Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1210%$121
Dental Cleaning - Child$950%$95
Dental Exam - Comprehensive$1050%$105
Dental Exam - Periodic, Established Patient$580%$58
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1740%$174
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3420%$342
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2630%$263
Dental Filling - White (Resin): One Surface, Anterior$1810%$181
Dental Filling - White (Resin): One Surface, Posterior$2100%$210
Dental Filling - White (Resin): Three Surfaces, Posterior$3620%$362
Dental Filling - White (Resin): Two Surfaces, Anterior$2260%$226
Dental Filling - White (Resin): Two Surfaces, Posterior$2840%$284
Flouride - Topical Varnish Application$470%$47
Fluoride - Topical Application$450%$45
Maintenance Therapy - Periodontal$1580%$158
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3100%$310
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$960%$96
Root Canal - Anterior Tooth$9110%$911
Root Canal - Bicuspid Tooth$9790%$979
Sealant - Placed on Tooth Surface to Prevent Decay$590%$59
Tooth Extraction - Elevation and/or Forceps Removal$2150%$215
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$320%$32
X-Ray - Complete Intraoral Series$1890%$189
X-Ray - Four Images, Bitewings$840%$84
X-Ray - Intraoral, Periapical Radiographic Image$390%$39
X-Ray - Two Images, Bitewings$840%$84
X-Ray - Whole Mouth from Outside Mouth$1420%$142