Fee Schedule
D0150 Comprehensive Oral Evaluation
D0220 Intraoral Periapical X-ray
D1110 Prophylaxis - Adult
D2330 Resin based composite - One Surface - anterior
D2331 Resin based composite - Two Surfaces - anterior
D2332 Resin based composite - Three Surfaces - anterior
D2391 Resin based composite - One Surface - posterior
D2392 Resin based composite - Two Surfaces - posterior
D2393 Resin based composite - Three Surfaces - posterior
D2751 Crown - Porcelain Fused to Metal
D2920 Recement Crown
D2952 Cast Post and Core in addition to Crown
D3310 Root Canal Anterior (Excluding Final Restoration)
D3320 Root Canal Bicuspid (Excluding Final Restoration)
D3330 Root Canal Molar (Excluding Final Restoration)
D4263 Bone Replacing Bone Graft - First Side
D4341 Periodontal scaling and root planning - Per Quadrant
D5110 Complete Denture - Maxillary
D5120 Complete Denture - Mandibular
D5211 Maxillary Partial Denture
D5212 Mandibular Partial Denture
D6010 Surgical Placement of Endosteal Implant
D6056 Prefabricated abutment - Includes placement
D6060 Abutment Supported PFM Crown
D7140 Exraction, erupted tooth
D7240 Surgical Removal of Impacted Tooth - Wisdom Tooth
D8090 Comprehensive Orthodontic Treatment
​
​
$ 0
$ 0
$ 35
$ 60
$ 70
$ 90
$ 60
$ 70
$ 90
$ 220
$ 20
$ 100
$ 230
$ 240
$ 250
$ 400
$ 50
$ 450
$ 450
$ 450
$ 450
$ 849
$ 0
$ 220
$ 60
$ 150
$1,800