| D2140 |
Amalgam
- 1 Surface, Permanent |
$28.00 |
| D2150 |
Amalgam
- 2 Surfaces, Permanent |
$36.00 |
| D2160 |
Amalgam
- 3 Surfaces, Permanent |
$46.00 |
| D2161 |
Amalgam
- 4 or More Surfaces, Permanent |
$56.00 |
| D2330 |
Composite
Resin - 1 Surface, Anterior |
$38.00 |
| D2331 |
Composite
Resin - 2 Surfaces, Anterior |
$46.00 |
| D2332 |
Composite Resin -
3 Surfaces, Anterior |
$56.00 |
| D2335 |
Composite Resin -
4 or More Surfaces or Involving Incisal Angle, Anterior |
$66.00 |
| D2391 |
Composite Resin -
1 Surface, Posterior |
$50.00 |
| D2392 |
Composite Resin -
2 Surfaces, Posterior |
$65.00 |
| D2393 |
Composite Resin -
3 Surfaces, Posterior |
$85.00 |
| D2394 |
Composite Resin -
4 or More Surfaces, Posterior |
$95.00 |
| D2750 |
Crown -- Porcelain
to High Noble Metal (Gold and Lab Fees additional) |
$350.00 |
| D2751 |
Crown -- Porcelain
to Base Metal
(Lab Fees additional) |
$320.00 |
| D2920 |
Recement Crown |
$20.00 |
| D2931 |
Prefabricated Stainless
Steel Crown |
$48.00 |
| D2940 |
Sedative Filling |
$16.00 |
| D2950 |
Core Buildup, Including
Any Pins |
$55.00 |
| D2951 |
Pin Retention - Per
Tooth |
$20.00 |
| D2952 |
Cast Post and Core
In Additional to Crown |
$75.00 |
| D2953 |
Each Additional Cast
Post Same Tooth |
$40.00 |
| D2954 |
Prefab Post / Core
In Additional to Crown |
$60.00 |
| D2970 |
Temporary Crown (Fractured
Tooth) |
$40.00 |
