Company Name Provider Name Specialty Address City State Zip Code Phone Number
Maye Pediatric Dentistry Dr. Frank J. Maye Pediatric Dentistry 19615-33 S. State Road 7 Boca Raton Florida 33498 561-395-5081

Sign up today and get a 25% Discount at Maye Pediatric Dentistry!  Plan members get 2 FREE cleanings/exams every year at a participating General Dentistry office. Additional plan highlights include discounts on Crowns, Bridges, X-rays and Much More.  Click here to find out more!
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All-In-One Dental Plan Member Fee Schedule

ADA CODE DIAGNOSTIC & PREVENTIVE NATIONAL AVERAGE MEMBER FEE
D0120 PERIODIC ORAL EVALUATION (EVERY 6 MONTHS)  $49.00  FREE
D0140 LIMITED ORAL EVALUATION – PROBLEM FOCUSED  $71.00  FREE
D0150 COMPREHENSIVE ORAL EXAM (1ST VISIT)  $81.00  FREE
D1110 PROPHYLAXIS – ADULT CLEANING (EVERY SIX MONTHS)  $90.00  FREE
D1120 PROPHYLAXIS – CHILD CLEANING (EVERY SIX MONTHS)  $67.00  FREE
D1208 TOPICAL APPLICATION OF FLOURIDE  $37.00  FREE
D1330 ORAL HYGIENE INSTRUCTIONS  $40.00  FREE
D1351 SEALANT – PER TOOTH  $52.00  $24
X-RAYS
D0210 INTRAORAL – COMPLETE SERIES (INCLUDING BITEWINGS)  $129.00  $34
D0220 INTRAORAL – PERIAPICAL FIRST FILM  $28.00  $6
D0230 INTRAORAL – PERIAPICAL EACH ADDITIONAL FILM  $23.00  $5
D0270 BITEWING – SINGLE FILM  $26.00  $8
D0272 BITEWING – TWO FILMS  $44.00  $11
D0274 BITEWING – FOUR FILMS  $62.00  $13
D0330 PANORAMIC FILM  $108.00  $32
RESTORATIVE PROCEDURES (FILLINGS)
D2330 RESIN-BASED COMPOSITE – ONE SURFACE, ANTERIOR  $155.00  $57
D2331 RESIN-BASED COMPOSITE – TWO SURFACES, ANTERIOR  $189.00  $70
D2332 RESIN-BASED COMPOSITE – THREE SURFACES, ANTERIOR  $230.00  $90
D2335 RESIN-BASED COMPOSITE – FOUR OR MORE SURFACES, ANTERIOR  $285.00  $110
D2391 RESIN-BASED COMPOSITE – ONE SURFACE, POSTERIOR  $171.00  $77
D2392 RESIN-BASED COMPOSITE – TWO SURFACES, POSTERIOR  $224.00  $108
D2393 RESIN-BASED COMPOSITE – THREE SURFACES, POSTERIOR  $275.00  $135
D2394 RESIN-BASED COMPOSITE – FOUR OR MORE SURFACES, POSTERIOR  $322.00  $158
D2750 CROWN – PORCELAIN FUSED TO HIGH NOBLE METAL  $1,071.00  $585
D2751 CROWN – PORCELAIN FUSED TO PREDOMINATELY BASE METAL  $985.00  $495
D2920 RECEMENT CROWN  $100.00  $45
D2950 CORE BUILDUP – INCLUDING ANY PINS  $263.00  $107
D2954 PREFABRICATED POST AND CORE IN ADDITION TO CROWN  $323.00  $133
ENDODONTICS
D3310 ROOT CANAL – ANTERIOR (EXCLUDING FINAL RESTORATION)  $713.00  $314
D3320 ROOT CANAL – BICUSPID (EXCLUDING FINAL RESTORATION)  $825.00  $457
D3330 ROOT CANAL – MOLAR (EXCLUDING FINAL RESTORATION)  $995.00  $627
PROSTHODONTICS
D5110 COMPLETE DENTURE – MAXILLARY  $1,600.00  $750
D5120 COMPLETE DENTURE – MANDIBULAR  $1,600.00  $750
D5130 IMMEDIATE DENTURE – MAXILLARY  $1,721.00  $775
D5140 IMMEDIATE DENTURE – MANDIBULAR  $1,721.00  $775
D5211 MAXILLARY PATIAL DENTURE – RESIN BASE  $1,271.00  $750
D5212 MANDIBULAR PARTIAL DENTURE – RESIN BASE  $1,279.00  $750
D5213 MAXILLARY PARTIAL DENTURE – CAST METAL FRAMEWORK WITH RESIN DENTURE BASES  $1,680.00  $870
D5214 MANDIBULAR PARTIAL DENTURE – CAST METAL FRAMEWORK WITH RESIN DENTURE BASES  $1,680.00  $870
D5225 MAXILLARY PARTIAL DENTURE – FLEXIBLE BASE  $1,760.00  $825
D5226 MANDIBULAR PARTIAL DENTURE – FLEXIBLE BASE  $1,760.00  $825
D5410 ADJUST COMPLETE DENTURE – MAXILLARY  $70.00  $36
D5411 ADJUST COMPLETE DENTURE – MANDIBULAR  $70.00  $36
D5510 REPAIR BROKEN COMPLETE DENTURE BASE  $206.00  $170
D5520 REPLACE MISSING OR BROKEN TEETH  $175.00  $145
D5630 REPAIR OR REPLACE BROKEN CLASP  $206.00  $165
D5650 ADD TOOTH TO EXISTING PARTIAL DENTURE  $200.00  $145
D5660 ADD CLASP TO EXISTING PARTIAL DENTURE  $253.00  $165
D5730 RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)  $350.00  $189
D5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)  $350.00  $189
D5740 RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE)  $285.00  $184
D5741 RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE)  $285.00  $184
D5750 RELINE COMPLETE MAXILLARY DENTURE (LAB)  $450.00  $270
D5751 RELINE COMPLETE MANDIBULAR DENTURE (LAB)  $450.00  $270
D6240 PONTIC – PORCELAIN FUSED TO HIGH NOBLE METAL  $1,050.00  $585
D6241 PONTIC – PORCELAIN FUSED TO PREDOMINATELY BASE METAL  $971.00  $525
D6750 CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL  $1,064.00  $625
D6751 CROWN – PORCELAIN FUSED TO PREDOMINATELY BASE METAL  $980.00  $495
D6930 RECEMENT BRIDGE  $163.00  $65
ORAL SURGERY
D7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPTS REMOVAL)  $165.00  $59
D7210 SURGICAL REMOVAL OF ERUPTED TOOTH  $267.00  $85
D7510 INCISION/DRAINAGE OF ABCESS-INTRAORAL SOFT TISSUE  $250.00  $90
MISCELLANEOUS SERVICES
D9230 ADMINISTRATION OF NITROUS OXIDE  $70.00  $75
D9433.40 IN OFFICE WHITENING WITH TRAYS  $650.00  $299
D9433.41 IN OFFICE WHITENING WITHOUT TRAYS  $400.00  $199
D9940 OCCLUSAL GUARD  $620.00  $225
D9900 MISSED APPOINTMENT WITHOUT 24 HOUR NOTICE  $50.00  $30
This fee schedule is for participating General Dentists only.
All procedures not listed will be charged at a 25% discount.
Plan members will receive a 25% discount to see a participating specialist.
No Lab Fees Allowed.


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