Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1040%$104 Medium
Dental Cleaning - Child$840%$84 Medium
Dental Exam - Comprehensive$900%$90 Medium
Dental Exam - Periodic, Established Patient$490%$49 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1880%$188 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3400%$340 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2610%$261 Medium
Dental Filling - White (Resin): One Surface, Anterior$1690%$169 Medium
Dental Filling - White (Resin): One Surface, Posterior$1890%$189 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3400%$340 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2020%$202 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2610%$261 Medium
Flouride - Topical Varnish Application$410%$41 Medium
Fluoride - Topical Application$430%$43 Medium
Maintenance Therapy - Periodontal$1500%$150 Medium
Orthodontic Treatment - Periodic Visit, Part of a Contract$1480%$148 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2750%$275 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$950%$95 Medium
Root Canal - Anterior Tooth$9240%$924 Medium
Root Canal - Bicuspid Tooth$1,0290%$1,029 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$580%$58 Medium
Tooth Extraction - Elevation and/or Forceps Removal$1830%$183 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$270%$27 Medium
X-Ray - Complete Intraoral Series$1460%$146 Medium
X-Ray - Four Images, Bitewings$710%$71 Medium
X-Ray - Intraoral, Periapical Radiographic Image$340%$34 Medium
X-Ray - Two Images, Bitewings$500%$50 Medium
X-Ray - Whole Mouth from Outside Mouth$1370%$137 Medium