Office Fees

Cleaning, Exam, Full Series of X-Rays, Fluoride (D0150)

$0 - $412

Certain PPO plans may cover 100%

Dental Exams

$53 - $89

Periodic Exam (D0120) — $53
Comprehensive Exam (D0150) — $87
Limited Exam (D0140) — $89

Emergency Exam

$121

Certain PPO plans may cover 100%

Dental Cleanings (Prophylaxis)

$85 - $106

Child Teeth Cleaning (D1120) $85
Adult Teeth Cleaning (D1110) $106

Dental X-Rays

$37 - $287

PA (D0220) — $37
Addt'l PAs (D0230) — $35
1 BWX (D0270) — $37
2 BWX (D0272) — $59
4 BWX (D0274) — $84
Panoramic X-Ray (D0330) — $143
CT (D0367) — $287

Dental Sealants (D1351)

$55

Fluoride (D1206)

$35

Posterior Composite (White) Fillings

$219 - $445

1 surface (D2391) — $219
2 surface (D2392) — $279
3 surface (D2393) — $347
4 surface (D2394) — $403
5 surface (D2394.1) — $445

Certain PPO plans may cover up to 80%

Anterior Composite (White) Fillings

$197 - $445

1 surface (D2330) —$197
2 surface (D2331) — $243
3 surface (D2332) — $301
4 surface (D2335) — $373
5 surface (D2335.1) — $445

Certain PPO plans may cover up to 50-80%

Periodontal Maintenance (D4910)

$170

Certain PPO plans may cover up to 80%

Porcelain Crown

$1,485 - $1,810

Crown only (D2740.1) — $1,485
Including the build up (D2950) —$1,810

Certain PPO plans cover up to 80%

Scaling & Root Planing

$200 - $310

1-3 Teeth (D4342) — $200
Quad (D4341) — $310

Root Canals

$1,025 - $1,529

Anterior (D3310) —$1,025
Bicuspid (D3320) — $1,180
Molar (D3330) — $1,529

Tooth Extractions

$230 - $593

Surgical Extraction (D7210) —$364

Bone Grafts

$450 - $870

With Extraction (D7953) — $450
With Implant Placement (D7950) — $870

Dental Implants (D6010/D6056/D6059)

$4,638

Implant Fixture (D6010) — $2,203
Abutment (D6057) — $824
Implant Crown (D6058) — $1,611

Includes 3-D X-ray–certain PPO plans may cover up to 50%

Denture Services

$75 - $2,099

Denture Repair — $75-$300
Denture Reline (D5750 & 5751) — $495
Flipper (D5820 & D5821) — $500-$1,000
Complete Upper (D5110) — $1,999
Complete Lower (D5120) — $1,999
Immediate Upper (D5130) —$2,050
Immediate Lower (D5140) — $2,050
Upper Partial (D5213) — $2,099
Lower Partial (D5214) — $2,099

Implant-Supported Dentures

$5,775 - $9,975

2 implant overdenture — $5,775
4 implant overdenture — $9,975

Includes all costs except sedation and tooth extractions

Implant-Supported Bridge

$21,000 / arch

Includes 6 implants per arch and all costs except tooth extraction

Sinus Augmentation

$937 - $2,756

Sinus Bump (D7952) — $937
Sinus Lift (D7951) — $2,756

Take-Home Whitening (Custom Trays)

$350

Upper — $175
Lower — $175

Take-Home Whitening (GO Whitening Package)

$80

Porcelain Veneers (D2740)

$1,485

Orthodontics (D8090)

$2,500 - $5,195

Certain PPO plans may cover up to 50%

Nitrous Sedation (D9230)

$99

Oral Conscious Sedation (D9248)

$385

IV Sedation

Starting at $300

$300 for first 15 minutes + $100 for each additional 15 minutes with a general dentist.

Certain PPO plans may cover up to 100%

Full Arch Occlusal Guard (D9944)

$575

Sleep Apnea Appliance

$2,350