Dental Procedures
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ProcedureEstimate of Total Cost Number of Visits What You Will Pay Uninsured Discount: 0%
Dental Cleaning - Adult$103N/A$103
Dental Cleaning - Child$83N/A$83
Dental Exam - Comprehensive$89N/A$89
Dental Exam - Periodic, Established Patient$49N/A$49
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$186N/A$186
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$236N/A$236
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$259N/A$259
Dental Filling - White (Resin): One Surface, Anterior$137N/A$137
Dental Filling - White (Resin): One Surface, Posterior$158N/A$158
Dental Filling - White (Resin): Three Surfaces, Posterior$473N/A$473
Dental Filling - White (Resin): Two Surfaces, Anterior$326N/A$326
Dental Filling - White (Resin): Two Surfaces, Posterior$298N/A$298
Flouride - Topical Varnish Application$35N/A$35
Fluoride - Topical Application$43N/A$43
Maintenance Therapy - Periodontal$149N/A$149
Oral Hygiene Instructions$38N/A$38
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$272N/A$272
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$87N/A$87
Root Canal - Anterior Tooth$843N/A$843
Sealant - Placed on Tooth Surface to Prevent Decay$57N/A$57
Tooth Extraction - Elevation and/or Forceps Removal$163N/A$163
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$26N/A$26
X-Ray - Complete Intraoral Series$144N/A$144
X-Ray - Four Images, Bitewings$70N/A$70
X-Ray - Intraoral, Periapical Radiographic Image$26N/A$26
X-Ray - Two Images, Bitewings$50N/A$50
X-Ray - Whole Mouth from Outside Mouth$127N/A$127