SERVICE        ITEM CODE       FEE

EXAMINATION & X-RAYS

Comprehensive Examination with X-rays…………..……………..011, 022, 022……….$130
Limited Examination with x-rays………………………………….……….013, 022………………..$55

PREVENTION AND WHITENING

Detailed periodontal examination………………………………………..221…………………………$50
Clean and polish by dentist, first visit………………………………….114, 121…………………..$130
Clean and polish by dentist, second visit if required……..115, 121…..………………$100
Professional home teeth whitening………………(119, 926)x2, 927……………………….$320

TOOTH EXTRACTIONS

Simple Extraction each tooth……………………..…….311……………………..…..……………………..$160
Complex Extraction each tooth….……………………314, 322, 323, 324…….………………$250

ROOT CANAL TREATMENT

Emergency pulp dressing…………………………………419………………………………………………..$210
Front teeth……………………………………………………………….415, 417 , 572……………………………..$700
Premolar Teeth……………………………………………………….415, 416, 417, 418, 572…………….$750 to $900
Molar Teeth………………………………………………………………415, 416×2, 417, 418×2 , 572…..$1,100.00

FILLINGS FRONT TEETH

One, Two, Three, Four, Five surface…………………521, 522,523, 524, 525………….$140 to $260

FILLINGS BACK TEETH

One, Two, Three, Four, or Five surface……………531, 532, 533, 534, 535…………$150 to $270

CROWNS & VENEERS

Ceramic Crowns………………………………………………………613……………………………………………$1,300
Gold Crowns……………………………………………………………..614……………………………………………$1,300
Veneers Indirect (Porcelain)……………………………….556………………………………………….$1,000
Veneers Direct (Composite)……………………………….526……………………………………………$350

DENTURES

Plastic (Acrylic) Full arch……………………………………….711 or 71………………………………….$1,400
Plastic (Acrylic) Partial, per arch…………………………721 or 722, 731’s 733’………….$750 to $1250
Metal (Cobalt Chrome) Partial, per arch…………727 or 728, 733’s…………………$1300 to $1800
Flexible Denture …………………………………………………………………………………………………………$900 to $1400

IMPLANTS AND RESTORATION OF IMPLANTS

Placing of implant with surgical guide
Clinical consultation required before price determined………………………..$1500 to $2000
Restoration of implant with crown
Clinical consultation required before price determined………………………..$2000 to $3000

DENTAL SPLINTS FOR TMJ DYSFUNCTION

Single arch normally upper…………………………………………………………….965……………………………$500

ANTI SNORING / SLEEP APNEA PREVENTION

Double arch appliance (adjustable)……………………………………………984……………………………$1,300