-party payer. On a standard ADA Dental Claim Form (#J400), the treating dentists NPI is entered in field 54 and the billing entitys NPI is entered in field 49. The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan. Find the claim number you wish to adjust and choose "Submit a request" in the Claim adjustment section. Universal Composites | Lysol IC Spray | Alpharetta, GA 30023. We make every effort to ensure that these emails are delivered. Standard size paper (8.5 x 11 inch) for claims and written documentation. At Henry Schein, you can Rely on Us for all of your dental practice needs. If you are not submitting claims electronically, talk with your practice management system vendor about activating your systems electronic claims component. by MetLife guidance in understanding your dental service providers fees. Generally, Delta Dental allows one reevaluation per claim. In this case, generally, the plan through current employment is primary. Consult with your provider prior to beginning any treatment. For DeltaCare USA, maximum contract allowances are not applicable. Free-form text use the Tooth number or letter field to indicate quadrant or arch(e.g., UR or L) and the Remarks box for necessary comments or notes. To find This helps ensure that you dont contribute to higher costs that can potentially jeopardize patients dental benefits plans. If you are looking for a specific dental procedure that is not on this sample, please contact our Customer Care Center toll-free at 1-888-632-5353 with the ADA Code of the procedure and we can provide the discounted fee. Cost estimates for services provided by out-of-network dentists (available in the out-of-network estimator) are based upon submitted claims data for out-of-network providers. The information provided here is for educational purposes only and should not be interpreted as legal advice. fees when you pay. Want to know before you set foot in the dentists office? Some procedures are not covered under your patient's plan, no matter what documentation is submitted. However, there are exceptions, such as theTRICARE Retiree Dental Program (TRDP), a federal plan that follows the effective date rule. The dental provider listings on DentalPlans.com are provided directly from each dental network or discount dental plan, which are responsible for their accuracy and completeness. Tubing Suction Connect | The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what dental benefits your plan will cover, or your out-of-pocket costs. Daniel Ribeiro , Dentist has not yet specified details about his residency. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. Use new claim forms that accommodate the NPI by providing a specific space for it. Delta Dental Dentist FAQ Daniel Ribeiro , Dentist has not yet indicated the hospitals that he is affiliated with. . Refer to your benefit plan to determine whether these requirements apply to you. Pediatric Dental Supplies & Instruments | Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. However, we strongly encourage you to get one, because you can use it as a single unique identifier with all payers. Therefore, it is always best to confirm information with yourhealth careprofessionals. Contact the Henry Schein Practice Services team using the contact form and a member of our team will be happy to help you determine the correct fee schedule for your practice. Fax: 617-886-1414. View plans, sample savings & pricing, patient reviews & practice information. Periapical radiographs - pre- and post-operative. After you register, claim your free Doctor.com profile to expand your reach online. Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you. Actual fees charged by your provider may vary for a variety of reasons. Reasonable efforts include: Maximum contract allowances are the total reimbursement amounts, under the member's benefit plan, on which Delta Dental calculates its payment and the patients financial obligation. For a complete description of the details of your coverage, please refer to your coverage documents. Example: This means Delta Dental has overpaid weve paid 100% of $80 instead of 80% of $80. The description of different treatment categories, and the inclusion of particular services in a treatmentcategory,is not advice that any particular treatment category is the right treatment for you or that you should not obtain any particular treatment. Use your FastAttach connection, a service available through NEA, to electronically transmit digitizedx-rays, narratives, intra-oral pictures, Explanation of Benefits (EOB) Statements or any other document needed to adjudicate the claim. The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan. DELTA DENTAL PATIENT DIRECT GENERAL DENTIST FEE SCHEDULE ALL PROCEDURES Effective from 06/01/2022 D2712 Crown - Resin-Based Composite (Indirect) $305 D2720 Crown - Resin With High Noble Metal $648 D2721 Crown - Resin With Predominantly Base Metal $561 D2722 Crown - Resin With Noble Metal $625 D2740 Crown - Porcelain/Ceramic $725 Extraction - Impacted Wisdom Tooth (Soft Tissue), Extraction - Impacted Wisdom Tooth (Partial Bony), Add Clasp to Existing Bridge (Partial Denture), Tooth Replacement Part of Permanent Bridge, 25739 Branch Rail Dr Ste 160 Chantilly, VA 20152, 7764 Armistead Rd Ste 100 Lorton, VA 22079, Nevermind, take me back to DentalPlans.com, Full Orthodontic Child Treatment (Braces), Full Orthodontic Adult Treatment (Braces), Surgical placement of implant body: endosteal implant, Abutment supported cast metal crown (predominantly base metal). Dental Periodontic Products | Dual coveragerefers to when a patient's dental treatment is covered by more than one dental benefits plan. Use these tips for clear, complete paper claims that will move smoothly through our system. Help the dental consultant review your claim. Please Note: The information displayed below is not a guarantee of coverage, and None of the information on this website represents or warrants that any particular drug or treatment is safe, appropriate or effective for you. Every health care provider transmitting health information in connection with a standard transaction in electronic form must obtain an NPI. Endodontic Instruments & Supplies | When Delta Dental of California is the secondary carrier and is subject to the provisions of the California Health and Safety Code 1374.19, we pay the lesser of: (1) the amount we would have paid in the absence of any other dental benefit coverage; or (2) the member's out-of-pocket cost payable under the primary plan for benefits that are covered by the secondary plan. Periodontics (including scaling and root planing), Description of service: Cost estimates for services provided by out-of-network dentists (available in the out-of-network estimator) are based upon submitted claims data for out-of-network providers. Use Provider Tools forfreereal-time claims with digital attachments and pre-treatment estimates. A pretreatment estimate is recommended before the start of extensive dental treatment.