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Unlimited cleanings at $95 Each

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Codes

Procedure

Standard Fee

Member Fee

D2330

1 surface anterior composite

$220

$135

D2331

2 surface anterior composite

$235

$165

D2332

3 surface anterior composite

$255

$190

D2391

1 surface posterior composite

$220

$135

D2392

2 surface posterior composite

$235

$165

D2393

3 surface posterior composite

$255

$190

Codes

Procedure

Standard Fee

Member Fee

D2740

All Porcelain

$1,300

$975

D2750

Porcelain fused to metal

$1,100

$875

D2950/ D2954

Core build up/ Post and Core

$190/ $225

FREE

Codes

Procedure

Standard Fee

Member Fee

D3310

Anterior root canal

$906

$680

D3320

Porcelain fused to metal

$1,040

$780

D3330

Core build up/Post and Core

$1,300

$980

Codes

Procedure

Standard Fee

Member Fee

D7140

Simple extraction

$225

$170

D7210

Surgical extraction

$275

$200

D7230

Impacted wisdom tooth

$350

$275

Codes

Procedure

Standard Fee

Member Fee

D4355

Full-mouth debridement

$225

$170

D4341

Deep cleaning (per quadrant)

$250

$187

D4342

Deep cleaning 1 – 3 teeth

$180

$135

Peridex antibiotic irrigation and rinse

$25

FREE

Codes

Procedure

Standard Fee

Member Fee

D6110/ D6120

Complete dentures (each)

$1,300

$975

D6211/ D6212

Acrylic partial (each)

$1,200

$935

D6213/ D6214

Cast frame partial (each)

$1,550

$1,140

D6225/ D6226

Flexible partial (each)

$1,550

$1,140

Digital X-Rays

Exams

Fluoride

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