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235 South 400 East, Bountiful, Utah, 84010

(801) 298-1812

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Limited Records

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Initial Records Appointment

  • Initial Records Appointment

  • Diagnosis is the key to any successful treatment. n order to arrive at a diagnosis, your records appointment will include the following tests. If it is determined that there are underlying disorders and/or conditions beyond which the initial records appointment will allow us to see, other records/tests may be indicated and recommended
    1. Initial Records Appointment

    Information is gathered in order to make a thorough assessment and diagnosis. This includes:

    ProcedureADA CodeMed CodeCost
    Comprehensive Oral Exam015099203$90.00
    FMX Digital Radiographs - All021070320$130.00
    Orofacial and Posture Images035099070$75.00
    Nutritional ScanNS$30.00
    Diagnostic Impressoins047099070$85.00
    Oral Cancer Phosphorescence048202431$30.00
    3D Digital Panoramic Image036770355$150.00
    Vitamin D TestVITD$45.00
    Heart Rate VariabilityHRV$30.00
    MEAS TestMEAS$30.00
    A1C TestA1C$30.00
    Total Diagnostic Fees: $725
    2. Consultation Appointment  

    Should more than 1-2 simple fillings be required to restore your orofacial system to health, Dr. Wall will analyze your records and create a customized care plan. The fee listed is for care plan creation and accompanying consultation appointment. As it can take Dr. Wall up to 2 hours to complete your treatment plans, this fee must be prepaid prior to Dr. Wall reviewing all your records.


    COST $305

    Payment of Fees

    If you have dental insurance, some of these fees may be reimbursable. Regardless of insurance coverage, however, payment for services rendered are due at the time of service. I understand that there is a NON-REFUNDABLE $200 deposit to reserve a diagnostic appointment.

    By signing below, I attest that I understand and agree to the above-listed procedures and associated fees.
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After submitting, feel free to return to the Patient Forms page. Please note, there are multiple forms for each section.

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(801) 298-1812
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