Dental Clinic Fees

ADA CODE

DESCRIPTION

HCC FEE

 

DIAGNOSTIC

 

D0150

Exam (New Patient or Established Patient)

$10

D0210

FMX complete series

$35

D0220

Periapical Radiograph (first PA film)

$2

D0230

Periapical (each additional radiograph)

$2

D0240

Occlusal Radiograph

$5

D0270

BWX single film

$2

D0272

BWX two films

$4

D0274

BWX four films

$8

D0330

Panoramic  Image

$40

 

Preventative Treatment

 

D1110

Prophylaxis-Adult

$30

D1120

Prophylaxis-Child

$25

D1206

Topical Application of Fluoride Varnish

$10

D1310

Nutritional Analysis

$0

D1320

Tobacco Analysis (Cessation)

$0

D1351

Sealant (per tooth)

$5

 

Periodontics

 

D4341

Periodontal Scaling and Root Planing-4 or more teeth per quadrant

$50/quad

D4342

Periodontal Scaling and Root Planing-1-3 teeth per quadrant

$40/quad

D4910

Periodontal Maintenance

$30

 

Other

 

 

Whitening Trays with 4 syringes of solution (10%, 15% or 35%)

$65

 

4 syringes of whitening solution (10%, 15% or 35%)

$45

D9940

Night Guard

$30

D9630

Peridex  16 oz. bottle

$12

D9630

Periomed

$12

D9630

Clinipro 5000

$10

 

This educational facility provides preventive care only.  An appointment is necessary and each appointment lasts 3.5 hours. Additional appointments may be necessary to complete treatment. The clinic does not accept cash or insurance. Forms of payment are checks, Visa, MasterCard, American Express and Discover credit/debit cards.

Please call 813-253-7527 to schedule an appointment.