Phased Treatment Plans & Digital Case Acceptance
Multi-phase clinical estimates, insurance copay calculations & legally binding e-signatures
Patient:
Case Status:
Created: 2026-09-19
Phased Comprehensive Restorative & Periodontal Care
Patient: Vance, Eleanor
Total Fee
$3,290.00
Insurance Est.
$2,180.00
Patient Copay
$1,110.00
1Phase 1: Emergency & Caries Control
Phase Total: $690.00 (Copay: $138.00)
D2392Resin composite - 2 surfaces, posterior #3 (MO)
Tooth #3 Surface (MO)
$280.00
D2393Resin composite - 3 surfaces, posterior #19 (MOD)
Tooth #19 Surface (MOD)
$340.00
D1206Fluoride varnish application
$70.00
2Phase 2: Prosthodontic Full Coverage Crown
Phase Total: $1,350.00 (Copay: $675.00)
D2740Crown - porcelain/ceramic substrate #14
Tooth #14
$1,250.00
D2950Core buildup, including any pins #14
Tooth #14
$100.00
3Phase 3: Quadrant Scaling & Periodontal Maintenance
Phase Total: $1,250.00 (Copay: $297.00)
D4341Periodontal SRP - Upper Right Quadrant
$295.00
D4341Periodontal SRP - Lower Left Quadrant
$295.00
Created: 2026-08-14
Molar Endodontics & Zirconia Crown Rehabilitation
Patient: Sterling, Marcus
Total Fee
$2,600.00
Insurance Est.
$1,650.00
Patient Copay
$950.00
1Endodontic Therapy
Phase Total: $1,350.00 (Copay: $270.00)
D3330Molar Endodontic RCT #19
Tooth #19
$1,350.00
2Crown Restoration
Phase Total: $1,250.00 (Copay: $680.00)
D2740Full Ceramic Zirconia Crown #19
Tooth #19
$1,250.00
Signed on 2026-08-14