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303 Merrick Rd, Lynbrook, NY 11563
844-638-3368
Fee Schedule
The prices listed are the total cost for the according procedure. There are no surprise costs
CODE | PROCEDURE | WHAT YOU'LL PAY WITH METRODENT | TYPICAL CHARGE (WITHOUT METRODENT) | SAVINGS |
|---|---|---|---|---|
D0140 | LIMITED ORAL EVALUATION | $24.00 | $101.00 | $77.00 |
D0145 | ORAL EVAL FOR PATIENT UNDER 3 YRS | $24.00 | $92.00 | $68.00 |
D0145 | ORAL EVAL PT<3 YR CNSL PRIM CAREGIVER | $24.00 | $92.00 | $68.00 |
D0150 | COMPREHENSIVE ORAL EXAMINATION | $30.00 | $120.00 | $90.00 |
D0160 | DETAILED ORAL EVALUATION | $30.00 | $207.00 | $177.00 |
D0170 | RE-EVALUATION-LIMITED | $25.00 | $93.00 | $68.00 |
D0180 | COMPREHENSIVE PERIODONTAL EVAL | $30.00 | $128.00 | $98.00 |
D0210 | X-RAYS-FULL MOUTH | $60.00 | $187.00 | $127.00 |
D0220 | PERIAPICAL X-RAY FIRST FILM | $10.00 | $41.00 | $31.00 |
D0230 | X-RAY PERIAPICAL - ADDITIONAL | $6.00 | $35.00 | $29.00 |
D0240 | OCCLUSAL FILM | $15.00 | $57.00 | $42.00 |
D0250 | XRAY - EXTRAORAL | $35.00 | $87.00 | $52.00 |
D0260 | EXTRAORAL-EACH ADDITIONAL | $25.00 | $0.00 | '- |
D0270 | X-RAY 1 BITEWING | $10.00 | $41.00 | $31.00 |
D0272 | X-RAYS 2 BITEWINGS | $16.00 | $64.00 | $48.00 |
D0273 | X-RAYS 3 BITEWINGS | $22.00 | $77.00 | $55.00 |
D0274 | X-RAYS 4 BITEWINGS | $28.00 | $92.00 | $64.00 |
D0277 | VERTICAL BITEWINGS 7-8 FILMS | $35.00 | $136.00 | $101.00 |
D0290 | X-RAY ANT. POST. OR LATERAL | $40.00 | $181.00 | $141.00 |
D0310 | SIALOGRAPHY | $50.00 | $495.00 | $445.00 |
D0320 | TMJ FILM | $200.00 | $793.00 | $593.00 |
D0321 | TMJ FILM | $80.00 | $278.00 | $198.00 |
D0322 | TOMOGRAPHIC SURVEY | $175.00 | $678.00 | $503.00 |
D0330 | PANORAMIC FILM | $50.00 | $160.00 | $110.00 |
D0340 | CEPHALOMETRIC FILM | $50.00 | $169.00 | $119.00 |
D0350 | ORAL/FACIAL IMAGES | $25.00 | $100.00 | $75.00 |
D0364 | CONE BEAM CT CAPTURE-LESS THAN WHOLE JAW | $200.00 | $427.00 | $227.00 |
D0365 | CONE BEAM CT - MANDIBLE | $200.00 | $460.00 | $260.00 |
D0366 | CONE BEAM CT | $200.00 | $440.00 | $240.00 |
D0367 | CONE BEAM CT - WITH OR WITHOUT CRANIUM | $200.00 | $467.00 | $267.00 |
D0368 | CONE BEAM CT CAPTURE AND INTER | $200.00 | $510.00 | $310.00 |
D0380 | CONE BEAM CT | $200.00 | $366.00 | $166.00 |
D0381 | CONE BEAM CT IMAGE | $200.00 | $423.00 | $223.00 |
D0382 | CONE BEAM CT IMAGE CAPTURE WITH FIELD OF VIEW OF O | $200.00 | $408.00 | $208.00 |
D0383 | CONE BEAM CT | $200.00 | $440.00 | $240.00 |
D0415 | BACTERIOLOGIC STUDIES | $25.00 | $232.00 | $207.00 |
D0431 | ADJUNCTIVE PRE-DIAGNOSTIC TEST | $35.00 | $93.00 | $58.00 |
D0460 | PULP VITALITY TEST | $20.00 | $80.00 | $60.00 |
D0470 | DIAGNOSTIC CASTS | $40.00 | $153.00 | $113.00 |
D0472 | ACCESSION TISSUE, EXM, PREP, REP | $40.00 | $163.00 | $123.00 |
