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How Much You'll Save!

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