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% |
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% |
Please note, fees are subject to change