D0473 | ACCESSION TISSUE-MICRO EXAM | $60.00 | $221.00 | $161.00 |
D0474 | ACCESSION OF TISSUE, GROSS AND MICROSCOPIC EXAMINA | $40.00 | $259.00 | $219.00 |
D0502 | OTHER ORAL PATHOLOGY PROCEDURES, BY REPORT | $40.00 | $176.00 | $136.00 |
D1110 | PROPHYLAXIS | $45.00 | $101.00 | $56.00 |
D1120 | PROPHYLAXIS - CHILD | $35.00 | $73.00 | $38.00 |
D1206 | TOPICAL FLUORIDE VARNISH | $20.00 | $48.00 | $28.00 |
D1208 | TOPICAL APPLICATION FLUORIDE | $20.00 | $42.00 | $22.00 |
D1310 | NUTRITIONAL COUNSELING | $15.00 | $74.00 | $59.00 |
D1320 | TOBACCO COUNSELING | $15.00 | $82.00 | $67.00 |
D1351 | SEALANT | $25.00 | $61.00 | $36.00 |
D1352 | PREVENTIVE RESIN RESTORATION | $25.00 | $113.00 | $88.00 |
D1510 | SPACE MAINTAINER-FIXED | $190.00 | $442.00 | $252.00 |
D1516 | SPACE MAINTAINER - FIXED - BILATERAL, MAXILLARY | $225.00 | $0.00 | '- |
D1517 | SPACE MAINTAINER - FIXED - BILATERAL, MANDIBULAR | $225.00 | $0.00 | '- |
D1520 | SPACE MAINTAINER - REMOVABLE | $185.00 | $534.00 | $349.00 |
D1526 | SPACE MAINTAINER - REMOVABLE - BILATERAL, MAXILLAR | $250.00 | $0.00 | '- |
D1527 | SPACE MAINTAINER - REMOVABLE - BILATERAL, MANDIBULAR | $250.00 | $0.00 | '- |
D1551 | RE-CEMENT OR RE-BOND BILATERAL SPACE MAINTAINER | $40.00 | $0.00 | '- |
D1552 | RE-CEMENT OR RE-BOND BILATERAL SPACE MAINTAINER | $40.00 | $0.00 | '- |
D1553 | RE-CEMENT OR RE-BOND UNILATERAL SPACE MAINTAINER | $40.00 | $0.00 | '- |
D2140 | AMALGAM ONE SURFACE - PERMANENT OR PRIMARY | $55.00 | $200.00 | $145.00 |
D2150 | AMALGAM TWO SURFACES - PERMANENT OR PRIMARY | $70.00 | $251.00 | $181.00 |
D2160 | AMALGAM THREE SURFACES - PERM OR PRIME | $80.00 | $307.00 | $227.00 |
D2161 | AMALGAM - FOUR OR MORE SURFACES PERM OR PRIM | $95.00 | $363.00 | $268.00 |
D2330 | RESIN - ONE SURFACE | $60.00 | $236.00 | $176.00 |
D2331 | RESIN - TWO SURFACES | $75.00 | $262.00 | $187.00 |
D2332 | RESIN THREE OR MORE SURFACES | $90.00 | $307.00 | $217.00 |
D2335 | RESIN - 4+ SRF OR INCISAL EDGE | $100.00 | $400.00 | $300.00 |
D2390 | RESIN BASED COMPOSITE CROWN | $200.00 | $630.00 | $430.00 |
D2391 | RESIN 1 SURFACE POSTERIOR | $75.00 | $258.00 | $183.00 |
D2392 | RESIN-2 SURFACES, POSTERIOR | $100.00 | $331.00 | $231.00 |
D2393 | RESIN-3 SURFACES, POST | $115.00 | $406.00 | $291.00 |
D2394 | RESIN-4 OR MORE SRF-POST | $125.00 | $487.00 | $362.00 |
D2410 | GOLD FOIL - 1 SURF. | $200.00 | $871.00 | $671.00 |
D2420 | GOLD FOIL - 2 SURF. | $275.00 | $1,013.00 | $738.00 |
D2430 | GOLD FOIL - 3 SURF. | $325.00 | $1,126.00 | $801.00 |
D2510 | INLAY-METALLIC - ONE SURFACE | $275.00 | $1,178.00 | $903.00 |
D2520 | INLAY METALLIC - TWO SURFACES | $350.00 | $1,268.00 | $918.00 |
D2530 | INLAY-METALLIC - THREE OR MORE S | $375.00 | $1,350.00 | $975.00 |
D2542 | ONLAY-METALLIC 2 SURFACE | $400.00 | $1,393.00 | $993.00 |
