Office Fees
Preventative Care
Cleaning, Exam, Full Series of X-Rays, Fluoride
$0- $450
D0150
Certain PPO plans may cover 100%
Emergency Exam
$121
Certain PPO plans may cover 100%
Dental Exams
$79- $138
Periodic Exam (D0120) – $79- $115
Comprehensive Exam (D0150) – $123- $138
Limited Exam (D0140) — $103- $116
Dental Cleanings (Prophylaxis)
$90 – $136
Child Teeth Cleaning(D1120) – $90- $99
Adult Teeth Cleaning (D1110) – $121- $136
Dental X-Rays
$39 - $456
PA (D0220) — $39- 45
Additional PAs ( D0230) — $34- 39
1 BWX (D0270) — $38 - 44
2 BWX (D0272) —$61- 68
4 BWX (D0274) — $85- 94
Panoramic X-Ray (D0330) —$ 149- $167
CT( D0367) — $426 - $456
Dental Sealants
$73 - $79
(D1351)
Fluoride
$25
(D1206)
Posterior Composite (White) Fillings
$239 - $
1 surface (D2391) — $267- $239
2 surface (D2392) — $304 - $339
3 surface (D2393) — $379 - $412
4 surface (D2394) — $442- $487
5 surface (D2394.1) — $
Certain PPO plans may cover up to 80%
Anterior Composite (White) Fillings
$222 - $
1 surface (D2330) —$222 - $249
2 surface (D2331) — $265 - $296
3 surface (D2332) — $328 - $364
4 surface (D2335) — $413 - $454
Periodontal Maintenance
$179- $196
(D4910)
Certain PPO plans may cover up to 80%
Restorative Dental Services
Porcelain Crown
$351 - $1,575
Including the build up (D2950) —$351- $ 394
Crown only (D2740.1) — $1,447- $ 1,575
Certain PPO plans cover up to 80%
Scaling & Root Planing
$255 - $361
1-3 Teeth (D4342) — $ 255- $ 279
Quad (D4341) — $340 - $361
Root Canals
$965 - $1,513
Anterior (D3310) — $965- $1,095
Bicuspid (D3320) — $ 1,108- $1,246
Molar (D3330) — $1,349 - $1,513
Tooth Extractions
$373 - $414
Surgical Extraction (D7210) —$ 373 - $414
Bone Grafts
$400 - $3,673
With Extraction (D7953) — $400 - $ 932
With Implant Placement (D7950) — $ 3,423 - $ 3,673
Dental Implants
$1,159 - $ 2,595
(D6010/D6056/D6059)
Implant Fixture (D6010) - $2,452 - $ 2,595
Abutment (D6057) — $1,159 - $ 1,222
Implant Crown (D6058) — $1,761 - $ 1,866
Includes 3-D X-ray–certain PPO plans may cover up to 50%
Denture Services
$75 - $ 2,738
Denture Repair — $75-$300
Denture Reline (D5750 & 5751) — $673 - 614
Flipper (D5820 & D5821) — $500-$1,000
Complete Upper (D5110) — $2,334 - $ 2,565
Complete Lower (D5120) — $2,354 - $ 2,567
Immediate Upper (D5130) $2,452- $2,718
Immediate Lower D5140) — $2,457 - $ 2,738
Upper Partial (D5213) — $2,403 - $ 2,651
Lower Partial Overdenture (D5214) — $ 2,403 - $2,667
Implant Supported Denture
$10,000 - $15,000
2 implant overdenture — $10,000
4 implant overdenture — $15,000
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
$2,452 - $3,889
Sinus Bump (D7952) — $2,452 - $ 2,801
Sinus Lift (D7951) — $2,654 – $ 3,889
Cosmetic Dental Services
Take Home Whitening (Custom Trays)
$350
Upper — $175
Lower — $175
Take Home Whitening (Glo Whitening Package
$300
In-Office Whitening
$500
Porcelain Veneers
$1,447 - $ 1,575
(D2740)
Additional Dental Services
Orthodontics
$5,500 - $6,418
D8090
Certain PPO plans may cover up to 50%
Nitrous Sedation
$39 - $121
(D9230)
IV Sedation
$650 - $800
Certain PPO plans may cover up to 100%
Oral Conscious Sedation
$300 - $450
(D9248)
Full Arch Occlusal Guard
$747- $833
(D9944)
Sleep Apnea Appliance
$5,775
Certain PPO plans may cover up to 100%