Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1100%$110 Medium
Dental Cleaning - Child$1200%$120 Medium
Dental Exam - Comprehensive$1200%$120 Medium
Dental Exam - Periodic, Established Patient$500%$50 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1910%$191 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3400%$340 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2650%$265 Medium
Dental Filling - White (Resin): One Surface, Anterior$1640%$164 Medium
Dental Filling - White (Resin): One Surface, Posterior$1910%$191 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3650%$365 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2050%$205 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2650%$265 Medium
Flouride - Topical Varnish Application$530%$53 Medium
Fluoride - Topical Application$530%$53 Medium
Maintenance Therapy - Periodontal$1500%$150 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2750%$275 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$890%$89 Medium
Root Canal - Anterior Tooth$8520%$852 Medium
Root Canal - Bicuspid Tooth$1,5410%$1,541 Medium
Root Canal - Molar$1,2080%$1,208 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$800%$80 Medium
Tooth Extraction - Elevation and/or Forceps Removal$2600%$260 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$270%$27 Medium
X-Ray - Complete Intraoral Series$1480%$148 Medium
X-Ray - Four Images, Bitewings$720%$72 Medium
X-Ray - Intraoral, Periapical Radiographic Image$380%$38 Medium
X-Ray - Two Images, Bitewings$760%$76 Medium
X-Ray - Whole Mouth from Outside Mouth$1580%$158 Medium