Queue›Robert Williams›Estimate

Treatment estimate

Robert Williams · Delta Dental Delta Dental PPO · Apr 23, 2026

Patient owes

$870.25

due at or before treatment

Insurance pays

$409.75

of $1,280.00 total fee

After this plan

$0.00

annual max will be exhausted

⚠ Max impactInsurance would normally pay an additional $667.16 on this treatment, but the annual max cap shifts that amount to the patient. Consider deferring D0140 to 2027.

Code	Treatment	Qty	Fee	Covered	Ded.	Insurance	Patient
D0140	Limited oral evaluation	1	$85.00	100%	—	$85.00	$0.00
D0220	Periapical first radiograph	1	$35.00	100%	—	$35.00	$0.00
D1110	Prophylaxis — adult	1	$110.00	100%	—	$110.00	$0.00
D0210	Full-mouth intraoral radiographs	1	$150.00	100%	—	$150.00	$0.00
D3310	Endodontic therapy, anterior tooth	1	$900.00	80%	$28.86	$29.75	$870.25