| Periodic oral examination |
$30 |
| Limited oral evaluation - problem focused |
$48 |
| Comprehensive oral evaluation |
$48 |
| Intraoral - complete series (including bitewings) |
$95 |
| Intraoral - periapical - first film |
$18 |
| Intraoral - periapical - each additional film |
$16 |
| Intraoral - occlusal film |
$24 |
| Extraoral - single film |
$30 |
| Extraoral - each additional film |
$26 |
| Bitewing - single film |
$17 |
| Bitewing - two films |
$28 |
| Bitewing - four films |
$42 |
| Panoramic film |
$76 |
| Pulp vitality tests |
$32 |
| Diagnostic casts |
$70 |
| Preventative Dental Care |
National Average |
| Prophylaxis - adult |
$64 |
| Prophylaxis - child |
$44 |
| Topical application of fluoride (prophylaxis not included) -child |
$24 |
| Sealant - per tooth |
$36 |
| Space maintainer-fixed- unilateral |
$223 |
| Space maintainer-fixed- bilateral |
$366 |
| Space maintainer - removable - unilateral |
$353 |
| Restorative Dental Care |
National Average |
| Amalgam - one surface, primary |
$72 |
| Amalgam - two surfaces, primary |
$91 |
| Amalgam - three surfaces, primary |
$109 |
| Amalgam - one surface, permanent |
$83 |
| Amalgam - two surfaces, permanent |
$103 |
| Amalgam - three surfaces, permanent |
$126 |
| Resin - one surface, anterior |
$101 |
| Resin - two surfaces, anterior |
$127 |
| Resin - three surfaces, anterior |
$152 |
| Resin - one surface, posterior - primary |
$90 |
| Resin - two surfaces, posterior - primary |
$113 |
| Resin - three surfaces, posterior - primary |
$131 |
| Resin - one surface, posterior - permanent |
$109 |
| Resin - two surfaces, posterior - permanent |
$146 |
| Resin - three surfaces, posterior - permanent |
$179 |
| Crown - resin (laboratory) |
$328 |
| Crown - porcelain fused to high noble metal |
$821 |
| Crown - porcelain fused to predominantly base metal |
$703 |
| Crown - porcelain fused to noble metal |
$754 |
| Crown - full cast high noble metal |
$776 |
| Crown - 3/4 cast metal |
$830 |
| Recement crown |
$64 |
| Prefabricated stainless steel crown - primary tooth |
$175 |
| Prefabricated stainless steel crown - permanent tooth |
$188 |
| Sedative filling |
$66 |
| Pin retention - per tooth, in addition to restoration |
$31 |
| Cast post and core in addition to crown |
$277 |
| Prefabricated post and core in addition to crown |
$228 |
| Temporary crown (fractured tooth) |
$156 |
| Endodontics |
National Average |
| Pulp cap - direct (excluding final restoration) |
$38 |
| Pulp cap - indirect (excluding final restoration) |
$33 |
| Therapeutic pulpotomy (excluding final restoration) |
$91 |
| Anterior (excluding final restoration) |
$417 |
| Bicuspid (excluding final restoration) |
$498 |
| Molar (excluding final restoration) |
$648 |
| Periodontics |
National Average |
| Gingivectomy - per quadrant |
$343 |
| Gingivectomy - per tooth |
$110 |
| Mucogingival surgery - per quad |
$482 |
| Osseous surgery (including flap entry and closure) - per quadrant |
$826 |
| Periodontal scaling and root planing - per quadrant |
$167 |
| Periodontal maintenance procedures (following active therapy) |
$102 |
| Dentures - Removable |
National Average |
| Complete denture - maxillary |
$899 |
| Complete denture - mandibular |
$862 |
| Immediate denture - maxillary |
$968 |
| Immediate denture - mandibular |
$937 |
| Maxillary partial denture - resin base (including any conventional clasps, rests, and teeth) |
$617 |
| Mandibular partial denture - resin base (including any conventional clasps, rests, and teeth) |
$695 |
| Maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests, and teeth) |
$1,021 |
| Mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests, and teeth) |
$1,015 |
| Adjust complete denture - maxillary |
$50 |
| Adjust complete denture - mandibular |
$48 |
| Adjust partial denture - maxillary |
$53 |
| Adjust partial denture - mandibular |
$50 |
| Oral Surgery |
National Average |
| Single tooth |
$94 |
| Each additional tooth |
$85 |
| Root removal - exposed roots |
$120 |
| Surgical removal of erupted tooth requiring elevation of flap and removal of bone/or section of tooth |
$179 |
| Removal of impacted tooth - soft tissue |
$218 |
| Removal of impacted tooth - partially bony |
$284 |
| Removal of impacted tooth - completely bony |
$331 |
| Surgical removal of residual tooth roots (cutting procedure) |
$185 |
| Surgical exposure of unerupted tooth with ortho attachments |
$397 |
| Alveoplasty in conjunction with extractions - per quadrant |
$156 |
| Orthodontics |
National Average |
| Comprehensive orthodontic treatment - adolescents |
$4,200 |
| Comprehensive orthodontic treatment - adults |
$4,200 |
| Consultation |
$0 |
| Diagnostic workup |
$0 |
