Office Fees

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%

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

Take-Home Whitening (Custom Trays)

$299

Take-Home Whitening (GO Whitening Package)

$75

Porcelain Veneers

$1,285

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