Preventative Dentistry
| D1110 | Prophylaxis - Adult | $ 24.00 |
| D1120 | Prophylaxis - Child | $ 24.00 |
| D1203 | Application Topical Fluoride - Child | $ 5.00 |
| D1204 | Application Topical Fluoride - Adult | $ 5.00 |
| D1351 | Sealant - Per Tooth | $ 14.00 |
| D1510 | Space Maintainer - Fixed Unilateral | $ 60.00 |
| D1515 | Space Maintainer - Fixed Bilateral | $ 75.00 |
A specific preventative treatment may present unusual circumstances requiring an additional cost. Please consult the affiliated dentist as to the total procedure cost prior to treatment.