| D0120 | Periodic Evaluation | $56.00 |
| D1110 | Adult Cleaning | $101.00 |
| D0274 | 4 Bitewings x-rays | $71.00 |
| D0220 | Single PA x-ray | $33.00 |
| D2392 | Resin 2 Surf Filling | $268.00 |
| D0150 | Comprehensive Eval | $98.00 |
| D0230 | Additional PA x-ray | $27.00 |
| D1206 | Flouride Varnish | $47.00 |
| D2740 | Porcelain Crown | $1,306.00 |
| D0210 | Full Mouth x-rays | $151.00 |
| D1120 | Child Cleaning | $75.00 |
| D4910 | Periodontal Maint. | $159.00 |
| D0140 | Limited Evaluation | $88.00 |
| D7210 | Surgical Extraction | $315.00 |
| D2950 | Core Buildup | $297.00 |
2018 Office Fee Disclosure
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- 2018 Office Fee Disclosure
2018 Office Fee Disclosure
