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2010 SCHEDULE OF ORTHODONTIC SERVICES
Paul Ouellette, DDS, MS & Associates
A. Diagnostic Services
*ADA Code
Fee Ranges
Initial Consultation
0150
NO CHARGE
Recall Consultation
0120
NO CHARGE
Digital Extra-oral & Intra-oral Imaging (Photography)
0350
$75 per study
Digital Study Model Analysis
0470
$150 per study
Panoramic Digital Radiography
0330
$75 per study
Cephalometric Digital Radiography
0340
$150 per study
Case Records Analysis & Diagnostic Report
0150
$450 per report
Surgical or Progress Study Models
0470
$150 per study
Initial Diagnostic Records Inclusive (X-rays or CBCT Scan, Digital Models, Photos)
NA
$450 @Start Visit
Transfer Case Update Records (X-rays or CBCT Scan, Digital Models, Photos)
NA
$450 @Start Visit
Diagnostic Records Duplication Fee (X-rays or CBCT Scan, Digital Models, Photos)
NA
$50 - $75
Consultation with Other Specialist(s) or As Expert Witness
9310
$850 per hour
 

NOTICE TO NEW PATIENTS:This is our most current 2010 schedule of orthodontic services and general fee ranges BEFOREany discounts. When you visit our office for a NO CHARGE consultation, Doctor Ouellette will determine your case difficulty and estimated treatment time. A detailed explanation of all apparent orthodontic problems will be presented. If orthodontic treatment is necessary, our office will give you a written estimate and a customized payment plan. We accept most insurance plans, credit cards, debit cards and checks. We also offer NO DOWN PAYMENT plans as well as NO INTEREST monthly payment plans. We pride ourselves in making orthodontic treatment AFFORDABLE at Affordablebraces.com. We all look forward to meeting you in the near future.

Thank you................................................. Doctor Ouellette & Staff.

B. Limited Treatment Cases
*ADA Code
Fee Ranges
Limited Treatment of Primary Dentition
8010
$1,500 - $3,600
Limited Treatment of Transitional Dentition
8020
$2,500 - $3,800
Limited Treatment of Adolescent Dentition
8030
$2,500 - $4,200
Limited Treatment of Adult Dentition
8040
$3,600 - $4,600
C. Interceptive Treatment Cases (Phase I)
*ADA Code
Fee Ranges
Interceptive Treatment of Primary Dentition
8050
$2,800 - $3,800
Interceptive Treatment of Transitional Dentition
8060
$2,800 - $3,800
D. Comprehensive Treatment Cases (Phase II)
*ADA Code
Fee Ranges
Comprehensive Treatment of Primary Dentition
8070
$4,900 - $6,500
Comprehensive Treatment of Transitional Dentition
8080
$4,900 - $6,500
Comprehensive Treatment of Adolescent & Adult Dentition
8090
$4,900 - $6,500
E. Other Services
*ADA Code
Fee Ranges
Appliance(s) Removal, Construct & Place Retainer(s)
8680
$950
Appliance(s) Removal without Retainer(s)
8680
$150 - $450
Initial Retainer Appliance Fee For New Patients
8680
$350 per arch
Essix Clear/Invisible Retainer(s)
8680
$175 per arch
Tooth Positioner Appliance
8680
$350
Lost or Broken Retainer(s) For Patients of Record
8680
$250 per arch
Broken Retainer(s) Repair (Plus $45 Appt Fee)
5610
$55 - $150
Functional Appliance(s) (Twin Block, Herbst, European Appliances)
8680
$350 - $1,500
Orthopedic Appliance(s) (Chin cup / Face Mask / Headgears)
8680
$350 - $1,500
Occlusal (Bite) Adjustments / Limited
9951
$150 - $300
Occlusal (Bite) Adjustments / Complete
9952
$400
Fixed Retainer(s) Bonded To Back of Teeth (Clear Essix Retainer(s) Included)
8680
$350 per arch
Extensive Treatment Planning &/or Surgical Case Work-up
9450
$1,500
After Hours Office Visit / Emergency Care Visit New Patient
9440
$250 minimum charge
Extraction of Primary Teeth or Coronal Remnants
7111
$75 per tooth
Maxillary Partial Denture (Flipper with Pontic Teeth)
5211
$750 per arch
Mandibular Partial Denture (Flipper with Pontic Teeth)
5212
$750 per arch
Space Maintainer Bilateral / Fixed
1515
$650 per arch
Space Maintainer Bilateral / Removable
1525
$650 per arch
Recementation Space Maintainer
1550
$75 per visit
Broken or Missed Appointments without Notice
9999
$50 per no show
Provisional Splinting of Traumatized Teeth (Extracoronal Stabilization)
4321
$300 - $950
Invisalign Comprehensive Treatment (Includes $1,600 Lab & $200 Materials Fee)
8090
$6,000 - $6,500
Invisalign Limited Treatment (Includes $1600 Lab & $200 Materials Fee)
8090
$4,500 - $5,500
Temporary Anchorage Device -- Anesthesia + Insertion (per TAD)
 
