Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1230%$123
Dental Cleaning - Child$880%$88
Dental Exam - Comprehensive$1060%$106
Dental Exam - Periodic, Established Patient$600%$60
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2190%$219
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3450%$345
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2870%$287
Dental Filling - White (Resin): One Surface, Anterior$1870%$187
Dental Filling - White (Resin): One Surface, Posterior$2190%$219
Dental Filling - White (Resin): Three Surfaces, Posterior$3560%$356
Dental Filling - White (Resin): Two Surfaces, Anterior$2480%$248
Dental Filling - White (Resin): Two Surfaces, Posterior$2870%$287
Flouride - Topical Varnish Application$420%$42
Fluoride - Topical Application$450%$45
Maintenance Therapy - Periodontal$1850%$185
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3130%$313
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$1090%$109
Root Canal - Anterior Tooth$1,0660%$1,066
Root Canal - Bicuspid Tooth$1,2670%$1,267
Root Canal - Molar$1,5720%$1,572
Sealant - Placed on Tooth Surface to Prevent Decay$690%$69
Tooth Extraction - Elevation and/or Forceps Removal$2330%$233
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$350%$35
X-Ray - Complete Intraoral Series$2020%$202
X-Ray - Four Images, Bitewings$840%$84
X-Ray - Intraoral, Periapical Radiographic Image$440%$44
X-Ray - Two Images, Bitewings$610%$61
X-Ray - Whole Mouth from Outside Mouth$1560%$156