Fee Scheduels

General / Specialist Dentist Fees

Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25
Details Fees
Initial/Periodic Exam Free
Limited Exam Free
Comprehensive Exam Free
Initial/Periodic Exam Free
Intraoral Complete Series $75
Intraoral Single Film $14
Intraoral Addt’l. Film $14
Bitewing – Two Films $15
Bitewing – Four Films $20
Panoramic Film $75
Pulp Vitality Tests $15
Diagnostic Casts $25

Non-listed procedures performed by General Dentists are provided to Members at a Courtesy Fee of 25% off the General Dentist’s usual and customary fees.Fees effective February 1, 2020

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