Dental Cost Estimator

Adjunctive General Services

Palliative Treatment

Amalgam and Composite Restorations (Fillings)

Amalgam (Silver Filling)- One Surface, Primary or Permanent Tooth

Composite (White Filling) - One Surface, Anterior (Front) Tooth

Composite (White Filling) - One Surface, Posterior (Back) Tooth

Amalgam (Silver Filling) - Two Surfaces, Primary or Permanent Tooth

Composite (White Filling) - Two Surfaces, Anterior (Front) Tooth

Composite (White Filling) - Two Surfaces, Posterior (Back) Tooth

Amalgam (Silver Filling) - Three Surfaces, Primary or Permanent Tooth

Composite (White Filling) - Three Surfaces, Anterior (Front) Tooth

Composite (White Filling) - Three Surfaces, Posterior (Back) Tooth

Amalgam (Silver Filling) - Four or More Surfaces, Primary or Permanent Tooth

Composite (White Filling) - Four or More Surfaces or Involving Angle, Anterior (Front) Tooth

Composite (White Filling) - Four or More Surfaces, Posterior (Back) Teeth

Crowns

Crown - Porcelain/Ceramic Substrate

Crown - Porcelain Fused to High Noble Metal (i.e., gold)

Crown - Porcelain Fused to Predominantly Base Metal

Crown - Porcelain Fused to Noble Metal

Diagnostic Services

Comprehensive Oral Evaluation

Comprehensive Periodontal Evaluation

Limited Oral Evaluation - Problem Focused

Periodic Oral Evaluation

Endodontics

Root Canal, Anterior (Front) Tooth

Root Canal, Molar Tooth

Root Canal, Bicuspid Tooth

Therapeutic Pulpotomy, Excluding Final Restoration

Extractions

Extraction, Erupted Tooth or Exposed Root (Simple Extraction)

Fixed Partial Denture (Bridge)

Fixed Partial Denture (Bridge) - Pontic - Porcelain Fused to High Noble Metal (i.e., gold)

Fixed Partial Denture (Bridge) - Retainer Crown, Full Cast Noble Metal

Fixed Partial Denture (Bridge) - Retainer Crown, Porcelain Fused to High Noble Metal (i.e., gold)

General Anesthesia

Deep Sedation/General Anesthesia - each 15 minute increment

Orthodontics

Comprehensive Orthodontic Treatment of the Adolescent Dentition

Other Restorative Services

Core Buildup, Including Any Pins When Required

Post & Core

Prefabricated Stainless Steel Crown - Primary Tooth

Periodontics

Osseous Surgery - Four or More Teeth Per Quadrant

Periodontal Maintenance (Periodontal Prophylaxis, Periodontal Cleaning)

Periodontal Scaling/Root Planing - Four or More Teeth Per Quadrant

Periodontal Scaling/Root Planing - One to Three Teeth Per Quadrant

Preventive Services

Topical Application of Fluoride - Child

Cleaning (Prophylaxis) - Adult

Cleaning (Prophylaxis) - Child

Sealant - Per Tooth

Professional Consultation

Consultation

Removable Dentures

Mandibular (Lower) Partial Denture - Cast Metal Framework with Resin Denture Base

Maxillary (Upper) Partial Denture - Cast Metal Framework with Resin Denture Base

Restorative Services

Prefabricated Post & Core

Recement or Rebond Crown

Surgical Extractions

Surgical Removal of Impacted Tooth - Completely Bony (Full Bony Impaction)

Surgical Removal of Impacted Tooth - Partially Bony (Partial Bony Impaction)

Surgical Removal of Impacted Tooth - Soft Tissue (Soft Tissue Impaction)

Surgical Removal of Residual Tooth Roots

Surgical Removal of Erupted Tooth and Removal of Bone and/or Section of Tooth (Surgical Extraction)

X-rays, Radiographs

Bitewings - Four Films

Bitewings - Two Films

Complete Series of X-rays (Full Mouth X-rays)

Additional Periapical Film (PA X-ray)

Panoramic Film (Panorex Film)

Periapical Film (PA X-ray)

Estimate Cost of Dental Care