D2543 | ONLAY-METALLIC 3 SURFACE | $450.00 | $1,468.00 | $1,018.00 |
D2544 | ONLAY-METALLIC 4+ SURFACE | $475.00 | $1,532.00 | $1,057.00 |
D2610 | INLAY-PORCELAIN 1 SURFACE | $350.00 | $1,272.00 | $922.00 |
D2620 | INLAY-PORCELAIN 2 SURFACES | $425.00 | $1,333.00 | $908.00 |
D2630 | INLAY-PORCELAIN-3 OR MORE SURF | $500.00 | $1,401.00 | $901.00 |
D2642 | ONLAY-PORCELAIN/CERAMIC 2 SURFACE | $400.00 | $1,433.00 | $1,033.00 |
D2643 | ONLAY - PORCELAIN/CERAMIC 3 SURFACE | $500.00 | $1,488.00 | $988.00 |
D2644 | ONLAY - PORCELAIN/CERAMIC - FOUR OR MORE SURFACES | $500.00 | $1,545.00 | $1,045.00 |
D2650 | INLAY-COMPOSITE-ONE SURFACE | $200.00 | $1,182.00 | $982.00 |
D2651 | INLAY COMPOSITE 2 SRF | $250.00 | $1,221.00 | $971.00 |
D2652 | INLAY COMPOSITE 3 SRF | $300.00 | $1,285.00 | $985.00 |
D2662 | ONLAY - RESIN-BASED COMPOSITE - TWO SURFACES | $300.00 | $1,302.00 | $1,002.00 |
D2663 | ONLAY - COMPOSITE 3 SURFACE | $350.00 | $1,364.00 | $1,014.00 |
D2664 | ONLAY - COMPOSITE 4 OR MORE SRF | $400.00 | $1,417.00 | $1,017.00 |
D2710 | CROWN - RESIN (LABORATORY) | $200.00 | $1,288.00 | $1,088.00 |
D2712 | CROWN - 3/4 RESIN BASED COMP-IND | $200.00 | $1,396.00 | $1,196.00 |
D2720 | CROWN - RESIN WITH METAL | $500.00 | $1,488.00 | $988.00 |
D2721 | CROWN - RESIN WITH BASE METAL | $450.00 | $1,412.00 | $962.00 |
D2722 | CROWN - RESIN WITH NOBLE METAL | $475.00 | $1,457.00 | $982.00 |
D2740 | CROWN - PORCELAIN/CERAMIC SUBSTRATE | $550.00 | $1,606.00 | $1,056.00 |
D2750 | CROWN - PORC. FUSED TO METAL | $625.00 | $1,609.00 | $984.00 |
D2751 | CROWN - PORC. FUSED TO BASE METAL | $575.00 | $1,468.00 | $893.00 |
D2752 | CROWN - PORC. FUSED TO NOBLE METAL | $625.00 | $1,533.00 | $908.00 |
D2780 | CROWN - 3/4 CAST HIGH NOBLE METAL | $550.00 | $1,541.00 | $991.00 |
D2781 | CROWN - 3/4 CAST BASE METAL | $500.00 | $1,446.00 | $946.00 |
D2782 | CROWN - 3/4 CAST NOBLE METAL | $500.00 | $1,489.00 | $989.00 |
D2783 | CROWN - 3/4 PORCELAIN/CERAMIC | $475.00 | $1,570.00 | $1,095.00 |
D2790 | CROWN - FULL CAST METAL | $500.00 | $1,649.00 | $1,149.00 |
D2791 | CROWN - FULL CAST BASE METAL | $475.00 | $1,453.00 | $978.00 |
D2792 | CROWN - FULL CAST NOBLE METAL | $475.00 | $1,529.00 | $1,054.00 |
D2794 | CROWN - TITANIUM | $525.00 | $1,574.00 | $1,049.00 |
D2799 | PROVISIONAL CROWN | $75.00 | $611.00 | $536.00 |
D2910 | RECEMENT INLAY | $40.00 | $160.00 | $120.00 |
D2915 | RECEMENT POST & CORE | $40.00 | $153.00 | $113.00 |
D2920 | RECEMENT CROWN | $40.00 | $155.00 | $115.00 |
D2929 | PREFABRICATED PORCELAIN/CERAMIC CROWN ? PRIMARY TO | $100.00 | $494.00 | $394.00 |
D2930 | PREFABRICATED SS CROWN-PRIMARY | $100.00 | $380.00 | $280.00 |
D2931 | STAINLESS STEEL CROWN-PERM | $100.00 | $432.00 | $332.00 |
D2932 | PREFAB RESIN CROWN | $100.00 | $475.00 | $375.00 |
