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Fee Scheduling 

General Dental Care – ADA Codes 

Fees valid if performed by General Dentists exclusively at The Dentists’ Office. Rates start at the pricing shown and may differ depending on doctor recommendation.

Service Plan Fee Usual Fee Savings
Evaluations      
0120 Exam-Periodic $37 $68 45%
0140 Exam - Limited $54 $99 45%
0145 Oral Examination under 3 $55 $100 45%
0150 Comprehensive Exam $59 $108 45%
FREE Services/Consultations      
Oral Cancer Screening FREE    
Cosmetic Consultation FREE    
Orthodontic Consultation FREE    
Preventative      
0210 Full Mouth X-Ray $112 $173 35%
0220-0230 Single X-Ray $19 $37 50%
0270-0274 Bitewings $41 $82 50%
0330 Panoramic X-ray $78 $156 50%
1110 Basic Cleaning – Adult $70 $117 40%
1110 Basic Cleaning – Teen $58 $97 40%
1120 Basic Cleaning – Child $57 $87 35%
1206 Fluoride Treatment $23 $41 45%
1351 Sealant – Per Tooth $37 $67 45%
Restorations (Fillings)      
Composite Fillings – Anterior      
2330 1 Surface $164 $218 25%
12331 2 Surface $195 $260 25%
2332 3 Surface $237 $316 25%
2335 4 Surface $302 $378 20%
Composite Fillings – Posterior      
2391 1 Surface $181 $241 25%
2392 2 Surface $230 $307 25%
2393 3 Surface $255 $393 35%
2394 4 Surface $306 $471 35%
Inlay/Onlay Restorations      
Porcelain Inlay      
2610 1 Surface $1049 $1311 20%
2620 2 Surface $1085 $1356 20%
2630 3+ Surface $1155 $1444 20%
Porcelain/Ceramic/CEREC Onlay      
2642 2 Surface $1165 $1371 15%
2643 3 Surface $1198 $1409 15%
2644 4 + Surface $1261 $1484 15%
Service Plan Fee Usual Fee Savings
Crown/Single Restorations      
2740 Crown – Porcelain/Ceramic $1040 $1300 20%
2740 Crown – CEREC $1040 $1300 20%
2750 Crown – Porcelain/High Noble $1040 $1300 15%
2790 Crown – Full Cast High Noble $1192 $1402 15%
2920 Replacement Perm Crown $103 $137 25%
2929 Porcelain Crown/Primary Tooth $346 $433 20%
2930 PreFab Stainless – Primary $236 $314 25%
2933 Stainless Steel Crown/Resin Window $330 $413 20%
2950 Core Buildup, Including Pins $175 $318 45%
2954 PreFab Post & Core-Per Tooth $228 $415 45%
2962 Porcelain Veneer $1171 $1464 20%
Implant Restorations      
6052 Precision Attachment $505 $561 10%
6056 Prefabricated Abutment $679 $754 10%
6057 Custom Implant Abutment $810 $900 10%
6059 Abutment Supported PFM $1469 $1632 10%
6061 Abutment Supported All Porc. $1377 $1530 10%
Endodontics
3220 Therapeutic Pulpotomy $219 $243 10%
3221 Pulpal Debridement $242 $269 10%
3310 Root Canal – Anterior $809 $899 10%
3320 Root Canal – Bicuspid $915 $1017 10%
3330 Root Canal – Molar $1120 $1244 10%
Periodontics      
4342 Scaling/Root Planing
1-3 Teeth Per Quadrant		 $170 $212 20%
4341 Scaling/Root Planing
4 or more Teeth Per Quadrant		 $209 $299 30%
4355 Full Mouth Debridement $156 $208 25%
4910 Periodontal Maintenance $135 $169 20%
4381 Arestin – Minocycline HCI $99 $110 10%
Service Plan Fee Usual Fee Savings
Dentures and Partials      
5110 Complete Denture (Upper) $1469 $1836 20%
5120 Complete Denture (Lower) $1469 $1836 20%
5130 Immediate Denture (Upper) $1628 $2035 20%
5140 Immediate Denture (Lower) $1628 $2035 20%
5211 Partial Denture Acrylic (Upper) $1214 $1428 15%
5212 Partial Denture Acrylic (Lower) $1214 $1428 15%
5213 Partial Denture Metal (Upper) $1699 $1999 15%
5214 Partial Denture Metal (Lower) $1699 $1999 15%
5511-5512 Repair Denture - Broken Base $253 $316 20%
5520 Repair Tooth $229 $286 20%
5611-5612 Repair Partial Acrylic $243 $286 15%
5640 Repair Partial Tooth $243 $286 15%
5850 Tissue Conditioning (Upper) $161 $230 30%
5851 Tissue Conditioning (Lower) $161 $230 30%
Adjustments to Dentures      
5650 Add Tooth to Existing Partial $243 $286 15%
5750-5751 Reline Denture,
In Lab, Per Arch		 $403 $576 30%
5760-5761 Reline Partial,
In Lab, Per Arch		 $357 $510 30%
5820-5821 Interim Partial Denture,
Per Arch		 $478 $598 20%
Fixed Bridge Work      
6210 Maryland Bridge Pontic $1135 $1335 15%
6240 Porcelain/Metal Pontic $1135 $1335 15%
6545 Maryland Bridge Abutment $723 $851 15%
6750 Porcelain/Metal Abutment $1145 $1347 15%
6930 Recement Fixed Bridge $171 $201 15%
Extractions      
7111 Primary Tooth Remnant Coronal $95 $158 40%
7140 Extraction Erupted Tooth $139 $199 30%
7210 Surgical Removal - Erupted Tooth $289 $321 10%
Miscellaneous      
1510 Space Maintainer (Unilateral) $300 $375 20%
1516-1517 Space Maintainer
(Fixed Bilateral) Upper & Lower		 $429 $536 20%
9110 Palliative Treatment $94 $171 45%
9230 Nitrous $64 $92 30%
9940 Occlusal Guard (Hard/Soft) $453 $566 20%
Teeth Whitening Procedures      
9972 Whitening Take Home $214 $357 40%
9972 Whitening In House $229 $286 20%
       
