Office Fees

15 Most Common Procedures

 Code Description Fee
 D0120 Periodic Oral Evaluation $68
 D1110 Prophylyaxis-Adult $116
 D0220 Intraoral-Perioapical 1st Film $35
 D0274 Bitewings-Four Films $80
 D0230 Intraoral-Perioapical Each Add’l $29
 D1206 Topical Fluoride Varnish $52
 D1120 Prophylaxis-Child $88
 D2392 Resin-Composite-2S, Posterior $275
 D2391 Resin-Composite-1S, Posterior $216
 D0210 Intraoral-Complete Series (BW) $164
 D0272 Bitewings-Two Films $54
 D4910 Periodontal Maintenance $174
 D1351 Sealant-Per Tooth $62
 D2750 Crown-Porc. Fuse High Noble Mtl. $1420
 D9230 Analgesia-Inhal of Nitrous Oxide $91

All fees are estimates as actual charges are dependent on the circumstances at the time a service is rendered. If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular service provided at this office.  If you are not covered by health insurance, you are strongly encouraged to contact our office to discuss payment options and the actual amount of your financial responsibility.

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