Office Fees

Preventative Dental Care

CLEANING, EXAM, FULL SERIES OF X-RAYS, FLUORIDE (D0150)

$0-$451

Certain PPO plans may cover 100%

Dental Exams

$0-$451

Periodic Exam (D0120) $58

Comprehensive Exam (D0150) $94

Limited Exam (D0140) $85

EMERGENCY EXAM

$0-147

Certain PPO plans may cover 100%

DENTAL CLEANINGS (PROPHYLAXIS)

$80-$107

Child Teeth Cleaning (D1120) $80

Adult Teeth Cleaning (D1110) $107

DENTAL X-RAYS

$32-$261

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

FLUORIDE (D1206)

$30

EMERGENCY EXAM

$0-147

Certain PPO plans may cover 100%

POSTERIOR COMPOSITE (WHITE) FILLINGS

$199-$510

1 surface — $226

2 surface — $290

3 surface — $364

4 surface — $425

5 surface — $510

Certain PPO plans may cover up to 80%

ANTERIOR COMPOSITE (WHITE) FILLINGS

$205-$404

1 surface —$205

2 surface — $254

3 surface — $295

4 surface — $375

5 surface —$404


Certain PPO plans may cover up to 50-80%

PERIODONTAL MAINTENANCE (D4910)

$140

Certain PPO plans may cover up to 80%

Restorative Dental Care

PORCELAIN CROWN

$1,365-$1,690

$1,365 (crown only)

$1,690 (Including the build up)


Certain PPO plans cover up to 80%

SCALING & ROOT PLANING

$225 - $310

1-3 Teeth (D4342): $225

Quad (D4341): $310

ROOT CANALS

$900 - $1,250

Anterior (D3310): $900

Bicuspid (D3320): $1,030

Molar (D3330): $1,250

DENTAL IMPLANTS (D6010/D6056/D6059)

$4,450

D6010: $2,000

D6057: $950

D6058: $1,500

Includes 3-D X-ray–certain PPO plans may cover up to 50%

DENTURE SERVICES

$75 - $2,150

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

IMPLANT-SUPPORTED DENTURES

$5,500-9,500

2 implant overdenture — $5,500

4 implant overdenture — $9,500

Includes all costs except sedation and tooth extractions

IMPLANT-SUPPORTED BRIDGE

$20,000 / arch

Includes 4+ implants per arch and zirconia final upgrade

SINUS AUGMENTATION

$795- $2,025

Sinus Bump (D7952): $795

Sinus Lift (D7951): $2,025

Cosmetic Dental Care

TAKE-HOME WHITENING (CUSTOM TRAYS)

$299

TAKE-HOME WHITENING (GO WHITENING PACKAGE)

$75

PORCELAIN VENEERS

$1,380

Additional Services

ORTHODONTICS (D8090)

$2,500-5,500

Certain PPO plans may cover up to 50%

NITROUS SEDATION

$99

ORAL CONSCIOUS SEDATION

$364

IV SEDATION

$0-750

Certain PPO plans may cover up to 100%

FULL ARCH OCCLUSAL GUARD (D9944)

$565

SLEEP APNEA APPLIANCE

$5,775