Dental Cleaning - Adult | $107 | N/A | $107 |
Dental Cleaning - Child | $86 | N/A | $86 |
Dental Exam - Comprehensive | $91 | N/A | $91 |
Dental Exam - Periodic, Established Patient | $51 | N/A | $51 |
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent | $219 | N/A | $219 |
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $385 | N/A | $385 |
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $263 | N/A | $263 |
Dental Filling - White (Resin): One Surface, Anterior | $177 | N/A | $177 |
Dental Filling - White (Resin): One Surface, Posterior | $189 | N/A | $189 |
Dental Filling - White (Resin): Three Surfaces, Posterior | $342 | N/A | $342 |
Dental Filling - White (Resin): Two Surfaces, Anterior | $205 | N/A | $205 |
Dental Filling - White (Resin): Two Surfaces, Posterior | $263 | N/A | $263 |
Flouride - Topical Varnish Application | $43 | N/A | $43 |
Fluoride - Topical Application | $43 | N/A | $43 |
Maintenance Therapy - Periodontal | $153 | N/A | $153 |
Oral Hygiene Instructions | $44 | N/A | $44 |
Orthodontic Treatment - Periodic Visit, Part of a Contract | $118 | N/A | $118 |
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $280 | N/A | $280 |
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $89 | N/A | $89 |
Tooth Extraction - Elevation and/or Forceps Removal | $186 | N/A | $186 |
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $28 | N/A | $28 |
X-Ray - Complete Intraoral Series | $148 | N/A | $148 |
X-Ray - Four Images, Bitewings | $72 | N/A | $72 |
X-Ray - Intraoral, Periapical Radiographic Image | $38 | N/A | $38 |
X-Ray - Two Images, Bitewings | $51 | N/A | $51 |
X-Ray - Whole Mouth from Outside Mouth | $131 | N/A | $131 |