Premier Family Dental Care
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Dental Cleaning - Adult | $113 | 0% | $113 | Medium |
| Dental Exam - Periodic, Established Patient | $59 | 0% | $59 | Medium |
| Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $231 | 0% | $231 | Medium |
| Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $162 | 0% | $162 | Medium |
| Dental Filling - White (Resin): One Surface, Anterior | $231 | 0% | $231 | Medium |
| Dental Filling - White (Resin): One Surface, Posterior | $201 | 0% | $201 | Medium |
| Maintenance Therapy - Periodontal | $163 | 0% | $163 | Medium |
| Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $331 | 0% | $331 | Medium |
| Tooth Extraction - Elevation and/or Forceps Removal | $315 | 0% | $315 | Medium |
| X-Ray - Complete Intraoral Series | $247 | 0% | $247 | Medium |
| X-Ray - Four Images, Bitewings | $84 | 0% | $84 | Medium |
| X-Ray - Intraoral, Periapical Radiographic Image | $44 | 0% | $44 | Medium |
