Office Fees
Preventative Dental Care
Cleaning, Exam, Full Series of X-Rays, Fluoride (D0150)
$0-$396
Certain PPO plans may cover 100%
Dental Exams
$47-$78
Periodic Exam (D0120) $47
Comprehensive Exam (D0150) $76
Limited Exam (D0140) $78
Emergency Exam
$0-142
Certain PPO plans may cover 100%
Dental Cleanings (Prophylaxis)
$74-$92
Child Teeth Cleaning (D1120) $74
Adult Teeth Cleaning (D1110) $92
Dental X-Rays
$31-$395
PA (D0220): $33
Addt'l PAs (D0230): $31
1 BWX (D0270): $33
2 BWX (D0272): $52
4 BWX (D0274): $74
Panoramic X-Ray (D0330): $124
CT (D0367): $395
Dental Sealants (D1351)
$49
Fluoride (D1206)
$30
Posterior Composite (White) Fillings
$190-$385
1 surface — $190
2 surface — $241
3 surface — $300
4 surface — $349
5 surface — $385
Certain PPO plans may cover up to 80%
Anterior Composite (White) Fillings
$171-$385
1 surface —$171
2 surface — $211
3 surface — $260
4 surface — $323
5 surface —$385
Certain PPO plans may cover up to 50-80%
Periodontal Maintenance (D4910)
$149
Certain PPO plans may cover up to 80%
Restorative Dental Care
Porcelain Crown
$1,285-$1,572
$1,285 (crown only)
$1,572 (Including the build up)
Certain PPO plans cover up to 80%
Scaling & Root Planing
$175 - $270
1-3 Teeth (D4342): $175
Quad (D4341): $270
Root Canals
$897 - $1,384
Anterior (D3310): $897
Bicuspid (D3320): $1,020
Molar (D3330): $1,384
Tooth Extractions
$201-513
Surgical Extraction (D7210): $315
Bone Grafts
$409-$790
With Extraction (D7953): $409
With Implant Placement: (D7950) $790
Dental Implants (D6010/D6056/D6059)
$4208
D6010: $1,999
D6056: $748
D6059: $1,461
Includes 3-D X-ray–certain PPO plans may cover up to 50%
Denture Services
$75 - $1,814
Denture Repair: $75-$300
Denture Reline (D5750 & 5751): $429
Flipper (D5820 & D5821): $500-$1,000
Complete Upper (D5110): $1,727
Complete Lower (D5120): $1,727
Immediate Upper (D5130): $1,794
Immediate Lower (D5140): $1,794
Upper Partial (D5213): $1,814
Lower Partial (D5214): $1,814
Implant-Supported Dentures
$5,500-9,500
2 implant overdenture — $5,500
4 implant overdenture — $9,500
Includes all costs except sedation and tooth extractions
Implant-Supported Bridge
$20,000 / arch
Includes 6 implants per arch and all costs except tooth extraction
Sinus Augmentation
$850 - $2,500
Sinus Bump (D7952): $850
Sinus Lift (D7951): $2,500
Cosmetic Dental
Take-Home Whitening (Custom Trays)
$299
Take-Home Whitening (GO Whitening Package)
$75
Porcelain Veneers
$1,285
Additional Services
Orthodontics (D8090)
$2,500-5,200
Certain PPO plans may cover up to 50%
Nitrous Sedation
$152
Oral Conscious Sedation
$350
IV Sedation
$0-588
Certain PPO plans may cover up to 100%
Full Arch Occlusal Guard (D9944)
$500
Sleep Apnea Appliance
$2,060