ADA CODE | TREATMENT / DESCRIPTION | VIP Program Fees | UCR Standard Fees |
---|---|---|---|
D0120 | Periodic Oral Evaluation | $0 | $61 |
D0140 | Limited Oral Evaluation – Problem Focused | $0 | $91 |
D0150 | Comprehensive Oral Evaluation | $0 | $107 |
D0210 | Intraoral – Radiographic Image | $0 | $159 |
D0270 | Bitewing – Radiographic Image | $0 | $64 |
D0330 | Panoramic Radiographic Imag | $0 | $135 |
D1110 | Prophylaxis – Adult | $0 | $110 |
D1208 | Topical Application of Fluoride – Excludes Varnish | $25 | $46 |
D1351 | Sealant – Per Tooth | $54 | $60 |
D2330 | Resin-Based Composite One Surface, Anterior | $163 | $200 |
D2391 | Resin-Based Composite One Surface, Posterior | $175 | $217 |
D2740 | Crown – Porcelain/Ceramic Subrate | $1,104 | $1,380 |
D2750 | Crown – Porcelain Fused to High Noble Metal | $1,080 | $1,350 |
D3120 | Pulp Cap – Indirect (Excludes Final Restoration) | $85 | $100 |
D3310 | Endodontic Therapy, Anterior Tooth | $725 | $900 |
D3320 | Endodontic Therapy, Bicuspid Tooth | $823 | $1,028 |
D3330 | Endodontic Therapy, Molar (Excludes Final Restoration) | $997 | $1,246 |
D4341 | Periodical Scaling and Root Planting – 4+ Teeth Per Quadrant | $150 | $304 |
D4346 | Scaling With Moderate to Severe Inflammation – Full Mouth | $240 | $300 |
D4355 | Full Mouth Debridement | $0 | $215 |
D4910 | Periodontal Maintenance | $0 | $166 |
D7140 | Extraction, Erupted Tooth or Exposed Root | $171 | $213 |
NOTE: With the exception of confirmed bookings - Prices are subject to change without notice.