Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1090%$109
Dental Cleaning - Child$860%$86
Dental Exam - Comprehensive$910%$91
Dental Exam - Periodic, Established Patient$500%$50
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1890%$189
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3420%$342
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2630%$263
Dental Filling - White (Resin): One Surface, Anterior$1730%$173
Dental Filling - White (Resin): One Surface, Posterior$1890%$189
Dental Filling - White (Resin): Three Surfaces, Posterior$3420%$342
Dental Filling - White (Resin): Two Surfaces, Anterior$2140%$214
Dental Filling - White (Resin): Two Surfaces, Posterior$2630%$263
Flouride - Topical Varnish Application$430%$43
Fluoride - Topical Application$430%$43
Maintenance Therapy - Periodontal$1530%$153
Orthodontic Treatment - Periodic Visit, Part of a Contract$1430%$143
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2750%$275
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$950%$95
Root Canal - Bicuspid Tooth$1,0290%$1,029
Sealant - Placed on Tooth Surface to Prevent Decay$590%$59
Tooth Extraction - Elevation and/or Forceps Removal$2040%$204
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$280%$28
X-Ray - Complete Intraoral Series$1500%$150
X-Ray - Four Images, Bitewings$720%$72
X-Ray - Intraoral, Periapical Radiographic Image$350%$35
X-Ray - Two Images, Bitewings$510%$51
X-Ray - Whole Mouth from Outside Mouth$1370%$137