| CODE |
PROCEDURES |
YOUR COST
WITH ADMS |
| 06210 |
Cast Gold Pontic |
$410*** |
| 06240 |
Pontic - Porcelain/Gold |
440*** |
| 06241 |
Pontic - Porcelain/Metal |
410 |
| 06545 |
Cast Metal Retainer (Maryland Bridge) (each) |
230 |
| 06751 |
Porcelain Crown/Metal |
410 |
| 06752 |
Porcelain Crown/Gold |
440*** |
| 06780 |
3/4 Gold Crown |
440*** |
| 06790 |
Full Gold Crown |
440*** |
| 06791 |
Full Cast Crown |
440 |
| 06930 |
Recement Bridge |
40 |
| 06970 |
Cast Post-N-Core |
175 |
| 06972 |
Prefab. Post-N-Core |
85 |
| 06973 |
Core Buildup |
85 |
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ORAL SURGERY PROCEDURES |
|
| 07140 |
Routine Extraction |
$32 |
| 07210 |
Surgical Impaction - Simple |
65 |
| 07220 |
Soft Tissue Impaction |
105 |
| 07230 |
Partial Bony Impaction |
125 |
| 07240 |
Complete Bony Impaction |
150 |
| 07250 |
Root Recovery |
85 |
| 07310 |
Alveoplasty (Quad w/Extraction) |
75 |
| 07510 |
Incision and Drainage to Abscess (Intraoral) |
75 |
| 07970 |
Excision/Hyper Tissue |
65 |
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OTHER SERVICES |
|
| 09110 |
Emergency Palliative Treatment |
$30 |
| 09310 |
Consultation |
15 |
| 01012 |
Infection Control |
10 |
| 09430 |
Office Visit for Observation |
15 |
| 09490 |
Broken Appointment Without 24 Hr. Notice |
25 |
| 09440 |
Office Visit (After Hours) |
50 |
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* NC - No Charge
** Other Endodontic and Periodontic Services
will be provided by the respective Specialists.
*** Plus cost of gold
Cost Of Lab Is An Additional Charge - Not Included In The Fees Listed
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