ADA Code |
Sample
General Dentist
Procedures
|
Dental Office
Fees Up To*
|
Dental Plan
Fees |
Dental Plan
Savings Up To
|
00120 |
Periodic Oral Exam |
$68 |
$13 |
81% |
00150 |
Initial Oral Exam |
$120 |
$32 |
74% |
00210 |
X-Ray: Intraoral Complete Series |
$167 |
$50 |
71% |
00330 |
X-Ray: Panoramic |
$144 |
$50 |
66% |
01110 |
Regular Teeth Cleaning (Light Scaling & Polishing) |
$117 |
$46 |
61% |
02140 |
Amalgam Filling (Silver Colored) 1 Surface (Anterior) |
$182 |
$45 |
76% |
02150 |
Amalgam Filling (Silver Colored) 2 Surface (Anterior) |
$238 |
$65 |
73% |
02330 |
Resin Based composite - 1 Surface, Anterior |
$209 |
$70 |
67% |
02331 |
Resin Based Composite - 2 Surface Anterior |
$259 |
$95 |
64% |
02750 |
Porcelain Crown with High Noble Metal |
$1,408 |
$550 |
61% |
03310 |
Root Canal Anterior |
$933 |
$375 |
60% |
03320 |
Root Canal Bicuspid |
$1,072 |
$390 |
64% |
04355 |
Deep Teeth Cleaning (Full Mouth Debridement / Removal of heavy tartar buildup) |
$267 |
$97 |
64% |
08080 |
Orthodontic Braces by General dentist - children under age 19 |
$6,205 |
$2,250 |
64% |
08090 |
Orthodontic Braces by General dentist - adult 19 and over |
$6,518 |
$2,400 |
64% |
*Current Dental Terminology® 2011
American Dental Association, All Rights Reserved.
*National Dental Advisory Service 2011
Invisalign discounts may not apply..
Lab Fees Billed Separately with 25% discount.
Fees will vary by region.
|
|
Dental Plans Include
Additional Healthcare Benefits
No Additional Charge |
|
