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 $36 $65 45%
0140 Exam - Limited $53 $97 45%
0145 Oral Examination under 3 $52 $95 45%
0150 Comprehensive Exam $58 $105 45%
FREE Services/Consultations      
Oral Cancer Screening FREE    
Cosmetic Consultation FREE    
Orthodontic Consultation FREE    
Preventative      
0210 Full Mouth X-Ray $111 $170 35%
0220-0230 Single X-Ray $18 $36 50%
0270-0274 Bitewings $40 $80 50%
0330 Panoramic X-ray $77 $153 50%
1110 Basic Cleaning – Adult $68 $114 40%
1110 Basic Cleaning – Teen $56 $94 40%
1120 Basic Cleaning – Child $55 $84 35%
1206 Fluoride Treatment $21 $38 45%
1351 Sealant – Per Tooth $36 $66 45%
Restorations (Fillings)      
Composite Fillings – Anterior      
2330 1 Surface $161 $214 25%
12331 2 Surface $191 $255 25%
2332 3 Surface $233 $310 25%
2335 4 Surface $297 $371 20%
Composite Fillings – Posterior      
2391 1 Surface $177 $236 25%
2392 2 Surface $226 $301 25%
2393 3 Surface $250 $385 35%
2394 4 Surface $300 $462 35%
Inlay/Onlay Restorations      
Porcelain Inlay      
2610 1 Surface $1028 $1285 20%
2620 2 Surface $1063 $1329 20%
2630 3+ Surface $1133 $1416 20%
Porcelain/Ceramic/CEREC Onlay      
2642 2 Surface $1142 $1344 15%
2643 3 Surface $1174 $1381 15%
2644 4 + Surface $1237 $1455 15%
Service Plan Fee Usual Fee Savings
Crown/Single Restorations      
2740 Crown – Porcelain/Ceramic $1000 $1250 20%
2740 Crown – CEREC $1000 $1250 20%
2750 Crown – Porcelain/High Noble $1063 $1250 15%
2790 Crown – Full Cast High Noble $1143 $1345 15%
2920 Replacement Perm Crown $98 $131 25%
2929 Porcelain Crown/Primary Tooth $329 $411 20%
2930 PreFab Stainless – Primary $231 $308 25%
2933 Stainless Steel Crown/Resin Window $324 $405 20%
2950 Core Buildup, Including Pins $171 $311 45%
2954 PreFab Post & Core-Per Tooth $224 $407 45%
2962 Porcelain Veneer $1040 $1300 20%
Implant Restorations      
6052 Precision Attachment $495 $550 10%
6056 Prefabricated Abutment $653 $725 10%
6057 Custom Implant Abutment $779 $865 10%
6059 Abutment Supported PFM $1425 $1583 10%
6068 Abutment Supp. All Ceramic Ret. Fixed $1332 $1480 10%
Endodontics
3220 Therapeutic Pulpotomy $209 $232 10%
3221 Pulpal Debridement $231 $257 10%
3310 Root Canal – Anterior $792 $880 10%
3320 Root Canal – Bicuspid $897 $997 10%
3330 Root Canal – Molar $1094 $1215 10%
Periodontics      
4342 Scaling/Root Planing
1-3 Teeth Per Quadrant
$158 $198 20%
4341 Scaling/Root Planing
4 or more Teeth Per Quadrant
$205 $293 30%
4355 Full Mouth Debridement $153 $204 25%
4910 Periodontal Maintenance $133 $166 20%
4381 Arestin – Minocycline HCI $97 $108 10%
Service Plan Fee Usual Fee Savings
Dentures and Partials      
5110 Complete Denture (Upper) $1424 $1780 20%
5120 Complete Denture (Lower) $1424 $1780 20%
5130 Immediate Denture (Upper) $1552 $1940 20%
5140 Immediate Denture (Lower) $1552 $1940 20%
5211 Partial Denture Acrylic (Upper) $1177 $1385 15%
5212 Partial Denture Acrylic (Lower) $1177 $1385 15%
5213 Partial Denture Metal (Upper) $1632 $1920 15%
5214 Partial Denture Metal (Lower) $1632 $1920 15%
5511-5512 Repair Denture - Broken Base $248 $310 20%
5520 Repair Tooth $224 $280 20%
5611-5612 Repair Partial Acrylic $238 $280 15%
5640 Repair Partial Tooth $238 $280 15%
5850 Tissue Conditioning (Upper) $158 $225 30%
5851 Tissue Conditioning (Lower) $158 $225 30%
Adjustments to Dentures      
5650 Add Tooth to Existing Partial $238 $280 15%
5750-5751 Reline Denture,
In Lab, Per Arch
$396 $565 30%
5760-5761 Reline Partial,
In Lab, Per Arch
$350 $500 30%
5820-5821 Interim Partial Denture,
Per Arch
$464 $580 20%
Fixed Bridge Work      
6210 Maryland Bridge Pontic $1106 $1301 15%
6240 Porcelain/Metal Pontic $1113 $1309 15%
6545 Maryland Bridge Abutment $709 $834 15%
6750 Porcelain/Metal Abutment $1123 $1321 15%
6930 Recement Fixed Bridge $167 $196 15%
Extractions      
7111 Primary Tooth Remnant Coronal $93 $155 40%
7140 Extraction Erupted Tooth $134 $191 30%
7210 Surgical Removal - Erupted Tooth $284 $315 10%
Miscellaneous      
1510 Space Maintainer (Unilateral) $290 $363 20%
1515 Space Maintainer (Bilateral) $420 $525 20%
9110 Palliative Treatment $92 $168 45%
9230 Nitrous $60 $85 30%
9940 Occlusal Guard (Hard/Soft) $444 $555 20%
Teeth Whitening Procedures      
9972 Whitening Take Home $210 $350 40%
9972 Whitening In House $224 $280 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 $897 $997 10%
*3320 Bicuspid Root Canal $1023 $1137 10%
*3330 Molar Root Canal $1170 $1300 10%
*3346 Retreat Anterior Canal $1103 $1225 10%
*3347 Retreat Bicuspid Canal $1338 $1487 10%
*3348 Retreat Molar Canal $1438 $1598 10%
3410 Anterior Apicoectomy $963 $1070 10%
3421 Bicuspid Apicoectomy $1139 $1266 10%
3425 Molar Apicoectomy $1241 $1379 10%
9310 Consultation $135 $150 10%
*Does not include cost of Restorative Treatment      
Oral Surgery      
6010 Single Implant $1782 $1980 10%
7140 Erupted Extraction $194 $216 10%
7210 Surgical Extraction $315 $350 10%
7220 Soft Tissue Impaction $342 $380 10%
7230 Partial Bony Impaction $433 $481 10%
7240 Full Bony Impaction $512 $569 10%
7241 Fully Bony – Complicated $590 $656 10%
7280 Surgical Access of Tooth $527 $585 10%
7283 Placement of Device
to Facilitate Eruption
$465 $517 10%
7286 Biopsy of Oral Soft Tissue $394 $438 10%
7953 Bone Graft $525 $583 10%
9222-9223 General Anesthetic
(15 minutes)
$234 $260 10%
9310 Consultation $154 $171 10%
       
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Please note, fees are subject to change.