| Service | Co-payment
"Basic Care"
|
Regular Fee |
| Adult Cleaning
(Every 6 months) |
No Charge | $108 |
| Children's Cleaning
(Every 6 months) |
No Charge | $75 |
| Examination | No Charge | $101 |
| X-Rays
(Every 12 Months) |
No Charge | $153 |
| Fluoride Treatment for Children
(Every 6 Months) |
No Charge | $40 |
| Service | Co-payment
"Basic Care"
|
Regular Fee |
| 1 Surface
(composite/tooth-colored) |
$153 | $191 |
| 2 Surfaces
(composite/tooth-colored) |
$195 | $244 |
| 3 Surfaces
(composite/tooth-colored) |
$239 | $299 |
| 4 Surfaces
(composite/tooth-colored) |
$315 | $394 |
| Service | Co-payment
"Basic Care"
|
Regular Fee |
| Cosmetic Whitening | $325 | $550 |
| Service | Co-payment
"Basic Care"
|
Regular Fee |
| Soft-Tissue Management
(per quadrant) |
$261 | $326 |
| Periodental Maintenence | $129 | $161 |
| Service | Co-payment
"Basic Care"
|
Regular Fee |
| Invisalign ®
(financing available, as low as $225/month) |
$4,038 | $5,047 |
| Nightguard | $480 | $600 |
| Service | Co-payment
"Basic Care"
|
Regular Fee |
| Porcelain Crown
(per unit) |
$1,158 | $1,447 |
| Gold Crown (per unit) |
$1,280 | $1,600 |
| Service | Co-payment
"Basic Care"
|
Regular Fee |
| Cosmetic Consultation | No Charge | No Charge |
| Emergency Exam | $60 | $75 |
| Sealants (per tooth) |
$48 | $60 |