Northeast General Dentists
Fee Schedule II

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 $14.00
X-rays (up to full mouth, or at least 3 films taken) $35.00 $75.00
Panarex $35.00 $95.00
Oral Examination and Diagnosis No Charge $45.00
Child Cleaning & Polishing - Excluding Fluoride $30.00 $65.00
Adult Cleaning, Polishing and Scaling $45.00 $100.00
Topical Fluoride Treatment for Children $20.00 $40.00
Palliative Treatment (Emergency Treatment of Pain) $30.00 $55.00
Sealants (Pit & Fissure, Per Tooth) $20.00 $40.00
Consultation (Including 2nd Opinion and/or Extensive Examination) $35.00 $55.00

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RESTORATIVE PROCEDURES (FILLINGS) NDPA FEE USUAL FEE
Silver Amalgams: Primary
One Surface $41.00 $57.00
Two Surfaces $47.00 $72.00
Three Surfaces $60.00 $85.00
Four Surfaces or more $70.00 $105.00
Silver Amalgams: Permanent
One Surface $44.00 $82.00
Two Surfaces $53.00 $115.00
Three Surfaces $64.00 $134.00
Four Surfaces or more $83.00 $159.00
Composite Resins: Anterior
One Surface $54.00 $82.00
Two Surfaces $68.00 $128.00
Three Surfaces $82.00 $153.00
Four Surfaces or more or involving incisal angle $103.00 $182.00
Composite Resins: Posterior
One Surface $58.00 $88.00
Two Surfaces $76.00 $128.00
Three Surfaces $105.00 $192.00
Pin retention, per pin $24.00 $50.00
Sedative Filling $34.00 $55.00

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COSMETIC PROCEDURES NDPA FEE USUAL FEE
Bonding/Veneers (per tooth)
Full face buildup (chairside) $185.00 $315.00
Laminate veneer - porcelain - laboratory $390.00 $695.00

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ENDODONTICS (performed by General Dentists) NDPA FEE USUAL FEE
Pulp capping (excl. final restoration) $27.00 $55.00
Pulpotomy (excl. final restoration) $55.00 $90.00
Root Canal Therapy
Anterior $282.00 $450.00
Bicuspid $345.00 $555.00
Molar $450.00 $725.00

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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 $115.00
Osseous or mucogingival surgery (per quadrant) $420.00 $695.00
Perio maintenance $50.00 $75.00

 

ORAL SURGERY (performed by General Dentists) NDPA FEE USUAL FEE
Extraction: Simple
Single tooth $55.00 $95.00
(each additioal tooth) $44.00 $72.00
Complex $77.00 $160.00
Incision and drainage $55.00 $135.00
Root removal $65.00 $145.00
Surgical Extractions:
Soft tissue impaction $125.00 $215.00
Partial bony impaction $165.00 $335.00
Full bony impaction $205.00 $430.00

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FIXED PROSTHODONTICS NDPA FEE USUAL FEE
Porcelain on non-precious metal crown $370.00 $685.00
All metal crown (not gold) $370.00 $685.00
Pontics $465.00 $875.00
Porcelain on semi to high noble metal crown $465.00 $875.00
Post and core (chairside) $115.00 $210.00
Core buildup - including pins $95.00 $175.00
Cast post (non-gold) laboratory $175.00 $325.00
Re-cement crown $30.00 $70.00
Re-cement bridge - per abutment $40.00 $72.00
Redo existing crown facing-crown build up $85.00 N/A
Maryland Bridge (without pontic - per wing) $225.00 $395.00
Laboratory processed temporary (per tooth) $77.00 $120.00
Temporary Crown (as part of crown procedure) NO CHARGE

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REMOVABLE PROSTHODONTICS NDPA FEE USUAL FEE
Complete Maxillary denture (including adjustments) $595.00 $895.00
Complete Mandibular denture (including adjustments) $595.00 $895.00
Partials:
Acrylic (upper or lower metal clasps) $450.00 $805.00
Cast alloy with palatal or lingual bar $615.00 $955.00
Uuilateral (Nesbeth appliance) $355.00 $595.00
Precision or Semi-Precision Partial
With two attachments $1185.00 $2050.00
With three attachments $1580.00 $2700.00
Denture adjustments (for dentures made in another office) $33.00 $60.00
Nite guard or flipper $250.00 400.00
Reline:
In office $145.00 $205.00
Laboratory processed $195.00 $305.00
Broken Denture (no teeth involved) $77.00 $110.00
Replace tooth on denture $65.00 $107.00
Space Maintainers
Unilateral $187.00 $280.00
Bilateral $240.00 $310.00

 

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