Treatments
COMPOSITE *WHITE+FILLING
One surface – D2391
$180
Two surface – D2392
$230
Three surface – D239
$270
Please be aware many insurances will automatically downgrade you to a silver filling no matter what you or your dentist want to do.
Zirconia Crowns for Front Teeth
Prefabricated Zirconia Crown – D2929
$389
Simple Extractions (Most Baby Teeth)
Simple Extraction – D7140
$185
Nitrous oxide (Laughing Gas)
Nitrous Oxide – D9230
$110
Stainless Steel Crowns
Stainless Steel Crown for Primary (Baby) Tooth – D2930
$260
Stainless Steel Crown for Permanent Tooth – D2931
$332
Pulpotomy (Baby Root Canal)
Pulpotomy – D3220
$160
Silver Diamine Fluoride (SDF)
SDF, Caries Arresting Medicament – D1354
$50
Anesthesia (15 minute increments)
D9222 – Anesthesia / Sedation First 15 Minutes
$200
D9223 – Anesthesia / Sedation Each Additional 15 minutes
$175
Services
Exams
Limited or Problem Focused Exam – D0140
$60
Comprehensive Oral Evaluation – D0150
$60
Periodic oral evaluation (Check up) – D0120
$70
Consultation for Dental Treatment under Anesthesia – D9310
$150
Cleanings
Children’s Prophy – D1120
$80
Adult’s Prophy (13 years and up) – D1110
$86
Fluoride Treatments
Fluoride Varnish – D1206
$30
Fluoride Treatment other than Varnish – D1208
$30
Radiographs (X rays)
Intraoral Full Mouth Images – D0210
$140
Bitewing: 2 Images – D0272
$36
Bitewing: 4 Images – D0274
$50
Occlusal Image -D0240
$28
1st Periapical – D0220
$22
Additional Periapicals – D0230
$16
Sealants
Sealant – D1351
$62
Need Help?
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