D2933 | PREFAB SS CROWN W/RESIN WINDOW | $150.00 | $488.00 | $338.00 |
D2934 | PREFAB ESTHETIC COATED SS CRWN | $100.00 | $514.00 | $414.00 |
D2940 | PROTECTIVE RESTORATION | $40.00 | $168.00 | $128.00 |
D2950 | CROWN BUILD-UP | $75.00 | $374.00 | $299.00 |
D2951 | PIN SUPPORT PER TOOTH | $30.00 | $104.00 | $74.00 |
D2952 | CAST POST & CORE | $160.00 | $574.00 | $414.00 |
D2953 | EACH ADDITIONAL INDIRECTLY FABRICATED POST - SAME | $25.00 | $419.00 | $394.00 |
D2954 | PREFAB POST & CORE | $120.00 | $480.00 | $360.00 |
D2955 | POST REMOVAL | $75.00 | $412.00 | $337.00 |
D2957 | EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH | $20.00 | $272.00 | $252.00 |
D2961 | RESIN LAMINATE - LABORATORY | $250.00 | $1,334.00 | $1,084.00 |
D2962 | PORCELAIN LAMINATE | $375.00 | $1,641.00 | $1,266.00 |
D2980 | REPAIR BROKEN CROWN FACING | $100.00 | $396.00 | $296.00 |
D3110 | PULP CAP-DIRECT | $30.00 | $117.00 | $87.00 |
D3120 | PULP CAP-INDIRECT | $20.00 | $117.00 | $97.00 |
D3220 | VITAL PULPOTOMY | $80.00 | $283.00 | $203.00 |
D3221 | PULPAL DEBRIDEMENT | $40.00 | $324.00 | $284.00 |
D3222 | PARTIAL PULPOTOMY FOR APEXOGENESIS | $75.00 | $404.00 | $329.00 |
D3230 | PULPAL THERAPY-PRIMARY-ANTERIO | $150.00 | $384.00 | $234.00 |
D3240 | PULPAL THERAPY-PRIMARY-POSTERI | $200.00 | $428.00 | $228.00 |
D3310 | ROOT CANAL THERAPY-ANTERIOR TOOTH | $350.00 | $1,063.00 | $713.00 |
D3320 | ROOT CANAL THERAPY-BICUSPID TOOTH | $425.00 | $1,209.00 | $784.00 |
D3330 | ROOT CANAL THERAPY-MOLAR TOOTH | $600.00 | $1,466.00 | $866.00 |
D3331 | TX OF ROOT CANAL OBSTRUCTION | $125.00 | $801.00 | $676.00 |
D3332 | INCOMPLETE ENDODONTIC THERAPY | $175.00 | $626.00 | $451.00 |
D3333 | INTERNAL ROOT REPAIR OF PERFORATION DEFECTS | $75.00 | $467.00 | $392.00 |
D3346 | RETREATMENT-RCT - ANTERIOR | $450.00 | $1,221.00 | $771.00 |
D3347 | RETREATMENT OF RCT - BICUSPID | $525.00 | $1,385.00 | $860.00 |
D3348 | RETREATMENT RCT - MOLAR | $700.00 | $1,648.00 | $948.00 |
D3351 | APEXIFICATION - INITIAL | $150.00 | $495.00 | $345.00 |
D3352 | APEXIFICATION - INTERIM MEDICATION | $100.00 | $360.00 | $260.00 |
D3353 | APEXIFICATION/RECALCIFICATION - FINAL VISIT | $250.00 | $735.00 | $485.00 |
D3410 | APICOECTOMY - FIRST ROOT | $250.00 | $987.00 | $737.00 |
D3421 | APICOECTOMY - PREMOLAR - FIRST ROOT | $250.00 | $1,101.00 | $851.00 |
D3425 | APICOECTOMY - MOLAR - FIRST ROOT | $250.00 | $1,236.00 | $986.00 |
D3426 | APICOECTOMY - EACH ADDITIONAL ROOT | $150.00 | $560.00 | $410.00 |
D3430 | RETROGRADE FILLING | $100.00 | $387.00 | $287.00 |
D3450 | ROOT RESECTION | $200.00 | $671.00 | $471.00 |
D3470 | INTENTIONAL REPLANTATION | $350.00 | $1,095.00 | $745.00 |
D3910 | ISOLATION OF TOOTH - RUBBER DAM | $100.00 | $307.00 | $207.00 |
D3920 | HEMISECTION | $200.00 | $634.00 | $434.00 |
D3950 | CANAL PREP. AND FITTING OF DOW | $75.00 | $347.00 | $272.00 |
