Home / New Patients / Patient Forms / TMJ Records
TMJ Records

Schedule Your Consultation Today!

Ask the doctor

 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:
    ProcedureADA CodeMed CodeCost
    Detailed Focused Evaluation016099204$85.00
    FMX Digital Radiographs - All021070320$96.00
    Orofacial and Posture Images035099070$63.00
    3D Cone Beam CT Scan and Review036070486$299.00
    Diagnostic Casts047099070$75.00
    Oral Cancer Phosphorescence048202431$25.00
    Computerized Jaw Tracking (JT)0999JT97750$51.00
    Computerized Joint Survey (JVA)0999JVA77077$63.00
    Neurologic Testing0999NT95831$49.00
    Pharyngometer (Airway)0999PR92520$57.00
    A1C TestA1C$25.00
    Heart Rate VariabilityHRV$25.00
    Nutritional ScanNS$25.00
    Vitamin D TestVITD$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.
  • MM slash DD slash YYYY
After submitting, feel free to return to the Patient Forms page. Please note, there are multiple forms for each section.

 

Schedule Your Consultation Today!

Skip to content