Northeast General Dentists
Fee Schedule I

Last Printing April 2002
(all procedures as performed by a general Dentist)

 

DIAGNOSTIC & PREVENTATIVE PROCEDURES NDPA FEE USUAL FEE
Single x-ray (any type) $8.00 $18.00
X-rays (up to full mouth, or at least 3 films taken) $35.00 $90.00
Panarex $35.00 $90.00
Oral Examination and Diagnosis No Charge $50.00
Child Cleaning & Polishing - Excluding Fluoride $30.00 $70.00
Adult Cleaning, Polishing and Scaling $45.00 $100.00
Topical Fluoride Treatment for Children $20.00 $42.00
Palliative Treatment (Emergency Treatment of Pain) $30.00 $62.00
Sealants (Pit & Fissure, Per Tooth) $20.00 $43.00
Consultation (including 2nd opinion and/or a very extensive examination) $35.00 $62.00

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RESTORATIVE PROCEDURES (FILLINGS) NDPA FEE USUAL FEE
Silver Amalgams: Primary
One Surface $45.00 $64.00
Two Surfaces $52.00 $81.00
Three Surfaces $63.00 $100.00
Four Surfaces or more $73.00 $123.00
Silver Amalgams: Permanent
One Surface $49.00 $88.00
Two Surfaces $61.00 $118.00
Three Surfaces $70.00 $140.00
Four Surfaces or more $88.00 $168.00
Composite Resins: Anterior
One Surface $60.00 $92.00
Two Surfaces $75.00 $135.00
Three Surfaces $90.00 $168.00
Four Surfaces or more or involving incisal angle $109.00 $198.00
Composite Resins: Posterior
One Surface $63.00 $105.00
Two Surfaces $85.00 $148.00
Three Surfaces or more $127.00 $215.00
Pin retention, per pin $27.00 $55.00
Sedative Filling $40.00 $65.00

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COSMETIC PROCEDURES NDPA FEE USUAL FEE
Bonding/Veneers (per tooth)
Full face buildup (chairside) $210.00 $350.00
Laminate veneer - porcelain - laboratory $435.00 $800.00

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ENDODONTICS (performed by General Dentists) NDPA FEE USUAL FEE
Pulp capping (excl. final restoration) $31.00 $59.00
Pulpotomy (excl. final restoration) $65.00 $115.00
Root Canal Therapy
Anterior $320.00 $500.00
Bicuspid $365.00 $690.00
Molar $480.00 $750.00

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PERIODONTICS (performed by General Dentists) NDPA FEE USUAL FEE
Periodontal scaling and root planing, in the
presence of periodontal disease, (per quadrant)
$65.00 $145.00
Osseous or mucogingival surgery (per quadrant) $465.00 $780.00
Perio maintenance $55.00 $85.00

 

ORAL SURGERY (performed by General Dentists)   USUAL FEE
Extraction: Simple
Single tooth $60.00 $105.00
(each additioal tooth) $49.00 $80.00
Complex $88.00 $175.00
Incision and drainage $65.00 $150.00
Root removal $75.00 $120.00
Surgical Extractions:
Soft tissue impaction $140.00 $235.00
Partial bony impaction $185.00 $335.00
Full bony impaction $230.00 $435.00

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FIXED PROSTHODONTICS NDPA FEE USUAL FEE
Porcelain on non-precious metal crown $425.00 $768.00
All metal crown (not gold) $435.00 $768.00
Pontics $585.00 $880.00
Porcelain on semi to high noble metal crown $585.00 $880.00
Post and core (chairside) $149.00 $220.00
Core buildup - including pins $125.00 $195.00
Cast post (non-gold) laboratory $215.00 $325.00
Re-cement crown $37.00 $75.00
Re-cement bridge - per abutment $50.00 $80.00
Maryland Bridge (without pontic - per wing) $280.00 $435.00
Laboratory processed temporary (per tooth) $90.00 $150.00
Temporary Crown (as part of crown procedure) NO CHARGE

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REMOVABLE PROSTHODONTICS NDPA FEE USUAL FEE
Complete Maxillary denture (includ. adjustments) $635.00 $990.00
Complete Mandibular denture (includ. adjustments) $635.00 $990.00
Partials:
Acrylic (upper or lower metal clasps) $475.00 $895.00
Cast alloy with palatal or lingual bar $690.00 $1005.00
Uuilateral (Nesbeth appliance) $410.00 $600.00
Precision or Semi-Precision Partial
With two attachments $1260.00 $2150.00
With three attachments $1840.00 $2800.00
Denture adjustments (for dentures made at another office) $40.00 $66.00
Nite guard or flipper $280.00 430.00
Reline:
In office $160.00 $230.00
Laboratory processed $220.00 $315.00
Broken Denture (no teeth involved) $83.00 $124.00
Replace tooth on denture $70.00 $120.00
Space Maintainers
Unilateral $200.00 $280.00
Bilateral $240.00 $315.00

 

bulletPlease Note: Rates are Subject to Periodic Change
Without Prior Notification