Dental Cleaning - Adult | $114 | N/A | $114 |
Dental Cleaning - Child | $81 | N/A | $81 |
Dental Exam - Comprehensive | $97 | N/A | $97 |
Dental Exam - Periodic, Established Patient | $56 | N/A | $56 |
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent | $205 | N/A | $205 |
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $324 | N/A | $324 |
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $261 | N/A | $261 |
Dental Filling - White (Resin): One Surface, Anterior | $191 | N/A | $191 |
Dental Filling - White (Resin): Three Surfaces, Posterior | $324 | N/A | $324 |
Dental Filling - White (Resin): Two Surfaces, Anterior | $232 | N/A | $232 |
Flouride - Topical Varnish Application | $49 | N/A | $49 |
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $288 | N/A | $288 |
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $83 | N/A | $83 |
Root Canal - Anterior Tooth | $843 | N/A | $843 |
Root Canal - Bicuspid Tooth | $962 | N/A | $962 |
Sealant - Placed on Tooth Surface to Prevent Decay | $64 | N/A | $64 |
Tooth Extraction - Elevation and/or Forceps Removal | $202 | N/A | $202 |
X-Ray - Complete Intraoral Series | $224 | N/A | $224 |
X-Ray - Four Images, Bitewings | $74 | N/A | $74 |
X-Ray - Intraoral, Periapical Radiographic Image | $34 | N/A | $34 |
X-Ray - Whole Mouth from Outside Mouth | $150 | N/A | $150 |