| 0120 | Periodic exam | 64.00 | |
| 0210 | Full-mouth series x-rays | 161.00 | |
| 0274 | 4 Bite-wing x-rays | 77.00 | |
| 1110 | Adult prophylaxis | 113.00 | |
| 2330 | Anterior one-surface resin composite | 192.00 | |
| 2391 | Posterior one-surface resin composite | 207.00 | |
| 2750 | Porcelain fused to high noble metal crown | 1263.00 | |
| 2740 | Porcelain ceramic crown | 1288.00 | |
| 2950 | Core build-up for crown | 313.00 | |
| 3330 | Molar root-canal therapy | 1252.00 | |
| 4341 | Perio scaling/ root planing per quadrant | 320.00 | |
| 4910 | Periodontal maintenance | 167.00 | |
| 6010 | Surgical placement of implant | 2039.00 | |
| 7140 | Simple extraction exposed tooth | 205.00 | |
| 7210 | Surgical Extraction | 317.00 |
Gentle care, healthy smiles · · · 719-574-2424
