Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1200%$120 Medium
Dental Cleaning - Child$860%$86 Medium
Dental Exam - Comprehensive$1030%$103 Medium
Dental Exam - Periodic, Established Patient$580%$58 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2130%$213 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3450%$345 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2780%$278 Medium
Dental Filling - White (Resin): One Surface, Anterior$2000%$200 Medium
Dental Filling - White (Resin): One Surface, Posterior$2130%$213 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3450%$345 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2400%$240 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2780%$278 Medium
Flouride - Topical Varnish Application$700%$70 Medium
Fluoride - Topical Application$430%$43 Medium
Maintenance Therapy - Periodontal$1800%$180 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3030%$303 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$1060%$106 Medium
Root Canal - Anterior Tooth$1,0040%$1,004 Medium
Root Canal - Bicuspid Tooth$1,2310%$1,231 Medium
Root Canal - Molar$1,5260%$1,526 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$670%$67 Medium
Tooth Extraction - Elevation and/or Forceps Removal$2270%$227 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$340%$34 Medium
X-Ray - Complete Intraoral Series$2340%$234 Medium
X-Ray - Four Images, Bitewings$820%$82 Medium
X-Ray - Intraoral, Periapical Radiographic Image$430%$43 Medium
X-Ray - Two Images, Bitewings$580%$58 Medium
X-Ray - Whole Mouth from Outside Mouth$1520%$152 Medium