January 12, 2022
Top 15 Most Frequent Procedures
Cash Price with 10% Cash Discount
ADA 0120 - Periodic Oral Exam - $57.60
ADA 1110 - Adult Prophylaxis (cleaning) - $94.50
ADA 0274 - Four Bitewing X-Rays - $63.00
ADA 0220 - Single Periapical X-Ray - $28.80
ADA 4910 - Periodontal Maintenance Cleaning - $139.50
ADA 2391 - One Surface Posterior (back) Composite (tooth color) Filling - $175.50
ADA 2392 - Two Surface Posterior Composite Filling - $220.50
ADA 0140 - Limited (problem focused) Oral Exam - $76.50
ADA 0210 - Full Mouth X-Ray (18 films) - $135.00
ADA 0150 - Initial (new patient) Oral Exam - $87.30
ADA 1120 - Child Prophylaxis (cleaning) - $58.50
ADA 1351 - Sealant - $54.00
ADA 0230 - Periapical Each Additional Film - $22.50
ADA 2950 - Crown Build Up - $265.50
ADA 2740 - Ceramic Crown - $1170.00
The health care price listed for any given health care service is an estimate. Actual charges for the health care service are dependent on the circumstances, including any complications or exceptional treatment, at the time the service is rendered.
If you are covered by health insurance or a dental plan, you are strongly encouraged to consult with your insurer or plan to determine accurate information about your financial responsibility for a particular health care service provided by a health care provider at this office. If you are not covered by health insurance or a dental plan, you are strongly encouraged to contact our billing office at [insert telephone number] to discuss payment options prior to receiving a health care service from a health care provider at this office since posted health care prices may not reflect the actual amount of your financial responsibility.