Dental Cleaning - Adult | $91 | N/A | $91 |
Dental Cleaning - Child | $76 | N/A | $76 |
Dental Exam - Comprehensive | $95 | N/A | $95 |
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent | $181 | N/A | $181 |
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $310 | N/A | $310 |
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $211 | N/A | $211 |
Dental Filling - White (Resin): One Surface, Anterior | $166 | N/A | $166 |
Dental Filling - White (Resin): One Surface, Posterior | $194 | N/A | $194 |
Dental Filling - White (Resin): Three Surfaces, Posterior | $308 | N/A | $308 |
Dental Filling - White (Resin): Two Surfaces, Anterior | $207 | N/A | $207 |
Dental Filling - White (Resin): Two Surfaces, Posterior | $238 | N/A | $238 |
Flouride - Topical Varnish Application | $44 | N/A | $44 |
Fluoride - Topical Application | $47 | N/A | $47 |
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $87 | N/A | $87 |
Root Canal - Anterior Tooth | $772 | N/A | $772 |
Root Canal - Bicuspid Tooth | $919 | N/A | $919 |
Sealant - Placed on Tooth Surface to Prevent Decay | $61 | N/A | $61 |
Tooth Extraction - Elevation and/or Forceps Removal | $184 | N/A | $184 |
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $26 | N/A | $26 |
X-Ray - Four Images, Bitewings | $71 | N/A | $71 |
X-Ray - Intraoral, Periapical Radiographic Image | $32 | N/A | $32 |
X-Ray - Two Images, Bitewings | $56 | N/A | $56 |
X-Ray - Whole Mouth from Outside Mouth | $126 | N/A | $126 |