New York General Dentist Fee Schedule

** Any treatment provided by a participating specialist, if available, in Oral Surgery, Orthodontics, Periodontics, Pedodontics, Prosthodontics or Endodontics, will be charged at a 25% reduction of participating specialist’s fees for that particular case.

120Periodic Oral Evaluation20
140Limited Oral Evaluation – Problem Focused (Emergency)35
150Comprehensive Oral Evaluation25
210X-Rays Intraoral – Complete Series (Incl. Bitewings)59
220X-Rays Intraoral – Periapical – First Film12
230X-Rays Intraoral – Periapical – Each Additional Film8
240X-Rays – Intraoral – Occlusal Film19
270X-Rays – Bitewing – Single Film12
272X-Rays – Bitewing – Two Films18
274X-Rays – Bitewing – Four Films30
330X-Ray Panoramic Film58
1110Dental Prophylaxis Adult(Cleaning)48
1120Dental Prophylaxis Children38
1208Topical Fluoride Application20
1351Topical Sealants – Per Tooth27
ADARestorative (fillings)Amount
2140Amalgam – 1 Surface, Permanent58
2150Amalgam – 2 Surfaces, Permanent75
2160Amalgam – 3 Surfaces, Permanent88
2161Amalgam – 4 or more Surfaces, Permanent115
2330Resin – 1 Surface, Anterior75
2331Resin – 2 Surfaces, Anterior92
2332Resin – 3 Surfaces, Anterior115
2335Resin – 4+ Surf Or Inv. Incisal Angle145
2380Resin – 1 Surface – Posterior – Primary65
2381Resin – 2 Surfaces – Posterior – Primary90
2382Resin – 3+ Surfaces – Posterior – Primary120
2391Resin – 1 Surface – Posterior – Permanent98
2392Resin – 2 Surfaces – Posterior – Permanent135
2393Resin – 2 Surfaces – Posterior – Permanent155
2394Resin – 4+ Surfaces – Posterior – Permanent205
ADACrowns (lab fees additional)Amount
2740Crown – Porcelain/Ceramic Substrate698
2750Crown – Porcelain/High Noble Metal655
2751Crown – Porcelain/Predominate Base Metal625
2752Crown – Porcelain/Noble Metal638
2790Crown – Full Cast High Noble Metal645
2791Crown – Full Cast Predominantly Base Metal630
2920Re-cement Crown60
2930Prefabricated Stainless Steel Crown – Primary Tooth135
2931Prefabricated Stainless Steel Crown – Perm Tooth155
2932Prefab Resin Crown175
2950Core Buildup, Including Any Pins130
2951Pin Retention Per Tooth (W/O Restoration)32
2952Cast Post/Core (Addition to Crown)210
2954Prefabricated Post and Core (Addition to Crown)165
2970Temporary Crown (Fractured Tooth)155
ADAEndodontics (General Dentist) exc. Final RestorationAmount
3220Therapeutic Pulpotomy78
3310Root Canal Anterior385
3320Root Canal Bicuspid465
3330Root Canal Molar585
ADAProsthodontics (Performed by a General Dentist)Amount
4210Gingivectomy/Gingivoplasty – 4+ contiguous teeth355
4341Perio. Scaling & Root Planning per Quad135
4355Full Mouth Debridement90
4910Periodontal Maintenance88
ADAProsthodontics, Removable (lab fees additional)Amount
5110Complete Upper Denture745
5120Complete Lower Denture745
5130Immediate Upper825
5140Immediate Lower825
5211Upper Partial-Resin Base775
5212Lower Partial-Resin Base775
5213Partial Upper Cast Metal Base795
5214Partial Lower Cast Metal Base795
5410Adjust Denture (Upper)42
5411Adjust Denture (Lower)42
5510Repair Broken Complete Denture Base105
5520Repair Missing or Broken Teeth/Each Tooth75
5610Repair Resin Denture Base95
5630Repair or Replace Broken Clasp85
5640Repair Broken Teeth – Per Tooth70
5650Add Tooth to Existing Partial Denture80
5660Add Clasp to Existing Partial Denture95
5730Reline Upper Denture – Chairside145
5731Reline Lower Denture – Chairside145
ADAProsthodontics, Fixed (lab fees additional)Amount
6240Pontic – Porcelain/High Noble Metal585
6241Pontic – Porcelain/Predominate Base Metal535
6242Pontic – Porcelain/Noble Metal545
6750Crown – Porcelain/High Noble Metal595
6751Crown – Procelain/Predominate Base Metal545
6752Crown – Porcelain/Noble Metal555
6930Re-cement Bridge75
ADAOral SurgeryAmount
7140Single Tooth Extraction75
7120Each Additional Extraction65
7210Surgical Removal of Erupted Tooth170
7220Removal of Impacted Tooth/Soft Tissue160
7230Removal of Impacted Tooth/Partially Bony200
7240Removal of Impacted Tooth/Completely Bony255
7250Surgical Removal of Residual Tooth Roots138
7510Incision & Drainage of Abscess/Intraoral95
8080Comprehensive Treatment – Adolescent25% off
8090Comprehensive Treatment – Adult25% off
ADAAdjunctive ServicesAmount
9110Palliative Treatment (emergency) Pain-minor50
9610Therapeutic Drug Injection60

*Please see a professional dentist for full treatment plan.

*** Same day enrollment is available.

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