Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1110%$111
Dental Cleaning - Child$890%$89
Dental Exam - Comprehensive$990%$99
Dental Exam - Periodic, Established Patient$540%$54
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2430%$243
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3900%$390
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$3110%$311
Dental Filling - White (Resin): One Surface, Anterior$2230%$223
Dental Filling - White (Resin): One Surface, Posterior$2480%$248
Dental Filling - White (Resin): Three Surfaces, Posterior$3900%$390
Dental Filling - White (Resin): Two Surfaces, Anterior$2690%$269
Dental Filling - White (Resin): Two Surfaces, Posterior$3110%$311
Flouride - Topical Varnish Application$530%$53
Fluoride - Topical Application$530%$53
Maintenance Therapy - Periodontal$1610%$161
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3030%$303
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$970%$97
Root Canal - Anterior Tooth$9830%$983
Root Canal - Molar$1,3920%$1,392
Sealant - Placed on Tooth Surface to Prevent Decay$650%$65
Tooth Extraction - Elevation and/or Forceps Removal$2160%$216
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$320%$32
X-Ray - Complete Intraoral Series$1730%$173
X-Ray - Four Images, Bitewings$820%$82
X-Ray - Intraoral, Periapical Radiographic Image$420%$42
X-Ray - Two Images, Bitewings$600%$60