Top 15 procedures

In 2017 SB 65 passed requiring all healthcare providers to provide a list of their top 15 performed procedures and their fees without any insurance or discount associated.


Code NumberExplanation Fee 

Adult Dental Cleaning and Prophylaxis

 D0120Periodic Exam of teeth  $62
 D2392Filling on a tooth that is on 2 different surfaces $293 
 D02201st X-ray that shows the root of a tooth $29 
 D0230Additional X-ray that shows the roots of teeth $29 
 D0274X-rays that show cavities between teeth $79 
 D1120Child's Cleaning 


 D0210Complete set of x-rays showing all teeth and roots $163 

Extraction of a tooth without having to move gums

or remove bone

 D2391Composite filling on one surface of a tooth $218 
 D2331Filling on front tooth on two surfaces $234 
 D2950Core Buildup to restore a tooth to allow a crown $340 
 D0150Comprehensive Exam generally a new patient $77 
 D2330Filling on front tooth limited to one surface  
 D2740All Porcelain Crown $1,285 


“The health care price listed for any given health care service is an estimate. Actual charges for the health care service are dependent on the circumstances, including any complications or exceptional treatment, at the time the service is rendered. 

If you are covered by health insurance or a dental plan, you are strongly encouraged to consult with your insurer or plan to determine accurate information about your financial responsibility for a particular health care service provided by a health care provider at this office. If you are not covered by health insurance or a dental plan, you are strongly encouraged to contact our billing office at [insert telephone number] to discuss payment options prior to receiving a health care service from a health care provider at this office since posted health care prices may not reflect the actual amount of your financial responsibility.”