‚Äč*****2017 Dental Treatment Fee *****

(PRICE SUBJECT TO CHANGE WITHOUT NOTICE)
**For any treatment that is not listed here, please call for detail
 

Dental codes      Dental treatments                                                  Fee

Exam and cleaning:

New Patient Exam with Cleaning and 4 Bite Wing (Adult)               150

New Patient Exam with Cleaning and 2 Bite Wing (child)                115

D0150                 Comprehensive Exam                                                    47

D0120                 Periodic oral exam                                                      33

D0140                 Limited Exam                                                                 43

D0220                 1 Periapical X-ray                                                        20

D0274                 4 Bite Wings                                                                  41

D1120                 Cleaning (child)                                                           42

D1110                 Cleaning (adult)                                                          62

D4355                 Full Mouth Debridement                                             96

D4342                 Deep Cleaning (1-3 teeth per quadrant)                    99

D4341                 Deep Cleaning (4 teeth or more per quadrant)        165

D9940                 Night Guard                                                                  350


Dental codes   Dental treatments                                                      Fee

Orthodontic Treatment:

D8010                 Limited Orthodontic Treatment                               2,800

D8070                 Comprehensive Treatment
                                          SIMPLE                                                          4,000
                                          COMPLEX                                                      4,500

D8080                 Orthodontic Positioner (Orthotain)                       2,800

D8692                 Wire Retainer Replacement                                       275

D8693                 Wire Retainer Repair/Bonding                                  285

D8210                 Clear Retainer Appliance                                          390



Dental codes   Dental treatments                                                    Fee

Tooth Color Filling (Composite):

D2330                 Front Tooth Filling 1 Surface                                90

D2331                 Front Tooth Filling 2 Surfaces                              110

D2332                 Front Tooth Filling 3 Surfaces                              125

D2335                 Front Tooth Filling 4 Surfaces or more               139

D2391                 Back Tooth Filling 1 Surface                                  135

D2392                 Back Tooth Filling 2 Surfaces                                160

D2393                 Back Tooth Filling 3 Surfaces                                186

D2394                 Back Tooth Filling 4 Surfaces or more                 207

Silver Filling (Amalgam):

D2140                 Back Tooth Filling 1 Surface                                  77

D2150                 Back Tooth Filling 2 Surfaces                                88

D2160                 Back Tooth Filling 3 Surfaces                                105

D2161                 Back Tooth Filling 4 Surfaces or More                 123

Dental codes   Dental treatments                                                   Fee

Crown:

D2950                 Core Build-Up (for retention of the Crown)       132

D2740                 Porcelain or Zirconium Crown                              760

D2750                 Porcelain Fused to High Noble Crown                  752

Denture:

D5213                 Partial Denture with Metal Framework               980

D5225                 Partial Denture Flexible Partial                           920

D5211                 Partial Denture Acrylic Partial                            780

D5820/5821       One to three teeth partial denture (flipper)       436

D5110                 Complete Denture (upper)                                       980

D5120                 Complete Denture (lower)                                      980  

Implant:

D6010                 Root Form Implant                                                    1,399

D6057                 Implant Abutment                                                      559  

D6058                 Implant Crown                                                           986


Dental codes   Dental treatments                                                    Fee

Root Canal Treatment:

D3310                 Front tooth Treatment                                            428

D3320                 Premolar Treatment                                                  510

D3330                 Molar Treatment                                                        637

Extraction:

D7140                 Simple Extraction                                                       85

D7210                 Surgical Extraction                                                  141

D7220                 Extraction with Soft Tissue Impaction                  164

D7230                 Extraction with Horizontal Partial Impaction    219  

D9999                 Reattachment of broken tooth to the       $300/tooth, $60/additional tooth

                           Neighboring teeth                                          

lIN DENTAL

gENERAL dENTISTRY

Copyright 2016. Lin Dental, LLC. All rights reserved.