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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 $39 $70 45%
0140 Exam - Limited $56 $102 45%
0145 Oral Examination under 3 $57 $103 45%
0150 Comprehensive Exam $61/td> $111 45%
Preventative      
0210 Full Mouth X-Ray $116 $178 35%
0220-0230 Single X-Ray $19 $38 50%
0270-0274 Bitewings $42 $84 50%
0330 Panoramic X-ray $81 $161 50%
1110 Basic Cleaning – Adult $71 $119 40%
1110 Basic Cleaning – Teen $60 $100 40%
1120 Basic Cleaning – Child $59 $90 35%
1206 Fluoride Treatment $23 $42 45%
1351 Sealant – Per Tooth $38 $69 45%
Restorations (Fillings)      
Composite Fillings – Anterior      
2330 1 Surface $168 $224 25%
12331 2 Surface $201 $268 25%
2332 3 Surface $243 $324 25%
2335 4 Surface $311 $389 20%
Composite Fillings – Posterior      
2391 1 Surface $186 $248 25%
2392 2 Surface $237 $316 25%
2393 3 Surface $263 $405 35%
2394 4 Surface $315 $485 35%
Inlay/Onlay Restorations      
Porcelain Inlay      
2610 1 Surface $1079 $1396 20%
2620 2 Surface $1116 $1396 20%
2630 3+ Surface $1188 $1485 20%
Porcelain/Ceramic/CEREC Onlay      
2642 2 Surface $1198 $1410 15%
2643 3 Surface $1231 $1449 15%
2644 4 + Surface $1298 $1527 15%
Service Plan Fee Usual Fee Savings
Crown/Single Restorations      
2740 Crown – Porcelain/Ceramic $1072 $1340 20%
2740 Crown – CEREC $1072 $1340 20%
2750 Crown – Porcelain/High Noble $1137 $1338 15%
2790 Crown – Full Cast High Noble $1227 $1443 15%
2920 Replacement Perm Crown $106 $141 25%
2929 Porcelain Crown/Primary Tooth $358 $447 20%
2930 PreFab Stainless – Primary $242 $322 25%
2933 Stainless Steel Crown/Resin Window $339 $424 20%
2950 Core Buildup, Including Pins $180 $327 45%
2954 PreFab Post & Core-Per Tooth $234 $426 45%
2962 Porcelain Veneer $1206 $1507 20%
Implant Restorations      
6052 Precision Attachment $520 $578 10%
6056 Prefabricated Abutment $698 $776 10%
6057 Custom Implant Abutment $833 $926 10%
6059 Abutment Supported PFM $1513 $1681 10%
6061 Abutment Supported All Porc. $1513 $1681 10%
Endodontics
3220 Therapeutic Pulpotomy $227 $252 10%
3221 Pulpal Debridement $249 $277 10%
3310 Root Canal – Anterior $833 $925 10%
3320 Root Canal – Bicuspid $941 $1046 10%
3330 Root Canal – Molar $1152 $1280 10%
Periodontics      
4342 Scaling/Root Planing
1-3 Teeth Per Quadrant
$174 $218 20%
4341 Scaling/Root Planing
4 or more Teeth Per Quadrant
$216 $308 30%
4355 Full Mouth Debridement $161 $214 25%
4910 Periodontal Maintenance $139 $174 20%
4381 Arestin – Minocycline HCI $102 $113 10%
Service Plan Fee Usual Fee Savings
Dentures and Partials      
5110 Complete Denture (Upper) $1511 $1889 20%
5120 Complete Denture (Lower) $1511 $1889 20%
5130 Immediate Denture (Upper) $1675 $2094 20%
5140 Immediate Denture (Lower) $1675 $2094 20%
5211 Partial Denture Acrylic (Upper) $1214 $1428 15%
5212 Partial Denture Acrylic (Lower) $1250 $1471 15%
5213 Partial Denture Metal (Upper) $1748 $2057 15%
5214 Partial Denture Metal (Lower) $1748 $2057 15%
5511-5512 Repair Denture - Broken Base $259 $324 20%
5520 Repair Tooth $235 $294 20%
5611-5612 Repair Partial Acrylic $251 $295 15%
5640 Repair Partial Tooth $251 $295 15%
5850 Tissue Conditioning (Upper) $166 $237 30%
5851 Tissue Conditioning (Lower) $166 $237 30%
Adjustments to Dentures      
5650 Add Tooth to Existing Partial $250 $294 15%
5750-5751 Reline Denture,
In Lab, Per Arch
$415 $593 30%
5760-5761 Reline Partial,
In Lab, Per Arch
$368 $525 30%
5820-5821 Interim Partial Denture,
Per Arch
$493 $616 20%
Fixed Bridge Work      
6210 Maryland Bridge Pontic $1168 $1374 15%
6240 Porcelain/Metal Pontic $1168 $1374 15%
6545 Maryland Bridge Abutment $745 $876 15%
6750 Porcelain/Metal Abutment $1178 $1386 15%
6930 Recement Fixed Bridge $176 $207 15%
Extractions      
7111 Primary Tooth Remnant Coronal $98 $163 40%
7140 Extraction Erupted Tooth $144 $205 30%
7210 Surgical Removal - Erupted Tooth $297 $330 10%
Miscellaneous      
1510 Space Maintainer (Unilateral) $309 $386 20%
1516-1517 Space Maintainer
(Fixed Bilateral) Upper & Lower
$442 $552 20%
9110 Palliative Treatment $97 $176 45%
9230 Nitrous $63 $90 30%
9940 Occlusal Guard (Hard/Soft) $466 $583 20%
Teeth Whitening Procedures      
9975 Whitening Take Home $221 $368 40%
       

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
Oral Surgery      
4266 Guided Tissue Regeneration $232 $258 10%
6010 Single Implant $1871 $2079 10%
6104 Bone Graft at time of Implant $552 $613 10%
7140 Erupted Extraction $185 $205 10%
7210 Surgical Extraction $297 $330 10%
7220 Soft Tissue Impaction $369 $410 10%
7230 Partial Bony Impaction $460 $511 10%
7240 Full Bony Impaction $554 $616 10%
7241 Fully Bony – Complicated $643 $714 10%
7280 Surgical Access of Tooth $606 $673 10%
7283 Placement of Device
to Facilitate Eruption
$489 $543 10%
7286 Biopsy of Oral Soft Tissue $437 $486 10%
7310 Alveoplasty 4+ Teeth per Quadrant $349 $388 10%
7311 Alveoplasty 1-3 Teeth per Quadrant $313 $348 10%
7951 Sinus Lift $1724 $1916 10%
7953 Bone Graft for Ridge Preservation $552 $613 10%
9222-9223 General Anesthetic
(15 minutes)
$246 $273 10%
9310 Consultation $161 $179 10%
9610 Therapeutic Parenteral Drug $69 $77 10%
       

Please note, fees are subject to change