$450 each
Power (One hour) Laser Bleaching
 
$350 - $500

TRANSFER CASES: In the event you transfer to another city after you start treatment in our practice we will refer you to another orthodontist that has a compatible treatment philosophy with our office. If you have paid your orthodontic fees in advance our office will return all unearned orthodontic fees. The amount of your refund will be determined as follows. Startup costs shall include, but may not be limited to, initial evaluation of orthodontic problems, diagnostic records, case treatment plan, formulation of treatment protocol, appliance fabrication, laboratory procedures, correspondence with your general dentist and other doctors as required. The fees charged for these services are usually a minimum of $1800. The minimum start up fees for Invisalign therapy is $3600 due to initial laboratory fees. Active orthodontic treatment is determined by the number of months you are under our care. You may not have a scheduled appointment every month; however, some months may require multiple appointments. You will be charged a minimum of $150 each month which may or may not be the same as your monthly payment plan. In an effort to make our orthodontic fees affordable you may have paid a smaller down payment and make larger monthly payments. We often give case fee discounts that may or may not be honored if you transfer before completion of your contract with our practice. There is also a records duplication fee of $50 due at the time of transfer. Hopefully you will not be transferred in the middle of your treatment. Many of our patients make arrangements to commute back to our office allowing us to finish the treatment. We can extend your visits to 12 week or more intervals to accommodate your commuting schedule. Clear aligner patients in most cases may elect to continue their treatments until completion and the final retainers can be mailed to you. If you have any chance of being transferred within 12 months of initiating treatment, it may be more prudent to postpone your orthodontic treatment until you relocate.

IF ORTHODONTIC INSURANCE covers all or part of the case fee, it may be paid directly to our practice or to the policyholder as agreed to by each party. The FINANCIALLY RESPONSIBLE PARTY must pay whatever part of the account balance not paid directly to the practice by the insurance company. DISCOUNT INSURANCE PLANS in most cases provide a 15% to 25% discount off our published fee schedule. As a rule our office charges a "flat" or "bundled" fee that includes one or more of the orthodontic services listed on our fee schedule. When quoting a discounted fee our office computes the fee on "unbundled" or full fee for service basis with no professional discounts. For example, a Child Case may require the following services from our published fee schedule (See Sections A -E): A: Initial Diagnostic Records Inclusive @ $450; D: Comprehensive Treatment of Adolescent Dentition $5200; E: Appliance(s) Removal, Construct & Place Retainer(s) @ $950. The total fee before discounts would be $6,500. A 25% fee reduction would make your final cost $4,875. Invisalign cases are computed the same way with the exception of adding $1000 more to defray initial laboratory fees. All other discounts or coupons would not apply to this type of insurance plan.
*HIPAA Compliant Codes pursuant to American Dental Association (ADA) Current Dental Terminology (CDT). Fees subject to change without notice.
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