Item #151

Mouth-guard

$200

Item #161

Fissure sealing – per tooth

$60

Item #311

Extraction – simple

$190

Item #323

Extraction – complicated

$400

Item #415

Root canal therapy debridement – one canal

$300

Item #416

Root canal therapy debridement – each additional canal

$145

Item #417

Root canal filling – one canal

$300

Item #418

Root canal filling – each additional canal

$145

Item #455

Change of root canal dressing

$120

Item #521

Filling for front tooth – 1 surface

$150

Item #522

Filling for front tooth – 2 surfaces

$210

Item #523

Filling for front tooth – 3 surfaces

$235

Item #524

Filling for front tooth – 4 surfaces

$260

Item #525

Filling for front tooth – 5 surfaces

$285

Item #526

Filling for front tooth – 6 surfaces

$300

Item #531

Filling for back tooth – 1 surface

$160

Item #532

Filling for back tooth – 2 surfaces

$230

Item #533

Filling for back tooth – 3 surfaces

$270

Item #534

Filling for back tooth – 4 surfaces

$290

Item #535

Filling for back tooth – 5 surfaces

$320

Item #536

Filling for back tooth – 6 surfaces

$330

Item #556

Porcelain veneer

$1550

Item #613

Crown – non-metallic

$1550

Item #615

Crown – metal fused to porcelain

$1550

Item #711

Complete denture – top

$1270

Item #712

Complete denture – bottom

$1270

Item #719

Complete dentures – top and bottom

$2450

Item #721

Partial denture – resin based – top

$940

Item #722

Partial denture – resin based – bottom

$940

Item #727

Partial denture – cast metal – top

$1650

Item #728

Partial denture – cast metal – bottom

$1650

Item #733

Per tooth on partial dentures

$45

Item #965

Occlusal splint – nightguard

$590