Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$870%$87
Dental Cleaning - Child$920%$92
Dental Exam - Comprehensive$1050%$105
Dental Exam - Periodic, Established Patient$420%$42
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1550%$155
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3260%$326
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2590%$259
Dental Filling - White (Resin): One Surface, Anterior$1650%$165
Dental Filling - White (Resin): One Surface, Posterior$2030%$203
Dental Filling - White (Resin): Three Surfaces, Posterior$3680%$368
Dental Filling - White (Resin): Two Surfaces, Anterior$2020%$202
Dental Filling - White (Resin): Two Surfaces, Posterior$2590%$259
Fluoride - Topical Application$410%$41
Maintenance Therapy - Periodontal$1270%$127
Orthodontic Treatment - Periodic Visit, Part of a Contract$1550%$155
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3940%$394
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$970%$97
Sealant - Placed on Tooth Surface to Prevent Decay$600%$60
Tooth Extraction - Elevation and/or Forceps Removal$1840%$184
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$230%$23
X-Ray - Complete Intraoral Series$1930%$193
X-Ray - Four Images, Bitewings$600%$60
X-Ray - Intraoral, Periapical Radiographic Image$360%$36
X-Ray - Two Images, Bitewings$530%$53
X-Ray - Whole Mouth from Outside Mouth$1390%$139