| 0120 | Periodic exam | 55.00 | |
| 0210 | Full-mouth series x-rays | 144.00 | |
| 0274 | 4 Bite-wing x-rays | 68.00 | |
| 1110 | Adult prophylaxis | 99.00 | |
| 2330 | Anterior one-surface resin composite | 168.00 | |
| 2391 | Posterior one-surface resin composite | 184.00 | |
| 2750 | Porcelain fused to high noble metal crown | 1140.00 | |
| 2740 | Porcelain ceramic crown | 1180.00 | |
| 2950 | Core build-up for crown | 285.00 | |
| 3330 | Molar root-canal therapy | 1175.00 | |
| 4341 | Perio scaling/ root planing per quadrant | 296.00 | |
| 4910 | Periodontal maintenance | 151.00 | |
| 6010 | Surgical placement of implant | 1865.00 | |
| 7140 | Simple extraction exposed tooth | 171.00 | |
| 7210 | Surgical Extraction | 280.00 |
Gentle care, healthy smiles · · · 719-574-2424