D4210 | GINGIVECTOMY OR GINGIVOPLASTY | $250.00 | $857.00 | $607.00 |
D4211 | GINGIVECTOMY ONE TO THREE TEETH-PER QUAD | $150.00 | $434.00 | $284.00 |
D4230 | ANATOMICAL CROWN EXPOSURE - FO | $500.00 | $1,047.00 | $547.00 |
D4231 | ANATOMICAL CROWN | $300.00 | $814.00 | $514.00 |
D4240 | GINGIVAL FLAP PROCEDURE | $300.00 | $1,025.00 | $725.00 |
D4241 | GINGIVAL FLP PROC 1-3 CONTIG/BOUND TEETH SP | $175.00 | $854.00 | $679.00 |
D4245 | APICALLY POSITIONED FLAP | $125.00 | $1,089.00 | $964.00 |
D4249 | CROWN LENGTHENING | $450.00 | $1,071.00 | $621.00 |
D4260 | OSSEOUS SURGERY - PER QUADRANT | $525.00 | $1,501.00 | $976.00 |
D4261 | OSSEOUS SURGERY 1-3 TEETH | $315.00 | $1,221.00 | $906.00 |
D4263 | OSSEOUS GRAFT - PER SITE | $150.00 | $885.00 | $735.00 |
D4264 | OSSEOUS GRAFT-ADDTIONAL | $100.00 | $688.00 | $588.00 |
D4265 | BIO MATERIALS TO AID REGEN | $150.00 | $734.00 | $584.00 |
D4266 | GUIDED TISSUE REGEN-RESORB | $225.00 | $1,049.00 | $824.00 |
D4267 | GUIDED TISSUE REGEN-NONRESORB | $275.00 | $1,201.00 | $926.00 |
D4268 | GUIDED TISSUE REGENERATION | $75.00 | $1,093.00 | $1,018.00 |
D4270 | PEDICLE SOFT TISSUE GRAFTS | $300.00 | $1,145.00 | $845.00 |
D4273 | SUBEPITH.CONNECTIVE TISS. GRAF | $600.00 | $1,504.00 | $904.00 |
D4274 | DISTAL OR PROXIMAL WEDGE PROCE | $150.00 | $929.00 | $779.00 |
D4275 | SOFT TISSUE ALLOGRAFT | $500.00 | $1,418.00 | $918.00 |
D4276 | COMB CON TIS DBL PED GRAFT/TTH | $550.00 | $1,494.00 | $944.00 |
D4277 | FREE SOFT TISSUE GRAFT | $325.00 | $1,329.00 | $1,004.00 |
D4320 | SPLINTING-INTRACORONAL | $150.00 | $703.00 | $553.00 |
D4321 | SPLINTING-EXTRACORONAL | $100.00 | $643.00 | $543.00 |
D4341 | PERIO TREATMENT PER QUAD | $75.00 | $363.00 | $288.00 |
D4342 | SCALING-ROOT PLANING 1-3 TEETH | $45.00 | $259.00 | $214.00 |
D4355 | FULL MOUTH DEBRIDEMENT | $45.00 | $256.00 | $211.00 |
D4381 | LOCALIZED DELIV. OF CHEMO.AGEN | $45.00 | $107.00 | $62.00 |
D4910 | PERIODONTAL MAINTENANCE | $60.00 | $193.00 | $133.00 |
D4920 | UNSCHEDULED DRESSING CHANGE (OTHER THAN TX DR) | $25.00 | $143.00 | $118.00 |
D5110 | COMPLETE UPPER DENTURE | $725.00 | $2,335.00 | $1,610.00 |
D5120 | COMPLETE LOWER DENTURE | $725.00 | $2,427.00 | $1,702.00 |
D5130 | IMMEDIATE FULL UPPER DENTURE | $725.00 | $2,591.00 | $1,866.00 |
D5140 | IMMEDIATE FULL LOWER DENTURE | $725.00 | $2,599.00 | $1,874.00 |
D5211 | UPPER PARTIAL-ACRYLIC BASE W/C | $550.00 | $1,901.00 | $1,351.00 |
D5212 | LOWER PARTIAL ACRYLIC W/CLASPS | $550.00 | $1,901.00 | $1,351.00 |
D5213 | UPPER PARTIAL - CAST METAL | $750.00 | $2,508.00 | $1,758.00 |
D5214 | LOWER PARTIAL - CAST METAL | $750.00 | $2,528.00 | $1,778.00 |
D5225 | MAXILLARY PARTIAL FLEX BASE | $1,000.00 | $2,228.00 | $1,228.00 |
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