235 South 400 East, Bountiful, Utah, 84010
(801) 298-1812
Natural Holistic Dentistry
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TMJ Records
TMJ Records
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TMJ Records
Diagnostic Records for TMJ, Sleep, and Craniofacial Pain
Diagnosis (finding the root of the problem) is the key to any successful treatment. This letter will explain our "diagnostic phase," which consists of three appointments.
1. Initial consultation appointment -
This is a screening/review of symptoms to determine if treatment is necessary.
Cost: $105
2. Records appointment -
Information is gathered in order to make a thorough assessment and diagnosis. This includes:
Procedure
ADA Code
Med Code
Cost
Detailed Focused Evaluation
0160
99204
$85.00
FMX Digital Radiographs - All
0210
70320
$96.00
Orofacial and Posture Images
0350
99070
$63.00
3D Cone Beam CT Scan and Review
0360
70486
$299.00
Diagnostic Casts
0470
99070
$75.00
Oral Cancer Phosphorescence
0482
02431
$25.00
Computerized Jaw Tracking (JT)
0999JT
97750
$51.00
Computerized Joint Survey (JVA)
0999JVA
77077
$63.00
Neurologic Testing
0999NT
95831
$49.00
Pharyngometer (Airway)
0999PR
92520
$57.00
A1C Test
A1C
$25.00
Heart Rate Variability
HRV
$25.00
Nutritional Scan
NS
$25.00
Vitamin D Test
VITD
$35.00
Total Diagnostic Fees: $973
3. Final consultation appointment -
Both the patient and the responsible party(s) should attend this final consultation. At this time, the diagnosis and treatment plan will be explained. The cost of the treatment will be explained and a financial agreement discussed/signed. Cost: $105
Payment of Fees
If you have dental and/or medical insurance, some of these fees may be reimbursable. Regardless of insurance coverage, however,
payment for services rendered is due at the time of service.
As a courtesy, you will be given a superbill at the end of your appointment. You may send this to your insurance company for direct reimbursement.
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(801) 298-1812
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