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* 1. Which NDA District is your practice located?NDA Districts

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* 2. What year did you graduate dental school?

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* 3. When are you planning to retire?

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* 4. You are:

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* 5. Your practice is:

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* 6. Number of dentists in this practice?

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* 7. Does your office accept Medicaid?

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* 8. How would you primarily  like to be contacted by the NDA?

PLEASE visit the ADA website to view or update your contact information. 

If you are not sure what address is on file or would like to change to a preferred address, login to the ADA website and below your name/photo, click on Account then Profile to update your information. 

It is very important that your email is up to date through the ADA website, since this is the email the NDA uses to contact you.
Please help the NDA understand staffing issues you may be experiencing

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* 9. Is your workplace fully staffed?

Please describe the makeup of your dental team - # of employed / ideal #

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* 10. # of Dentists - # employed / ideal #

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* 11. # of Hygienists - # employed / ideal #

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* 12. # of Assistants - # employed / ideal #

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* 13. # Front Office Staff - # employed / ideal #

Staff Compensation expressed in $/hour or $/year

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* 14. Office Manager

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* 15. Receptionist

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* 16. Bookkeeper

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* 17. Dental Assistant 1-4 years experience

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* 18. Dental Assistant 5-9 years experience

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* 19. Dental Assistant 10+ years experience

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* 20. Dental Hygienist 1-4 years experience

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* 21. Dental Hygienist 5-9 years experience

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* 22. Dental Hygienist 10+ years experience

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* 23. If paid on commission, what is the average commision percentage

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* 24. Full Time Employee Benefits - Check any that apply

Fee Survey - List Fee Amounts Charged

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* 25. D0120 - Periodic Exam

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* 26. D0140 - Limited Exam

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* 27. D0145 - <3yo Oral Eval

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* 28. D0150 - Comprehensive Oral Exam

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* 29. D0210 - Complete series of xrays (full mouth/FMX)

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* 30. D0220 - Intraoral - periapical first film

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* 31. D0272 - 2 BWX

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* 32. D0274 - 4 BWX

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* 33. D0330 - Panoramic film

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* 34. D0340 - Cephalometric film

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* 35. D0350 - Intraoral and extraoral photos

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* 36. D0364 - Cone Beam CT – limited field of view – includes interpretation and report

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* 37. D0380 - Cone Beam CT – limited field of view – practitioner not associated with interpretation and report

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* 38. D0470 - Diagnostic models

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* 39. D1110 - Prophylaxis – Adult

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* 40. D1120 - Prophylaxis- Child

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* 41. D1206 - Fluoride Varnish

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* 42. D1208 - Fluoride – excluding Varnish

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* 43. D1351 - Sealant – per tooth

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* 44. D1354 - Interim caries arresting medicament application, per tooth

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* 45. D1355 - Caries preventative medicament application, per tooth

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* 46. D2140 - Amalgam, 1 surface primary or permanent

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* 47. D2150 - Amalgam, 2 surface primary or permanent

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* 48. D2330 - Resin-based composite – one surface, anterior

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* 49. D2331 - Resin-based composite – two surfaces, anterior

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* 50. D2391 - Resin-based composite – one surface, posterior

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* 51. D2392 - Resin-based composite – two surfaces, posterior

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* 52. D2620 - Inlay porcelain/ceramic – two surfaces

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* 53. D2630 - Onlay porcelain/ceramic – three or more surfaces

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* 54. D2740 - Crown – porcelain/ceramic

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* 55. D2750 - Crown – porcelain fused to high noble metal

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* 56. D2792 - Crown – full cast noble metal

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* 57. D2930 - Stainless steel crown – primary tooth

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* 58. D2950 - Core buildup, including pins

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* 59. D3310 - Endodontic therapy anterior tooth, excluding final restoration

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* 60. D3320 - Endodontic therapy bicuspid tooth, excluding final restoration

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* 61. D3330 - Endodontic therapy molar tooth, excluding final restoration

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* 62. D3346 - Retreatment of previous RCT – anterior

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* 63. D3347 - Retreatment of previous RCT – bicuspid

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* 64. D3348 - Retreatment of previous RCT – molar

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* 65. D4341 - Periodontal Scaling & Root Planing 4+ teeth/quad

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* 66. D4342 - Periodontal scaling and root planing 1-3 teeth/quad

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* 67. D4346 - Scaling in presence of generalized moderate or severe gingival inflammation, full mouth (hard prophy)

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* 68. D4910 - Periodontal maintenance

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* 69. D5110/5120 - Complete denture

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* 70. D5225/5226 - Partial denture-flexible base

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* 71. D5284 - Partial denture – one piece, flexible base, per quad

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* 72. D6010 - Surgical placement of endosteal implant body

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* 73. D6056 - Pre-fabricated abutment

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* 74. D6057 - Custom fabricated abutment – includes placement

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* 75. D6058 - Abutment supported porcelain/ceramic crown (implant crown)

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* 76. D6059 - Abutment supported PFM (high noble metal) implant crown

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* 77. D6114/6115 - Implant/abutment supported fixed denture (full fixed hybrid)

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* 78. D7140 - Extraction, single tooth

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* 79. D7210 - Extraction, surgical erupted

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* 80. D8030 - Limited orthodontic adolescent

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* 81. D8040 - Limited orthodontic adult

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* 82. D8090 - Comprehensive orthodontic treatment of adult detention

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* 83. D8220 - Fixed appliance therapy

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* 84. D8660 - Pre-orthodontic treatment visit

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* 85. D9110 - Palliative (emergency) treatment, minor

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* 86. Are you an Associate?

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* 87. How long have you been practicing?

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* 88. How is your pay determined?

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* 89. Do you have an employement agreement?

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* 90. Check any of the clauses that appear in your employment agreement

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* 91. Do you plan to own your own office in the future

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* 92. Approximately how many hours per week are you working

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* 93. How do you obtain your patients

Thank you very much for filling out this survey.  You will be emailed the survey results via the email address that you have on file with the ADA.  If you are not sure what address is on file or would like to change to a preferred address, login to the ADA website https://ebusiness.ada.org/login/login.aspx

Below your name/photo, click on Account then Profile to update your information.  It is very important that your email is up to date through the ADA website, since this is the email the NDA uses to contact you.
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