Pennsylvania 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
Oral Exam$78$3160%
X-Rays 4 Bitewings$85$3657%
Adult Cleaning$120$5455%
Child Cleaning$100$3763%
Fillings$145$7151%
Crowns$1,285$76940%
Anterior Root Canal$700$38745%
Bicuspid Root Canal$750$52921%
Upper Denture Resin Base$1,250$51458%
Single Tooth Extraction$175$7060%
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For a sample list of fees, enter a ZIP code below.

This Fee Schedule applies only to fees charged by participating 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. The purpose of this schedule is to establish the maximum fee that general densist will charge for each procedure.

Fee’s subject to change without notice. Consult with your participating dentist prior to beginning any treatment. Some services, at the discretion of the general dentist, may need to be referred to a specialist (advanced degree).

Any quality of care concerns involving any participating EDP provider should be directed in writing to: EDP Dental Plan, Attn. Provider Relations, 424 Rosevale Ave Ronkonkoma, NY 11779.

The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment-many treatments may require more than one dental procedure. Please consult your EDP Provider for a detailed treatment plan prior to beginning any work.

If the dentist leaves the plan, you will need to select another participating EDP provider.

PLEASE NOTE: EDP Dental Plan is a discount dental plan, NOT INSURANCE. EDP does not pay claims to it’s members or it’s providers.Charges for services are paid by member directly to participating dentist at time of service. (1) Work in progress is not covered. (2) Any dental procedure performed by a non- participating dentist is not covered. (4) EDP cannot guarantee the continued participation of any dentist. (5) Not all types of dentists may be available in your area. (6) Some providers may charge for missed or broken appointments which is the member’s responsibility. (7) Please verify that the dentist is a participating provider when scheduling your appointment.

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