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DENVER PUBLIC SCHOOLS SCHEDULE OF PATIENT CHARGES
PROCEDURE Average Fee Patient Cost Diagnostic Dentistry Initial oral examination $22.00 -0- Periodical examination $22.00 -0- Complete x-ray series $60.00 -0- Periapical x-ray, first film $12.00 -0- Periapical x-ray, ea. additional film $12.00 -0- Bitewing x-ray, single film $13.00 -0- Bitewing x-ray, two films $25.00 -0- Bitewing x-ray, four films $38.00 -0- Panoramic x-rays $50.00 -0- Diagnostic casts $45.00 -0- Preventative Dentistry Prophylaxis, adult (cleaning) $45.00 -0- Prophylaxis, child (cleaning) $36.00 -0- Fluoride treatment $20.00 -0- Dietary planning $27.00 -0- Oral hygiene instruction $27.00 -0- Prevention training $20.00 -0- RESTORATION DENTISTRY + +%m .. + +l FINDER DAT" + +&m e s . h t m l c o v e r e d s e r v i c OVERE~1HTM y|+ \$ ESOURCEFRK + +,m m l X e x c l u OXs i o n s . h t XCLUS~1HTM z|+ \$ 1 i m a g e qs MAGES z|+ + i n d e x 3. h t m l NDEX~1 HTM z|+ \$ A$ w e l c o m e . h t m l ELCOM~1HTM z|+ \$ & es involving three tooth surfaces $80.00 -0- Silver Fillings - Permanent Teeth Cavities involving one tooth surface $55.00 -0- Cavities involving two tooth surfaces $65.00 -0- Cavities involving three tooth surfaces $80.00 -0- Cavities involving four tooth surfaces $100.00 -0- Composite Fillings Cavities involving one tooth surface $70.00 -0- Cavities involving two tooth surfaces $85.00 -0- coveredservices.htmlxp y.TEXTMOSS uVE OVERE~1HTMp exclusions.html < xp yTEXTMOSS uXE XCLUS~1HTMp images V xp hJ y uX^ MAGES p index.html yR < xp yTEXTMOSS uXE NDEX~1 HTMp welcome.htmlyR < xp y TEXTMOSS uXE! ELCOM~1HTMpsalary-text.gifL xp y GIFfBlWd 첷 SALARY~3GIFpspace-bar-1.gifL xp y GIFfBlWd () SPACE-~1GIFpspace-bar-2.gifL xp y GIFfBlWd ķ SPACE-~2GIFp telephone.gif L xp y GIFfBlWd `a TELEPH~1GIFptext-our-mission.gifp y GIFfBlWd 3ҷ4 TEXT-O~1GIFpWorking Benefits xp y / @ u,9 WORKIN~1 pindex-retirement-text.gif y GIFfBlWd Õ INDEX~23GIFpindex-salary-schedules.gif y GIFfBlWd X INDEX~24GIFpindex-search-DPS.gifp yGIFfBlWd INDEX~25GIFpindex-space-bar.gifp y GIFfBlWd ηǂ INDEX~26GIFpindex-staff-development.gif y GIFfBlWd Է INDEX~27GIFpindex-sub-teachers-text.gif y GIFfBlWd INDEX~28GIFpindex-workers-comp-text.gif y GIFfBlWd INDEX~29GIFp index.htmJ y L xp y TEXTBlWd t`f INDEX HTMpJob-Code-Alpha L xp y XLS5XCEL κm JOB-CO~1 pJob-Code-Alphabetical.xls y TEXTdosa s^W JOB-CO~1XLSpJob-Code-Numericalxp y XLS5XCEL ු JOB-CO~2 pates Event Schedule N=LEFT VALIGN=TOP> Cavities involving three tooth surfaces $100.00 -0-
ENDODONTICS Pulp capping $50.00 $15.00 Pulpotomy $90.00 $25.00 Root Canals Single root canal filling $325.00 $90.00 Bi-root canal filling $380.00 $100.00 Tri-root canal filling $495.00 $240.00 Apicoectomy, separate procedure $270.00 $135.00 Apicoectomy, with root canal filling $240.00 $120.00 Bleaching of nonvital teeth, each visit $120.00 $45.00 PERIODONTICS - GUM TREATMENT Perio prophylaxis $75.00 $20.00 Perio scaling in presence of gingival inflammation $90.00 $25.00 Perio scaling/root planing (per quadrant) $130.00 $35.00 Gingival curretage (per quadrant) $160.00 $45.00 Occlusal adjustment (limited) $80.00 $17.00 Perio maintenance following therapy $70.00 $17.00 Gingivectomy (per quadrant) $450.00 $225.00 Gingival flap/root planing (per quadrant) $575.00 $290.00 Osseous surgery (per quadrant) $750.00 $375.00 Pedicule soft tissue grafts $350.00 $175.00 Free soft tissue grafts $475.00 $240.00 ORAL SURGERY Routine removal of one tooth $80.00 $20.00 Each additional tooth $80.00 $22.00 Surgical removal of exposed tooth $125.00 $30.00 Surgical removal of tooth covered by gum tissue$135.00 $35.00 Surgical