| DIAGNOSTIC AND PREVENTATIVE |
|
| Office Visit |
$75.00 |
3 |
| Emergency Office Visit |
90 |
10 |
| Infection Control |
|
30% OFF |
|
X-Ray, Intraoral Pericapical, each
|
10 |
1 |
| X-Ray, Bitewings, each |
10 |
1 |
| X-Ray, Panoramic Film |
125 |
20 |
| X-Ray, Complete Series, Full Mouth |
150 |
25 |
| Routine Cleaning (incl. polishing & routine scaling) |
95 |
21 |
|
Sealant, per tooth
|
65 |
17 |
Comprehensive Oral Evaluation
|
|
95
|
20
|
| FILLINGS, CROWNS, AND BRIDGES |
|
| Silver Filling (Amalgam) primary or permanent |
|
|
1 Surface |
105 |
28 |
|
2 Surfaces |
155 |
34 |
|
3 Surfaces |
185 |
48 |
|
4 Surfaces |
225 |
65 |
| Tooth-Colored Fillings (Resin-based Composite) Anterior, Posterior, or involving Incisal Angle |
|
|
1 Surface |
150 |
46 |
|
2 Surfaces |
210 |
56 |
|
3 Surfaces |
260 |
90 |
|
4 Surfaces |
310 |
100 |
| Porcelain Crown fused to: |
|
| Non-precious or predominately base metal. |
950 |
353 |
Noble or High Noble metal
|
1200 |
415 |
| Full crown cast noble or High Noble metal |
1200 |
383 |
| Full crown cast nonprecious metal. |
1200 |
310 |
| Core Buildup, including any pins |
230 |
90 |
| Prefab Crown, Provisional or permanent |
225 |
90 |
| Fixed Bridge (Crown/Pontic Priced Per Unit) |
|
|
|
|
| ENDODONTICS (Root Canals, etc) |
|
| Pulp Cap - Direct |
75 |
18 |
| Pulp Cap - Indirect |
75 |
18 |
| Root Canal (excluding final restoration) |
|
|
|
Anterior |
600 |
185 |
|
Bicuspid |
750 |
235 |
|
Molar |
900 |
305 |
| |
|
|
| TOOTH REMOVAL/EXTRACTIONS (Performed by General Dentist) |
|
| Single Tooth, simple extraction, erupted tooth or exposed root |
125 |
35 |
| Impacted Tooth – Soft tissue |
225 |
78 |
| Impacted Tooth – Partially bony |
275 |
85 |
| Impacted Tooth – Completely bony |
350 |
95 |
| Surgical Removal resid. Roots |
225 |
80 |
| PROSTHODONTICS (Dentures, Partials, etc.) |
|
| Upper Full Denture |
1400 |
390 |
| Lower Full Denture |
1400 |
390 |
| Immediate Denture |
1200 |
370 |
| Upper partial |
1400 |
390 |
| Lower partial |
1400 |
390 |
| Flexible Partial or Complete |
|
30% OFF |
| Repair broken complete denture base |
115 |
45 |
| Replace missing/broken teeth – complete denture (each tooth) |
110 |
40 |
| Lab Cost will be extra |
|
|
| |
|
|
| PERIODONTICS (Performed by a General Dentist) |
|
| Consultation |
75 |
10 |
| Periodontal Scaling and Root Planing 4+ teeth Per Quadrant |
195 |
65 |
| Gingival Curettage 4+ Per Quadrant |
225 |
65 |
| Gingivectomy or Gingioplasy Per Quad |
450 |
200 |
| |
|
|
| ORTHODONTICS |
|
|
| Conventional Braces |
|
25% OFF |
| Cosmetic Braces |
|
25% OFF |
| Any Orthodontic Treatment |
|
25% OFF |
