| GENERAL
DENTISTRY |
Average
Fee Range |
Member
Fees |
| Office
Visit |
$45-75 |
$3 |
| Infection
Control |
|
30% OFF |
| Emergency
Office Visit |
50-75 |
3 |
| Single
Peri-Apical X-Ray |
35-50 |
1 |
| Bite
Wing X-Ray |
5-10 |
1 |
| Each
Additional X-Ray |
5-10 |
1 |
| Panoramic
X-Ray |
65-85 |
12 |
| Routine
Cleaning (includes polishing & routine
scaling) |
50-90 |
16 |
| Topical
Fluoride |
10-15 |
1 |
| Silver
Filling (Amalgam): |
1 Surface |
65-100 |
18 |
|
2 Surfaces |
100-125 |
24 |
|
3 Surfaces |
125-175 |
32 |
| Tooth-Colored
Fillings add $35-$75 per tooth |
|
|
| Cosmetic
Bonding |
125-300 |
70-150 |
| Full
Crown (all non-precious metal) |
500-750 |
240 |
| Porcelain
Crown Fused to Non-precious |
750-1200 |
303 |
| Buildup
or Post |
|
30% OFF |
| Gold
Crown |
700-1000 |
350 |
| Fixed
Bridge (Crown Priced Per Unit) Diagnostic
Models |
30-55 |
6 |
| |
|
|
| ENDODONTICS |
|
|
| Pulp
Cap - Direct |
$25-45 |
$13 |
| Pulp
Cap - Indirect |
55-75 |
13 |
| Root Canals: |
RCT 1
Canal |
550-950 |
108 |
|
RCT 2
Canals |
650-950 |
148 |
|
RCT 3
Canals |
750-1050 |
198 |
|
RCT 4
Canals |
850-1050 |
228 |
| |
|
|
| SIMPLE
EXTRACTIONS |
|
|
| Single
Tooth |
$50-75 |
$18 |
| Each
Additional Tooth |
50-75 |
16 |
| Simple
Surgical Extractions |
120-180 |
35 |
| Impacted
Tooth |
150-200 |
78 |
| |
|
|
| PROSTHETICS
(Dentures & Partials) |
|
|
| Complete |
|
|
|
Upper Denture |
$675-950 |
$298 |
|
Lower Denture |
675-950 |
298 |
| Partial |
|
|
|
Upper Denture |
675-850 |
175 |
|
Lower Denture |
675-850 |
175 |
| Missed
appointments without 24 hours notice |
|
15 |
| Lab
costs will be extra |
|
|
| |
|
|
| PERIODONTICS |
|
|
| Consultation |
|
$5 |
| Periodontal
Scaling and Root Planing Per Quadrant |
$120-150 |
65 |
| Gingival
Curettage Per Quadrant |
125-175 |
60 |
| Gingivectomy
Per Quadrant |
425-475 |
200 |
| |
|
|
| Periodontic
charges are for usual and customary service.
Periodontic fees only when performed by a
General Dentist. Any services performed
by a specialist will be at a 25% reduction.
Any other periodontal treatment or services
will be at an additional charge. Discuss
all fees with your Dentist prior to treatment. |
| |
|
|
| ORTHODONTICS
(Braces) |
|
|
| Conventional
Braces |
|
25% OFF |
| Cosmetic
Braces |
|
25% OFF |
| Any
Orthodontic Treatment |
|
25% OFF |
| |
|
|
| Orthodontics
- Orthodontic Fees listed are customary services.
Any orthodontic treatment that requires surgery,
head-gear, maxillary expansion or unusual
or ancillary services will have an additional
charge. At the orthodontic consultation
appointment, the orthodontist will explain
the length of treatment, all fees and payment
schedule. Orthodontic services are on
a space available basis only and not available
to any person that is currently in treatment.
Lost or broken appliances will be an additional
charge. Any
treatment provided by a participating advanced
degree specialist in endodontics, implantology,
pedodontics, periodontics, and oral surgery
will be charged at a 25% reduction of participating
specialist standard fees.
General
Dentistry not listed available at a 30%
discount. Discuss all fees with Dentist
prior to any treatment.
Prices
are subject to change without notice. |
