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Fee Schedule

Read below to see our complete fee schedule. A fee schedule is a list of dental procedures and the discounted price when using the dental plan. Fee schedules often vary greatly from one dentist, however with Dental Connect, you know what you're going to pay ahead of time!

ADA Fee CodeProcedureTypical FeeDental Connect FeeSAVINGS
D0120periodic oral evaluation - established patient$53$33$20
D0140limited oral evaluation - problem focused$76$44$32
D0150comprehensive oral evaluation - new or established patient$86$10$77
D0210intraoral - complete series (including bitewings)$134$80$54
D0220intraoral - periapical first film$29$19$10
D0230intraoral - periapical each additional film$23$15$8
D0270bitewing - single film$30$19$11
D0272bitewings - two films$45$29$16
D0273bitewings - three films$65$34$31
D0274bitewings - four films$85$41$44
D0330panoramic film$117$70$47
D1110prophylaxis - adult$96$56$40
D1120prophylaxis - child$71$41$30
D1351sealant - per tooth$56$32$24
D1510space maintainer - fixed - unilateral$355$216$139
D1515space maintainer - fixed - bilateral$531$320$211
D1520space maintainer - removable - unilateral$431$245$186
D1525space maintainer - removable - bilateral$594$339$255
D2140amalgam - one surface, primary or permanent$136$84$52
D2150amalgam - two surfaces, primary or permanent$171$106$65
D2160amalgam - three surfaces, primary or permanent$204$125$79
D2161amalgam - four or more surfaces, primary or permanent$243$150$93
D2330resin-based composite - one surface, anterior$161$93$68
D2331resin-based composite - two surfaces, anterior$197$115$82
D2332resin-based composite - three surfaces, anterior$236$138$98
D2335resin-based composite - four or more surfaces or involving incisal angle (anterior)$296$172$124
D2391resin-based composite - one surface, posterior$175$102$73
D2392resin-based composite - two surfaces, posterior$226$133$93
D2393resin-based composite - three surfaces, posterior$279$163$116
D2394resin-based composite - four or more surfaces, posterior$329$192$137
D2710crown - resin-based composite (indirect)$940$191$749
D2740crown - porcelain/ceramic subtrate$1,218 $681$537
D2750crown - porcelain fused to high noble metal$1,117 $672$445
D2751crown - porcelain fused to predominantly base metal$1,055 $640$415
D2752crown - porcelain fused to noble metal$1,115 $641$474
D2791crown - full cast predominantly base metal$1,052 $638$414
D2792crown - full cast noble metal$1,117 $640$477
D2910Re-cement Inlay/Onlay Partial$122$74$48
D2915Re-cement Cast or Prefab Pst/Cor$141$82$59
D2920Re-cement Crown$104$65$39
D2930prefabricated stainless steel crown - primary tooth$295$178$117
D2931prefabricated stainless steel crown - permanent tooth$356$211$145
D2932Prefabricated Resin Crown$432$241$191
D2940Sedative Filling$115$72$43
D2950core buildup, including any pins$281$162$119
D2951pin retention - per tooth, in addition to restoration$86$0$86
D2952post and core in addition to crown, indirectly fabricated$433$263$170
D2954prefabricated post and core in addition to crown$336$196$140
D2955Post Removal (not with Endo)$336$222$114
D2957Additonal Prefabricated Post$257$137$120
D2960Labial Veneer (laminate) Chairside$720$417$303
D2961Labial Veneer (resin laminate) Lab$1,198 $680$518
D2962Labial Veneer (procelain-laminate) Lab$1,264 $670$594
D2970Temporary Crown$353$159$194
D3110pulp cap - direct (excluding final restoration)$92$55$37
D3120pulp cap - indirect (excluding final restoration)$89$52$37
D3220therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament$198$119$79
D3310endodontic therapy, anterior tooth (excluding final restoration)$755$475$280
D3320endodontic therapy, bicuspid tooth (excluding final restoration)$869$553$316
D3330endodontic therapy, molar (excluding final restoration)$1,078 $685$393
D4210gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant$714$403$311
D4341periodontal scaling and root planing - four or more teeth per quadrant$252$160$92
D4910periodontal maintenance$126$60$66
D5110complete denture - maxillary$1,690 $1,015 $675
D5120complete denture - mandibular$1,713 $1,015 $698
D5130immediate denture - maxillary$1,839 $1,110 $729
D5140immediate denture - mandibular$1,872 $1,110 $762
D5211maxillary partial denture - resin base (including any conventional clasps, rests and teeth)$1,294 $801$493
D5212mandibular partial denture - resin base (including any conventional clasps, rests and teeth)$1,366 $801$565
D5213maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)$1,748 $1,075 $673
D5214mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)$1,735 $1,075 $660
D5410adjust complete denture - maxillary$95$56$39
D5411adjust complete denture - mandibular$96$57$39
D5510repair broken complete denture base$224$130$94
D5520replace missing or broken teeth - complete denture (each tooth)$183$108$75
D5630repair or replace broken clasp$256$152$104
D5650add tooth to existing partial denture$215$131$84
D5660add clasp to existing partial denture$259$155$104
D5730reline complete maxillary denture (chairside)$375$221$154
D5731reline complete mandibular denture (chairside)$376$221$155
D5740reline maxillary partial denture (chairside)$360$220$140
D5741reline mandibular partial denture (chairside)$365$209$156
D5750reline complete maxillary denture (laboratory)$470$290$180
D5751reline complete mandibular denture (laboratory)$480$291$189
D6010surgical placement: endosteal implant$2,224 $1,250 $974
D6065implant supported porcelain/ceramic crown$1,748 $1,586 $162
D6066implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal)$1,709 $1,011 $698
D6067implant supported metal crown (titanium, titanium alloy, high noble metal)$1,922 $980$942
D6240pontic - porcelain fused to high noble metal$1,106 $640$466
D6241pontic - porcelain fused to predominantly base metal$1,059 $640$419
D6242pontic - porcelain fused to noble metal$1,096 $640$456
D6750crown - porcelain fused to high noble metal$1,104 $638$466
D6751crown - porcelain fused to predominantly base metal$1,035 $619$416
D6752crown - porcelain fused to noble metal$1,103 $619$484
D7140extraction, erupted tooth or exposed root (elevation and/or forceps removal)$169$96$73
D7210surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth$289$165$124
D7220removal of impacted tooth - soft tissue$353$200$153
D7230removal of impacted tooth - partially bony$444$255$189
D7240removal of impacted tooth - completely bony$552$314$238
D7250surgical removal of residual tooth roots (cutting procedure)$311$174$137
D7310alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant$341$194$147
D7320alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant$514$288$226
D7510incision and drainage of abscess - intraoral soft tissue$252$145$107
D8070comprehensive orthodontic treatment of the transitional dentition$6,004 $3,600 $2,404
D8080comprehensive orthodontic treatment of the adolescent dentition$6,000 $4,200 $1,800
D8090comprehensive orthodontic treatment of the adult dentition$6,000 $4,650 $1,350
D9110palliative (emergency) treatment of dental pain - minor procedure$132$76$56
D9951occlusal adjustment - limited$157$95$62
D9952occlusal adjustment - complete$846$420$426

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