HNA Fee Schedule Orthodontics

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ADA Code ADA Description
D8010 Limited orthodontic treatment - primary dentition 1235
D8020 Limited orthodontic treatment - transitional dentition 1675
D8030 Limited orthodontic treatment - adolescent dentition 2565
D8040 Limited orthodontic treatment - adult dentition 3215
D8050 Interceptive orthodontic treatment - primary dentition 1149
D8060 Interceptive orthodontic treatment - transitional dentition 1494
D8070 Comprehensive orthodontic treatment - transitional dentition 3985
D8080 Comprehensive orthodontic treatment - adolescent dentition 4199
D8090 Comprehensive orthodontic treatment - adult dentition 4244
D8210 Removable appliance therapy 329
D8220 Fixed appliance therapy 425
D8660 Pre-orthodontic treatment visit 123
D8680 Orthodontic retention 335
D8691 Repair of orthodontic appliance 99
D8692 Replacement of lost or broken retainer 300
D8693 Rebonding or recementing and/or repair, as required, of fixed retainers 82
Disclaimer: This is not health insurance; the dental discount plan provides discounts from dental providers. The dental discount plan does not make payments directly to the providers of health care. The member will be required to pay for all dental treatment but will receive a discount from those providers that accept Health Networks of America’s Discount Dental Plan. Health Networks of America can be reached at 1-877-335-7526.