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
¿Necesitas ayuda con el pago? Los pacientes pueden conseguir ayuda a través de una compañía de financiamiento externa, CareCredit.