Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1170%$117
Dental Cleaning - Child$1000%$100
Dental Exam - Comprehensive$1120%$112
Dental Exam - Periodic, Established Patient$630%$63
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2140%$214
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3740%$374
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2890%$289
Dental Filling - White (Resin): One Surface, Anterior$1840%$184
Dental Filling - White (Resin): One Surface, Posterior$2140%$214
Dental Filling - White (Resin): Three Surfaces, Posterior$3740%$374
Dental Filling - White (Resin): Two Surfaces, Anterior$2350%$235
Dental Filling - White (Resin): Two Surfaces, Posterior$2890%$289
Flouride - Topical Varnish Application$500%$50
Maintenance Therapy - Periodontal$1740%$174
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3020%$302
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$1100%$110
Root Canal - Molar$1,6540%$1,654
Sealant - Placed on Tooth Surface to Prevent Decay$610%$61
Tooth Extraction - Elevation and/or Forceps Removal$2890%$289
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$350%$35
X-Ray - Complete Intraoral Series$2330%$233
X-Ray - Four Images, Bitewings$880%$88
X-Ray - Intraoral, Periapical Radiographic Image$380%$38
X-Ray - Two Images, Bitewings$610%$61
X-Ray - Whole Mouth from Outside Mouth$1450%$145