| GENERAL
DENTISTRY |
Average Fee
Range |
Member
Fees |
| Office Visit |
$45-75 |
$3 |
| Infection Control |
|
30% OFF |
| Emergency Office
Visit |
50-75 |
3 |
| Single Peri-Apical
X-Ray |
35-50 |
1 |
| Bite Wing X-Ray |
5-10 |
1 |
| Each Additional
X-Ray |
5-10 |
1 |
| Panoramic X-Ray |
65-85 |
12 |
| Routine Cleaning
(includes polishing & routine scaling) |
50-90 |
21 |
| Topical Fluoride |
10-15 |
1 |
| Silver Filling (Amalgam): |
1 Surface |
65-100 |
18 |
|
2 Surfaces |
100-125 |
24 |
|
3 Surfaces |
125-175 |
32 |
| Tooth-Colored
Fillings add $35-$75 per tooth |
|
|
| Cosmetic Bonding |
125-300 |
70-150 |
| Full Crown (all
non-precious metal) |
500-750 |
240 |
| Porcelain Crown
Fused to Non-precious |
750-1200 |
353 |
| Buildup or Post |
|
30% OFF |
| Gold Crown |
700-1000 |
350 |
| Fixed Bridge
(Crown Priced Per Unit) Diagnostic Models |
30-55 |
6 |
| |
|
|
| ENDODONTICS |
|
|
| Pulp Cap - Direct |
$25-45 |
$13 |
| Pulp Cap -
Indirect |
55-75 |
13 |
| Root Canals: |
RCT 1 Canal |
550-950 |
158 |
|
RCT 2 Canals |
650-950 |
198 |
|
RCT 3 Canals |
750-1050 |
228 |
|
RCT 4 Canals |
850-1050 |
258 |
| |
|
|
| SIMPLE
EXTRACTIONS |
|
|
| Single Tooth |
$50-75 |
$18 |
| Each Additional
Tooth |
50-75 |
16 |
| Simple Surgical
Extractions |
120-180 |
35 |
| Impacted Tooth |
150-200 |
78 |
| |
|
|
| PROSTHETICS
(Dentures & Partials) |
|
|
| Complete |
|
|
|
Upper Denture |
$675-950 |
$298 |
|
Lower Denture |
675-950 |
298 |
| Partial |
|
|
|
Upper Denture |
675-850 |
175 |
|
Lower Denture |
675-850 |
175 |
| Missed
appointments without 24 hours notice |
|
15 |
| Lab costs will be
extra |
|
|
| |
|
|
| PERIODONTICS |
|
|
| Consultation |
|
$5 |
| Periodontal
Scaling and Root Planing Per Quadrant |
$120-150 |
65 |
| Gingival Curettage
Per Quadrant |
125-175 |
60 |
| Gingivectomy Per
Quadrant |
425-475 |
200 |
| |
|
|
| Periodontic
charges are for usual and customary service. Periodontic
fees only when performed by a General Dentist. Any services
performed by a specialist will be at a 25% reduction. Any
other periodontal treatment or services will be at an additional
charge. Discuss all fees with your Dentist prior to
treatment. |
| |
|
|
| ORTHODONTICS
(Braces) |
|
|
| Conventional
Braces |
|
25% OFF |
| Cosmetic Braces |
|
25% OFF |
| Any Orthodontic
Treatment |
|
25% OFF |
| |
|
|
| Orthodontics
- Orthodontic Fees listed are customary services. Any
orthodontic treatment that requires surgery, head-gear, maxillary
expansion or unusual or ancillary services will have an additional
charge. At the orthodontic consultation appointment, the
orthodontist will explain the length of treatment, all fees and
payment schedule. Orthodontic services are on a space
available basis only and not available to any person that is
currently in treatment. Lost or broken appliances will be an
additional charge.
Any treatment provided by a
participating advanced degree specialist in endodontics,
implantology, pedodontics, periodontics, and oral surgery will be
charged at a 25% reduction of participating specialist standard
fees.
General Dentistry not listed
available at a 30% discount. Discuss all fees with Dentist
prior to any treatment.
Prices are subject to change
without notice. |