removal of tooth partially covered by bone $160.00 $45.00 Surgical removal of tooth completely covered by bone $220.00 $85.00 Alveoplasty, no extraction, each quadrant $125.00 $30.00 Alveoplasty, with extraction, each quadrant $100.00 $25.00 Excision removal $100.00 $25.00 Incision and drainage of abscess $110.00 $25.00 Frenulectomy, separate procedure $150.00 $27.00 Excision of hyperplastic tissue $120.00 $27.00 PROSTHODONTICS - REMOVAL DENTURES Complete upper denture $700.00 $330.00 Complete lower denture $700.00 $330.00 Immediate upper denture, not including reline$725.00 $350.00 Immediate lower denture, not including reline$725.00 $350.00 Partial upper or lower acrylic base denture, with clasps and rests $500.00 $205.00 Partial upper or lower cast base denture, with clasps or rests $750.00 $365.00 Complete denture adjustment $50.00 $22.00 Partial denture adjustment, upper $50.00 $22.00 Partial denture adjustment, lower $50.00 $22.00 Temporary Denture $250.00 $125.00 Office reline, complete upper or lower denture$160.00 $65.00 Office reline, partial upper or + +,m .. + +%m OVERE~1HTM + + XCLUS~1HTM + + NDEX~1 HTM + + ELCOM~1HTM + + pic.jpeg xp y JPEGogle $$ PHOTO-~1JPEpsalary-daeo .gif xp y GIFfBlWd A鷖A SALARY~1GIFpsalary-dcta.gif xp y GIFfBlWd 朷 ALARY~2GIFpsalary-text.gifL x p y GIFfBlWd LIGN=LEFT VALIGN=TOP> $75.00 $30.00 Dental repair, replace one broken tooth $85.00 $35.00 Replace additional teeth, each tooth $85.00 $35.00 Adding tooth to partial denture to replace removed tooth, each tooth, not involving clasp or abutment tooth$90.00 $40.00 Adding tooth to partial denture to replace removed tooth, each tooth, involving clasp or abutment tooth$140.00 $50.00 Replacing broken tooth, no other repairs $80.00 $35.00 Reattaching damaged clasp on denture $80.00 $35.00 Replacing broken clasp with new clasp $110.00 $45.00 Each additional clasp with rest $120.00 $55.00 PROSTHODONTICS - FIXED (PER UNIT) Bridge Replacement Teeth Cast semi-precious metal $530.00 $255.00 Porcelain fused to semiprecious metal $550.00 $275.00 Provisional bridgework, per unit $140.00 $65.00 Additional charge for gold (per unit) $60.00 $30.00 Abutments - Crowns Cast semi-precious metal $530.00 $255.00 Porcelain fused to semi-precious metal $550.00 $275.00 Additional charge for gold (per unit) $60.00 $30.00 OTHER DENTAL SERVICES Sealants (per tooth) $35.00 $15.00 Duplication of x-rays $25.00 $10.00 Consultation - Specialists only $35.00 $17.00 Emergency treatment, during office hours $35.00 $17.00 Emergency treatment, after office hours $50.00 $27.00 Emergency treatment requiring dental services shall be priced according to schedule Cancellation appointments - no charge if notified 24 hours prior to scheduled appointment BROKEN APPOINTMENTS, per 30 minutes $40.00 $30.00 Annual Maximum benefit Allowance - UNLIMITED
Notice Of Right To Continue Coverage
Deductible - NONE
ORTHODONTIC BENEFITS
50% of the Cost of Treatment limited to a Lifetime Maximum of $1000 per
Eligible Individual.
The federal government has recently enacted the Consolidated Omnibus Budget Reconciliation Act of 1C985 (COBRA) which allows certain individuals the option of continuing their group health insurance under specified conditions.
You and your dependents are eligible to continue insurance of up to 18 months when termination of insurance is due to a reduction in your hours worked, or upon termination of your employment.
NAVIGATION
Introduction | Welcome | Plan Requirements | Co-Ordination of Benefits | Patient Charges | Exclusions | Dental Offices and Codes
Denver Public Schools
Employee Benefits Department
900 Grant Street, Room 502
Denver, Colorado 80203
(303) 764-3371