Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1100%$110
Dental Cleaning - Child$1200%$120
Dental Exam - Comprehensive$1200%$120
Dental Exam - Periodic, Established Patient$500%$50
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2000%$200
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3400%$340
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2650%$265
Dental Filling - White (Resin): One Surface, Anterior$1670%$167
Dental Filling - White (Resin): One Surface, Posterior$1910%$191
Dental Filling - White (Resin): Three Surfaces, Posterior$3400%$340
Dental Filling - White (Resin): Two Surfaces, Anterior$2050%$205
Dental Filling - White (Resin): Two Surfaces, Posterior$2930%$293
Flouride - Topical Varnish Application$530%$53
Fluoride - Topical Application$530%$53
Maintenance Therapy - Periodontal$1540%$154
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2800%$280
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$890%$89
Root Canal - Anterior Tooth$1,0870%$1,087
Root Canal - Bicuspid Tooth$1,5410%$1,541
Root Canal - Molar$1,2190%$1,219
Sealant - Placed on Tooth Surface to Prevent Decay$590%$59
Tooth Extraction - Elevation and/or Forceps Removal$2600%$260
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$220%$22
X-Ray - Complete Intraoral Series$1480%$148
X-Ray - Four Images, Bitewings$950%$95
X-Ray - Intraoral, Periapical Radiographic Image$380%$38
X-Ray - Two Images, Bitewings$760%$76
X-Ray - Whole Mouth from Outside Mouth$1310%$131