Maryland Preventive Dentistry Program
Featuring Dentists from Your Neighborhood!

Call one of our participating Family Dentists to make an appointment for a complete examination with individual x-rays*. At the time of your visit pay the dentist just $5.00**.

You will always receive a very thorough examination and your MPD Family Dentist will make recommendations for further treatment when necessary. Any additional treatment will also be provided under these special low program fees.


Your dentist agrees…
"Everyone needs
a good dental program."

Every procedure covered 1 of 3 ways:
1. The annual examination with individual x-rays is covered 100% from our General Practitioners.

2. This Schedule of Benefits shows your specially reduced prices for the more common procedures. The difference between what the doctor normally charges and what you pay is automatically covered by your membership.

3. Procedures not covered above will be discounted 25% by your participating General Dentist.


Fee Schedule effective February 1, 2006 through January 31, 2007
 
Procedure Description
Special MPD Reduced Prices
Typical Charge in Maryland
00120 Annual Examination
FREE
 $69.00
00120 Semi-Annual Examination
FREE
 $69.00
00150 Initial or Comprehensive Examination
FREE
 $99.00
00220 Intraoral x-ray film, single, first
FREE
 $20.00
00230 Intraoral x-ray film, additional
FREE
 $18.00 each
00270 Bitewing x-ray film, single, first
FREE
 $17.00
00272 Bitewing x-ray film, two
FREE
 $30.00
00274 Bitewing x-ray film, four
FREE
 $55.00
PREVENTATIVE PROCEDURES
00140 Limited oral examination; problem focused $20.00 $35.00
00460 Pulp vitality test $25.00 $45.00
01110 Cleaning. Youth or adult $68.00 $89.00
01120 Cleaning. Child $49.00 $69.00
  Note: cleaning is light scaling & polishing. If you need more than this your cost will be higher. Reduced fee cleaning (light or heavy) available once every six months.    
01203 Topical flouride; child $22.00 $33.00
01204 Topical flouride; adult $22.00 $50.00
01351 Sealant - per tooth $25.00 $44.00
01360 Infection control. Each visit $5.00 $14.00
01510 Space maintainer; fixed unilateral $225.00 $282.00
01515 Space maintainer; fixed bilateral $248.00 $310.00
00210 Intra-oral complete x-ray series - once every 3 years $49.00 $109.00
00210 Intra-oral complete x-ray series - additional $72.00 $109.00
00330 Panoramic film - once very 3 years $49.00 $109.00
00330 Panoramic film - additional $72.00 $109.00
  Sterlization Surcharge $5.00 $14.00
RESTORATIVE PROCEDURES
   
MPD Members only pay
Others expect to pay
02140 Amalgam filling; 1 surface; permanent $74.00 $88.00
02150 Amalgam filling; 2 surfaces; permanent $84.00 $109.00
02160 Amalgam filling; 3 surfaces; permanent $100.00 $127.00
02161 Amalgam filling; 4 or more surfaces; permanent $116.00 $163.00
02330 Resin filling; 1 surface; anterior $84.00 $123.00
02331 Resin filling; 2 surfaces; anterior $101.00 $163.00
02332 Resin filling; 3 surfaces; anterior $127.00 $219.00
02335 Resin filling; 4 or more surfaces; anterior $164.00 $298.00
02391 Resin filling; 1 surface; posterior $79.00 $109.00
02392 Resin filling; 2 surfaces; posterior $119.00 $162.00
02393 Resin filling; 3 surfaces; posterior $145.00 $228.00
02394 Resin filling; 4 or more surfaces $150.00 $228.00
02750 Crown; porcelain fused to high noble $696.00 $1200.00
02751 Crown, porcelain fused to predominantly base metal $690.00 $1175.00
02920 Recement crown $49.00 $79.00
02930 Prefabricated stainless steel crown - #1 tooth $121.00 $185.00
02940 Prefabricated stainless steel crown - #2 tooth $144.00 $200.00
02940 Sedative filling $43.00 $76.00
 
ENDODONTIAL PROCEDURES
03110 Pulp cap; Direct; excluding final restoration $40.00 $65.00
03120 Pulp cap; indirect; excluding final restoration $45.00 $55.00
03220 Therapeutic pulpotomy; excluding final restoration $125.00 $169.00
03321 Pulpal debridement $125.00 $169.00
03310 Root canal; anterior; excluding final restoration $425.00 $531.00
03320 Root canal; bi-cuspid; excluding final restoration $500.00 $657.00
03330 Root canal; molar; excluding restoration $560.00 $749.00
 
