
Periodic Exam (6 month exam) for established patient - $59
Two Bitewing Radiographs (X-rays for children under 12) - $49
Prophylaxis Child - $81
Topical Flouride Varnish - $48
Total - $237
Periodic Exam (6 month exam) for established patient - $59
Four Bitewing Radiographs (X-rays for children under 12) - $74
Prophylaxis Adult - $111
Topical Flouride Varnish - $48
Total - $292
Limited Oral Evaluation (Emergency Exam) - $87
One Periapical Radiograph - $33
Total - $120
| Service | Cash Price |
|---|---|
| Periodic Exam (6 month exam) for established patient | $59 |
| Limited Oral Evaluation (Emergency Exam) | $87 |
| Two Bitewing Radiographs (X-rays for children <12 years) | $49 |
| Four Bitewings (X-rays for children < 12 years) | $74 |
| One Periapical radiograph | $33 |
| Prophylaxis Adult (12 years and older) | $111 |
| Prophylaxis Child | $81 |
| Topical Fluoride Varnish | $48 |
| Two surface filling | $206 |
| White Crown Primary Tooth | $328 |
| Stainless Steel Crown Primary Tooth | $308 |
| Nitrous Oxide (laughing gas) | $82 |