New York General Dentist Sample 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.

Performed by General DentistAVG COSTWITH EDPSAVINGS
Routine 6 Month Check-up$60$20$40
In Depth Check-Up$90$35$55
Full Mouth X-Rays$140$59$90
Bitewings - Four Films$80$30$50
Panoramic Film$120$58$62
Adult Cleaning$90$48$42
Child Cleaning$75$38$37
Sealant - Per Tooth$50$27$23
Silver Filling$110$58$52
White Filling$155$75$80
Root Canal - Anterior$600$385$215
Root Canal - Bicuspid$800$465$335
Root Canal - Molar$995$585$410
Upper Denture$1495$745$750
Single Tooth Extraction$150$75$75
Print Friendly, PDF & Email

For a sample list of fees, enter a ZIP code below.

This Fee Schedule applies only to fees charged by EDP Dental Plan General Dentists, NOT SPECIALISTS.

Any procedure not listed is available on a fee for service basis at a 25% discount from the participating provider’s usual fee.

Fee’s subject to change without notice. Consult with your participating dentist prior to beginning any treatment. Fees may not include all lab costs, which would be the member’s responsibility. Some services, at the discretion of the general dentist, may need to be referred to a specialist (advanced degree).

EDP Dental Plan is a discount dental plan, NOT INSURANCE. EDP Dental Plan does not pay claims. Charges for services are paid by the member directly to the participating dentist at time of service.

(1) Work in progress is not covered. (2) Work in progress after enrollment on the dental plan must be completed before selecting another participating dentist. (3) Any dental procedures performed by a non-participating dentist is not covered. (4) We cannot guarantee the continued participation of any dentist. If he/she leaves the plan, you will need to select another dentist. (5) Not all types of dentists may be available in your area; you may have to travel to receive care from a participating general dentist or specialist. (6) Some providers may charge for missed or broken appointments with no prior notice. (7) Please verify that the dentist is a participating provider when scheduling your appointment. (8) Fee schedules are subject to change without prior notification to members.

Print Friendly, PDF & Email