Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1030%$103
Dental Cleaning - Child$830%$83
Dental Exam - Comprehensive$890%$89
Dental Exam - Periodic, Established Patient$490%$49
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1860%$186
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3370%$337
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2590%$259
Dental Filling - White (Resin): One Surface, Anterior$1370%$137
Dental Filling - White (Resin): One Surface, Posterior$1580%$158
Dental Filling - White (Resin): Three Surfaces, Posterior$4730%$473
Dental Filling - White (Resin): Two Surfaces, Anterior$1630%$163
Dental Filling - White (Resin): Two Surfaces, Posterior$3520%$352
Flouride - Topical Varnish Application$350%$35
Fluoride - Topical Application$430%$43
Maintenance Therapy - Periodontal$1490%$149
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2720%$272
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$680%$68
Root Canal - Anterior Tooth$8430%$843
Root Canal - Bicuspid Tooth$9610%$961
Root Canal - Molar$1,1550%$1,155
Sealant - Placed on Tooth Surface to Prevent Decay$570%$57
Tooth Extraction - Elevation and/or Forceps Removal$1630%$163
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$260%$26
X-Ray - Complete Intraoral Series$1440%$144
X-Ray - Four Images, Bitewings$700%$70
X-Ray - Intraoral, Periapical Radiographic Image$260%$26
X-Ray - Two Images, Bitewings$420%$42
X-Ray - Whole Mouth from Outside Mouth$1270%$127