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Specialty Dental Care – ADA Codes 

Fees valid if performed by Dentists exclusively at The Dentists’ Office. Rates start at the pricing shown and may differ depending on doctor recommendation.

Service Plan Fee Usual Fee Savings
Endodontics (*Does not include cost of Restorative Treatment)
*3310 Anterior Root Canal $916 $1018 10%
*3320 Bicuspid Root Canal $1044 $1160 10%
*3330 Molar Root Canal $1198 $1331 10%
*3346 Retreat Anterior Canal $1130 $1255 10%
*3347 Retreat Bicuspid Canal $1365 $1517 10%
*3348 Retreat Molar Canal $1476 $1630 10%
3410 Anterior Apicoectomy $1034 $1149 10%
3421 Bicuspid Apicoectomy $1162 $1291 10%
3425 Molar Apicoectomy $1266 $1407 10%
9310 Consultation $138 $153 10%
*Does not include cost of Restorative Treatment      
Oral Surgery      
6010 Single Implant $1818 $2020 10%
7140 Erupted Extraction $202 $224 10%
7210 Surgical Extraction $326 $362 10%
7220 Soft Tissue Impaction $358 $398 10%
7230 Partial Bony Impaction $446 $496 10%
7240 Full Bony Impaction $538 $598 10%
7241 Fully Bony – Complicated $625 $694 10%
7280 Surgical Access of Tooth $588 $653 10%
7283 Placement of Device
to Facilitate Eruption		 $474 $527 10%
7286 Biopsy of Oral Soft Tissue $425 $472 10%
7953 Bone Graft $536 $595 10%
9222-9223 General Anesthetic
(15 minutes)		 $239 $265 10%
9310 Consultation $157 $174 10%
       
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Please note, fees are subject to change.