Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1040%$104 Medium
Dental Cleaning - Child$1200%$120 Medium
Dental Exam - Comprehensive$1200%$120 Medium
Dental Exam - Periodic, Established Patient$490%$49 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1880%$188 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3400%$340 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2610%$261 Medium
Dental Filling - White (Resin): One Surface, Anterior$1640%$164 Medium
Dental Filling - White (Resin): One Surface, Posterior$1880%$188 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3910%$391 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2010%$201 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$3210%$321 Medium
Flouride - Topical Varnish Application$530%$53 Medium
Fluoride - Topical Application$530%$53 Medium
Maintenance Therapy - Periodontal$2120%$212 Medium
Orthodontic Treatment - Periodic Visit, Part of a Contract$1580%$158 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3330%$333 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$880%$88 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$580%$58 Medium
Tooth Extraction - Elevation and/or Forceps Removal$2210%$221 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$270%$27 Medium
X-Ray - Complete Intraoral Series$2180%$218 Medium
X-Ray - Four Images, Bitewings$710%$71 Medium
X-Ray - Intraoral, Periapical Radiographic Image$340%$34 Medium
X-Ray - Two Images, Bitewings$760%$76 Medium
X-Ray - Whole Mouth from Outside Mouth$1850%$185 Medium