| Office
Visit |
Office Visit
|
$5 |
| Diagonstic
Care |
Oral Exams
|
No Charge |
X-rays
|
No Charge |
| Preventive
Care |
Prophylaxis - adult
& child
|
No Charge1 |
Topical Fluoride -
child
|
No Charge |
| Restorative
Care |
Filling - Permanent 1
surface amalgam
|
$54 |
Filling - Permanent 2
surfaces amalgam
|
$64 |
Filling - Permanent 3
surfaces amalgam
|
$75 |
Filling - Permanent 4
or more surfaces amalgam
|
$89 |
| Cosmetic
Care |
Labial
Veneer(laminate)-chairside
|
$187 |
Resin Filling -
permanent,one surface, posterior
|
$75 |
| Endodontic
Care |
Pulpotomy
|
$62 |
Root Canal - Anterior
|
$289 |
Root Canal - Bicuspid
|
$341 |
Root Canal - Molar
|
$459 |
| Periodontal
Care |
Gingivectomy - per
quadrant
|
$194 |
Gingivectomy - per
tooth
|
$72 |
Osseous Surgery
|
$520 |
Scaling/Root
Planingper quadrant
|
$101 |
| Oral
Surgery |
Extraction - of
erupted toothor expossed root
|
$60 |
Impaction - complete
bony
|
$200 |
Impaction - partial
bony
|
$176 |
Impaction - soft
tissue
|
$136 |
| Prosthodontic
Care |
Complete Upper or
|
$577 |
Crowns
|
$432 |
Denture (broken tooth
repair)
|
$57 |
Partial Denture
|
$430 |
| Orthodontic
Care |
Orthodontics - Adult
|
$3045 |
Orthodontics - Child
|
$2870 |
Retention
|
$210 |
| Other
Services |
Local Anesthesia
|
$14 |
Office Visit After
Hours
|
$56 |