PERIODONTAL PROCEDURES
04210 Gingivectomy; upper; per quadrant $284.00 $551.00
04210 Gingivectomy; lower; per quadrant $284.00 $599.00
04211 Gingivectomy; per tooth $49.00 $89.00
04260 Osseous surgery; flap entry, close, per quadrant $415.00 $674.00
04341 Periodontal scaling; root planning, per quadrant $135.00 $179.00
 
PROSTHODONTICS
05110 Denture; complete upper; including 6 months post-insertion care $750.00 $909.00
05410 Adjustments after six months $40.00 $40.00
05110 Denture; complete lower; including 6 months post-insertion care $750.00 $909.00
05410 Adjustments after six months $40.00 $40.00
       
05130 Denture; immediate upper; includes six months post insertion care. Does not include required future rebasing/relining procedure(s) or a complete new denture at a later date. $800.00 $999.00
05410 Adjustments after six months $40.00 $40.00
05130 Denture; immediate lower; includes six months post insertion care. Does not include required future rebasing/relining procedure(s) or a complete new denture at a later date. $800.00 $999.00
05410 Adjustments after six months $40.00 $40.00
       
05211 Partial; upper; acrylic base; including conventional clasps and rests $620.00 $706.00
05212 Partial; lower; acrylic base; including conventional clasps and rests $640.00 $706.00
       
05213 Partial; upper; predominantly cast base acrylic saddles, including conventional clasps and rests $775.00 $950.00
05214 Partial; lower; predominantly cast base acrylic saddles, including conventional clasps and rests $775.00 $950.00
 
ORAL SURGERY
07140 Extraction; simple, single tooth $89.00 $110.00
  Extraction; simple, each additional $80.00 $110.00
07111 Extraction; primary (child) $65.00 $99.00
07130 Extraction; root removal, root exposed $99.00 $165.00
07210 Extraction; surgical removal of erupted tooth $165.00 $199.00
07220 Extraction; impacted, soft tissue $179.00 $215.00
07230 Extraction; impacted partial boney $195.00 $250.00
07240 Extraction; impacted, complete boney $225.00 $309.00
 
ADDITIONAL GENERAL SERVICES
00016 Cancelled appointment w/o 24 hours notice; per every scheduled 30 minutes cancelled $35.00 $50.00
09110 Palliative care $60.00 $89.00
03960 Bleaching; per arch $179.00 $250.00
*typical costs are actual documented charges from various offices throughout Central Maryland
       
PARTICIPATING SPECIALIST CHARGES
Services performed by our participating specialists are reduced by them 20% from their normal and customary charges.
       

REMEMBER that if you do not use one of our participating Maryland Preventive Dentistry dentists that you will have absolutely no benefits. You MUST use one of our participating dentists in order to benefit from your Maryland Preventive Dentistry membership.

This is NOT an insurance product.

 

 

SPECIALIST SERVICES - 20%* Reduction

Benefit from the services of some of the best Board Eligible or Board Certified dental specialists in our area. From Oral Surgery to Braces - we have you covered. Your participating Specialists will reduce procedure costs for you by 20%* right off of the top! They reduce their Usual and Customary fees by 20%* and provide you the same excellent care that they give to every other patient.

Referrals? You don't need them since you are part of the Maryland Preventive Dentistry Program. Self-Referrals are the contemporary way of dealing with the need for a specialist. No one knows your situation better than you and your regular MPD dentist. When you also take advantage of consulting with your participating Family dentist, what healthcare team can better decide what your needs are?

All of our Specialists: Endodontists
Periodontists
Oral Surgeons
Orthodontists, etc.

Your participating General Practitioner will be glad to help you with information so that you can call one of our Specialists. If you prefer you may call us to obtain a complete list of all participating providers. You can also access this information on the web at
www.mpdprogram.com

Annual enrollment fees purchase you a 12 month membership in the program. We do not provide pro-rated refunds for any reason. As examples, but not necessarily limited to, moving out of area or having dental benefits provided by one's employment do not entitle one to any type of refund.

X-Rays
*Should you need a Complete Intra-Oral Series of xrays or a Panoramic x-ray these are available once every three years for only $49.00 each. See Fee Schedule for specifics. Individual Intra-oral and Bitewing xrays for diagnostic or preventive uses are covered 100%.

Changing jobs and losing your dental program?
Call us for your own dental coverage!

Know a friend who needs dental coverage?
Suggest they give us a call for the best rates in town!

Bought your own coverage but
wish your employer was paying for it?
Tell them to give us a call for the very best group rates around!
Maryland Preventive Dentistry Program
410-682-5517

Marketed and Administered by
Gatton & Associates
313 Eastern Blvd.
Baltimore, MD 21221
410-682-5517 Fax 410-682-5519

**unless you and the dentist agree to additional treatment at this time.

*20% reduction does not include any costs or services associated with Invisilign.                                                                   mpd2003b.doc