fee schedule

You can save as much as 30% off the cost of many procedures. Our comprehensive plan offers reduced fees making quality dentistry affordable to everyone!

 
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DIAGNOSTIC & PREVENTATIVE PROCEDURES (EXAMS & X-RAYS)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
120 PERIODIC ORAL EVALUATION $60 No Charge $60
140 EMERGENCY ORAL EXAM $79 No Charge $79
150 COMPREHENSIVE ORAL EVALUATION $99 No Charge $99
210-330 ALL X-RAYS No Charge
1110 PROPHYLAXIS - ADULT $101 $50 $51
1120 PROPHYLAXIS - CHILD $76 $50 $26
1206 FLUORIDE - CHILD (to age 16) $40 No Charge $40
 
Includes a maximum of 2 exams and fluorides (child) per plan year.
RESTORATIVE PROCEDURES (FILLINGS)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
2140 AMALGAM 1 SURFACE - PRI/PERM $148 $104 $44
2150 AMALGAM 2 SURFACE - PRI/PERM $188 $132 $56
2160 AMALGAM 3 SURFACE - PRI/PERM $227 $159 $68
2161 AMALGAM 4+SURFACE - PRI/PERM $271 $190 $81
2330 COMPOSITE - 1 SURFACE ANTERIOR $173 $121 $52
2331 COMPOSITE - 2 SURFACE ANTERIOR $210 $147 $63
2332 COMPOSITE - 3 SURFACE ANTERIOR $261 $183 $78
2335 COMPOSITE - 4 SURFACE ANTERIOR $335 $235 $101
2750 CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL $1,283 $898 $385
2752 CROWN - PORCELAIN FUSED TO NOBLE METAL $1,083 $758 $325
2790 CROWN - FULL CAST HIGH NOBLE $1,283 $898 $385
2940 SEDATIVE FILLING $119 $83 $36
2950 CORE BUILD UP WITH OR WITHOUT PINS $298 $209 $89
2951 PIN RETENTION - PER TOOTH $70 $49 $21
2954 PREFABRICATED POST & CORE IN ADDITION TO CROWN $365 $256 $110
COSMETIC PROCEDURES
CodeFull Length Description Typical Fee Plan Fee SAVINGS
2391 COMPOSITE - 1 SURFACE POSTERIOR $208 $146 $62
2392 COMPOSITE - 2 SURFACE POSTERIOR $268 $188 $80
2393 COMPOSITE - 3 SURFACE POSTERIOR $317 $222 $95
2394 COMPOSITE - 4 SURFACE POSTERIOR $371 $260 $111
2960 LABIAL VENEER RESIN - CHAIRSIDE $704 $493 $211
2962 LABIAL VENEER PORCELAIN - LAB $1,212 $848 $364
ENDODONTIC PROCEDURES (ROOT CANALS)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
3310 ROOT CANAL ANTERIOR $830 $581 $249
3320 ROOT CANAL BICUSPID $953 $667 $286
3330 ROOT CANAL MOLAR $1,136 $795 $341
3346 RETREAT ANTERIOR $920 $644 $276
3347 RETREAT BICUSPID $1,044 $731 $313
3348 RETREAT MOLAR $1,254 $878 $376
PERIODONTIC PROCEDURES (GUMS)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
4249 CROWN LENGTHENING $776 $543 $233
4260 OSSEOUS SURGERY INCL. FLAP - PER QUAD $1,348 $944 $404
4263 BONE REPLACEMENT - FIRST SITE IN QUAD $706 $565 $141
4264 BONE REPLACEMENT - EACH ADD. SITE IN QUAD $498 $398 $100
4341 SCALING AND ROOT PLANING - PER QUAD $215 $151 $65
4910 PERIODONTAL MAINTENANCE $101 $71 $30
REMOVABLE PROSTHODONTIC PROCEDURES (DENTURES)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
5110 COMPLETE UPPER DENTURE $1,730 $1,211 $519
5120 COMPLETE LOWER DENTURE $1,730 $1,211 $519
5130 IMMEDIATE UPPER DENTURE $1,839 $1,287 $552
5140 IMMEDIATE LOWER DENTURE $1,839 $1,287 $552
5213 UPPER PARTIAL - METAL BASE $1,730 $1,211 $519
5214 LOWER PARTIAL - METAL BASE $1,730 $1,211 $519
5225 UPPER PARTIAL DENTURE - FLEX/VALPLAST $1,947 $1,363 $584
5226 LOWER PARTIAL DENTURE - FLEX/VALPLAST $1,947 $1,363 $584
5610 REPAIR RESIN DENTURE BASE $216 $151 $65
5620 REPAIR CAST FRAMEWORK $324 $227 $97
5630 REPAIR OR REPLACE BROKEN CLASP $297 $208 $89
5650 ADD TOOTH TO EXISTING PARTIAL DENTURE $224 $157 $67
5750 RELINE COMPLETE UPPER DENTURE - LAB $527 $369 $158
5751 RELINE COMPLETE LOWER DENTURE - LAB $527 $369 $158
5820 INTERIM PARTIAL UPPER (FLIPPER) $692 $484 $208
5821 INTERIM PARTIAL LOWER (FLIPPER) $692 $484 $208
IMPLANT PROCEDURES
CodeFull Length Description Typical Fee Plan Fee SAVINGS
6010 SURGICAL PLACEMENT OF IMPLANT BODY $2,484 $1,987 $497
6056 PREFABRICATED ABUTMENT $803 $642 $161
6057 CUSTOM ABUTMENT $1,011 $809 $202
6058 IMPLANT SUPPORTED CROWN - PORCELAIN $1,408 $1,126 $282
6059 IMPLANT SUPPORTED CROWN - HIGH NOBLE $1,408 $1,126 $282
FIXED PROSTHODONTIC PROCEDURES (BRIDGEWORK)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
6240 PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL $1,283 $898 $385
6242 PONTIC - PORCELAIN FUSED TO NOBLE METAL $1,083 $758 $325
6750 CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL $1,283 $898 $385
6752 CROWN - PORCELAIN FUSED TO NOBLE METAL $1,083 $758 $325
ORAL SURGERY PROCEDURES (EXTRACTIONS)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
7140 EXTRACTION - ERUPTED TOOTH $189 $132 $57
7210 EXTRACTION - SURGICAL ERUPTED $297 $208 $89
7220 EXTRACTION - IMPACTED SOFT TISSUE $360 $252 $108
7230 EXTRACTION - IMPACTED PARTIAL BONY $436 $305 $131
7240 EXTRACTION - IMPACTED COMPLETE BONY $513 $359 $154
7250 SURGICAL REMOVAL OF RESIDUAL ROOT $357 $250 $107
7280 SURGICAL EXPOSURE OF UNERUPTED TOOTH $503 $352 $151
7510 INCISION & DRAINAGE ABSCESS $293 $205 $88
ORTHODONTIC PROCEDURES (BRACES)
CodeFull Length Description Typical Fee Plan Fee SAVINGS
8080 COMPREHENSIVE TREATMENT OF THE ADOLESCENT DENTITION:
  METAL $4,825 $3,620 $1,205
  CERAMIC $5,475 $4,270 $1,205
  UPPER CERAMIC AND LOWER METAL $5,150 $3,945 $1,205
  INVISALIGN $5,770 $5,000 $770
8090 COMPREHENSIVE TREATMENT OF THE ADULT DENTITION:
  METAL $4,825 $3,620 $1,205
  CERAMIC $5,475 $4,270 $1,205
  UPPER CERAMIC AND LOWER METAL $5,150 $3,945 $1,205
  INVISALIGN $5,770 $5,000 $770