Office Fees

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

$0-$412

Certain PPO plans may cover 100%

Dental Exams

$49-$81

Periodic Exam (D0120) $49
Comprehensive Exam (D0150) $79
Limited Exam (D0140) $81

Emergency Exam

$0-147

Certain PPO plans may cover 100%

Dental Cleanings (Prophylaxis)

$77-$96

Child Teeth Cleaning (D1120) $77
Adult Teeth Cleaning (D1110) $96

Dental X-Rays

$32-$261

PA (D0220): $34
Addt'l PAs (D0230): $32
1 BWX (D0270): $34
2 BWX (D0272): $54
4 BWX (D0274): $77
Panoramic X-Ray (D0330): $130
CT (D0367): $261

Dental Sealants (D1351)

$51

Fluoride (D1206)

$30

Posterior Composite (White) Fillings

$199-$404

1 surface — $199
2 surface — $253
3 surface — $315
4 surface — $366
5 surface — $404

Certain PPO plans may cover up to 80%

Anterior Composite (White) Fillings

$179-$404

1 surface —$179
2 surface — $221
3 surface — $273
4 surface — $339
5 surface —$404

Certain PPO plans may cover up to 50-80%

Periodontal Maintenance (D4910)

$156

Certain PPO plans may cover up to 80%

Porcelain Crown

$1,349-$1,650

$1,349 (crown only)
$1,650 (Including the build up)

Certain PPO plans cover up to 80%

Scaling & Root Planing

$183 - $283

1-3 Teeth (D4342): $183
Quad (D4341): $283

Root Canals

$941 - $1,453

Anterior (D3310): $941
Bicuspid (D3320): $1,071
Molar (D3330): $1,453

Tooth Extractions

$211 - $538

Surgical Extraction (D7210): $330

Bone Grafts

$429 - $829

With Extraction (D7953): $429
With Implant Placement: (D7950) $829

Dental Implants (D6010/D6056/D6059)

$4,417

D6010: $2,098
D6057: $7485
D6058: $1,534

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

Denture Services

$75 - $1,904

Denture Repair: $75-$300
Denture Reline (D5750 & 5751): $450
Flipper (D5820 & D5821): $500-$1,000
Complete Upper (D5110): $1,813
Complete Lower (D5120): $1,813
Immediate Upper (D5130): $1,883
Immediate Lower (D5140): $1,883
Upper Partial (D5213): $1,904
Lower Partial (D5214): $1,904

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

$892 - $2,625

Sinus Bump (D7952): $892
Sinus Lift (D7951): $2,625

Take-Home Whitening (Custom Trays)

$299

Take-Home Whitening (GO Whitening Package)

$75

Porcelain Veneers

$1,380

Orthodontics (D8090)

$2,500-5,200

Certain PPO plans may cover up to 50%

Nitrous Sedation

$99

Oral Conscious Sedation

$365

IV Sedation

$0-750

Certain PPO plans may cover up to 100%

Full Arch Occlusal Guard (D9944)

$500

Sleep Apnea Appliance

$5,775