Payment Options
Fee Schedule and Patient Responsibility
The health care price listed for any given health care service is an estimate. Actual charges for the health care service are dependent on circumstances, including any complications or exceptional treatment at the time the service is rendered.
PRIOR TO arriving at our clinic:
If you are insured, please consult with your insurer or plan to accurately determine your financial responsibility for the health care service, treatment(s), or procedure(s) you will be seeking at Dental Aid. If you are not insured, you are encouraged to contact a Dental Aid office (numbers listed below) to discuss payment options prior to receiving a health care service from a Dental Aid provider. Posted prices may not reflect the actual amount of your financial responsibility.
| Code | Description of Service | Fee/Price |
|---|---|---|
| D1110 | Simple Teeth cleaning for adults | $106 |
| D0120 | Recall or periodic oral health exam | $58 |
| D0140 | Emergency exam of a limited area of the mouth | $82 |
| D0150 | Complete first or initial exam of the mouth | $96 |
| D0220 | A radiographic or x-ray of a tooth and its roots | $32 |
| D0230 | Each additional x-ray of a tooth with its roots | $27 |
| D0272 | 2 x-rays showing the area between teeth | $46 |
| D0274 | 4 x-rays showing the area between teeth | $76 |
| D0330 | A panoramic x-ray showing the entire mouth | $123 |
| D1120 | Teeth cleaning for children | $73 |
| D1206 | Protective fluoride varnish for the teeth | $45 |
| D1351 | Protective coating or sealant for the teeth | $54 |
| D2391 | A tooth colored filling for a back tooth on one part or single surface of a tooth | $212 |
| D2392 | A tooth colored filling for a back tooth on two surfaces of the tooth | $265 |
| D2740 | Crown, Porcelain/ceramic | $1368 |
| D7140 | A normal extraction or removal of a tooth | $167 |
To make an appointment, please call the Dental Aid office closest to you.
