Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$870%$87 Medium
Dental Cleaning - Child$870%$87 Medium
Dental Exam - Comprehensive$1050%$105 Medium
Dental Exam - Periodic, Established Patient$420%$42 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1550%$155 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3260%$326 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2590%$259 Medium
Dental Filling - White (Resin): One Surface, Anterior$1650%$165 Medium
Dental Filling - White (Resin): One Surface, Posterior$2030%$203 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3680%$368 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2020%$202 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2590%$259 Medium
Fluoride - Topical Application$370%$37 Medium
Maintenance Therapy - Periodontal$1270%$127 Medium
Orthodontic Treatment - Periodic Visit, Part of a Contract$1550%$155 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3350%$335 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$970%$97 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$600%$60 Medium
Tooth Extraction - Elevation and/or Forceps Removal$1840%$184 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$300%$30 Medium
X-Ray - Complete Intraoral Series$1640%$164 Medium
X-Ray - Four Images, Bitewings$600%$60 Medium
X-Ray - Intraoral, Periapical Radiographic Image$360%$36 Medium
X-Ray - Two Images, Bitewings$430%$43 Medium
X-Ray - Whole Mouth from Outside Mouth$1390%$139 Medium