GA4

Service Listing

D0120 Periodic oral evaluation- established patient $$55.00

D0150  Comp Oral Eval-New or estab. Patient   $87.00

D0140  Limited Oral Evaluation    $81.00

D0220   Intraoral- periapical first image   $32.00     

D0210   Complete Series X-rays   $ 137.00

D0274   Bitewings 4    $67.00

D1110   Prophy Adult   $101.00

D1120   Prophy Child    $73.00

D2740    Crown- Porcelain/ceramic  $1270

D2752    Crown- Porcelain fused to noble metal   $1141.00

D2950    Core Buildup   $281.00

D7140   extraction erupted tooth  $190.00

D7210    surgical extraction   $301.00

D2392   Composite 2 surface Posterior  $  $283.00

D2391   Composite 1 surface Posterior  $ 181.00