Office Fees

Cleaning, Exam, Full Series of X-Rays, Fluoride

$0-$456

Certain PPO plans may cover 100%

Dental Exams

$56 - $93

Periodic Exam (D0120) — $56
Comprehensive Exam (D0150) — $91
Limited Exam (D0140) — $93

Emergency Exam

$126

Certain PPO plans may cover 100%

Dental Cleanings (Prophylaxis)

$89 - $111

Child Teeth Cleaning (D1120) $89
Adult Teeth Cleaning (D1110) $111

Dental X-Rays

$39 - $301

PA (D0220) — $39
Addt'l PAs (D0230) — $37
1 BWX (D0270) — $39
2 BWX (D0272) — $62
4 BWX (D0274) — $89
Panoramic X-Ray (D0330) — $150
CT (D0367) — $301

Dental Sealants (D1351)

$60

Fluoride (D1206)

$35

Posterior Composite (White) Fillings

$230 - $467

1 surface (D2391) — $230
2 surface (D2392) — $293
3 surface (D2393) — $364
4 surface (D2394) — $423
5 surface (D2394.1) — $467

Certain PPO plans may cover up to 80%

Anterior Composite (White) Fillings

$207 - $467

1 surface (D2330) —$207
2 surface (D2331) — $255
3 surface (D2332) — $316
4 surface (D2335) — $392
5 surface (D2335.1) — $467

Certain PPO plans may cover up to 50-80%

Periodontal Maintenance (D4910)

$179

Certain PPO plans may cover up to 80%

Porcelain Crown

$1,596 - $1,937

Crown only (D2740.1) — $1,596
Including the build up (D2950) —$1,937

Certain PPO plans cover up to 80%

Scaling & Root Planing

$210 - $326

1-3 Teeth (D4342) — $210
Quad (D4341) — $326

Root Canals

$1,076 - $1,679

Anterior (D3310) —$1,076
Bicuspid (D3320) — $1,239
Molar (D3330) — $1,679

Tooth Extractions

$382

Surgical Extraction (D7210) —$382

Bone Grafts

$450 - $870

With Extraction (D7953) — $450
With Implant Placement (D7950) — $870

Dental Implants (D6010/D6056/D6059)

$4,638

Implant Fixture (D6010) — $2,410
Abutment (D6057) — $908
Implant Crown (D6058) — $1,775

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

Denture Services

$75 - $2,204

Denture Repair — $75-$300
Denture Reline (D5750 & 5751) — $520
Flipper (D5820 & D5821) — $500-$1,000
Complete Upper (D5110) — $2,099
Complete Lower (D5120) — $2,099
Immediate Upper (D5130) —$2,153
Immediate Lower (D5140) — $2,153
Upper Partial (D5213) — $2,204
Lower Partial (D5214) — $2,204

Implant-Supported Dentures

$6,775 – $10,975

2 implant overdenture — $6,775
4 implant overdenture — $10,975

Includes all costs except sedation and tooth extractions

Implant-Supported Bridge

$22,000 / arch

Includes 6 implants per arch and all costs except tooth extraction

Sinus Augmentation

$937 - $2,756

Sinus Bump (D7952) — $1,029
Sinus Lift (D7951) — $3,038

Take-Home Whitening (Custom Trays)

$368

Upper — $184
Lower — $184

Take-Home Whitening (GO Whitening Package)

$85

Porcelain Veneers (D2740)

$1,559

Orthodontics (D8090)

$5,455

Certain PPO plans may cover up to 50%

Nitrous Sedation (D9230)

$105

Oral Conscious Sedation (D9244)

$405

IV Sedation

Starting at $362

$362 for first 15 minutes + $166 for each additional 15 minutes with a general dentist.

Certain PPO plans may cover up to 100%

Full Arch Occlusal Guard (D9944)

$604

Sleep Apnea Appliance

$2,468