Periodic Exam (D0120) $58
Comprehensive Exam (D0150) $94
Limited Exam (D0140) $85
Child Teeth Cleaning (D1120) $80
Adult Teeth Cleaning (D1110) $107
PA (D0220): $32
Addt'l PAs (D0230): $27
1 BWX (D0270): $31
2 BWX (D0272): $54
4 BWX (D0274): $75
Panoramic X-Ray (D0330): $130
CT (D0367): $261
1 surface — $226
2 surface — $290
3 surface — $364
4 surface — $425
5 surface — $510
Certain PPO plans may cover up to 80%
1 surface —$205
2 surface — $254
3 surface — $295
4 surface — $375
5 surface —$404
Certain PPO plans may cover up to 50-80%
Certain PPO plans may cover up to 80%
$1,365 (crown only)
$1,690 (Including the build up)
Certain PPO plans cover up to 80%
1-3 Teeth (D4342): $225
Quad (D4341): $310
Anterior (D3310): $900
Bicuspid (D3320): $1,030
Molar (D3330): $1,250
D6010: $2,000
D6057: $950
D6058: $1,500
Includes 3-D X-ray–certain PPO plans may cover up to 50%
Denture Repair: $75-$300
Denture Reline (D5750 & 5751): $545
Flipper (D5820 & D5821): $785-$1,570
Complete Upper (D5110): $2,025
Complete Lower (D5120): $2,025
Immediate Upper (D5130): $2,125
Immediate Lower (D5140): $2,125
Upper Partial (D5213): $2,150
Lower Partial (D5214): $2,150
2 implant overdenture — $5,500
4 implant overdenture — $9,500
Includes all costs except sedation and tooth extractions
Includes 4+ implants per arch and zirconia final upgrade
Sinus Bump (D7952): $795
Sinus Lift (D7951): $2,025
Certain PPO plans may cover up to 100%