| Dental Services |
Patient Pays |
PREVENTATIVE PROCEDURES
Teeth
Cleaning (2 times per year)
X-rays
Examinations
Fluoride Treatments |
$0.00 -You Pay Nothing! |
Periodontal Procedures
Gum Therapy
Deep Cleanings w/anesthesia |
$0.00 -You Pay Nothing! |
Fillings:
Silver Fillings
Composite “Tooth Colored” Fillings |
$0.00 -You Pay Nothing!
Small Out Of Pocket Expense |
Extractions with a General Dentist
Extractions with a Specialist (Oral Surgeon)
|
$0.00 -You Pay Nothing!
25% Courtesy Discount |
| Root Canal Procedures |
$150.00 Pre-set Co-payment |
| Crowns (Caps) |
$125.00 Pre-set Co-payment |
| Bridges (Permanently
placed to fill in for missing teeth) |
$125.00 per number of teeth involved
in bridge |
| Partial Dentures (Removable
appliance to fill in for missing teeth) |
$125.00 Pre-set Co-payment |
| Full Dentures (Removable
appliance to replace all missing teeth) |
$125.00 Pre-set Co-payment |
