MPD Dental Cost Savings Program
Procedures not specifically listed on the fee schedule in the participating General Dentist’s office are discounted 25%
Prices valid through 1/31/2020
PREVENTATIVE PROCEDURES
MPD Savings Prices versus Typical Prices without MPD Savings
MPD Savings Price
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Higher Prices Elsewhere
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00120 | Regular Routine Examination |
$50.00
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$90.00
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00140 | Limited oral examination; problem focused |
$100.00
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$125.00
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00460 | Pulp vitality test |
$25.00
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$45.00
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01110 | *Cleaning. Youth or adult |
$75.00
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$109.00
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01120 | *Cleaning. Child |
$55.00
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$84.00
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*Note: cleaning is light scaling & polishing. If you need more than this your cost will be higher. Reduced fee cleaning (light or heavy) available once every six months. | |||
01203 | Topical flouride; child or adult |
$22.00
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$50.00
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01351 | Sealant – per tooth |
$30.00
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$54.00
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01360 | Infection control. Each visit |
$5.00
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$14.00
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01510 | Space maintainer; fixed unilateral |
$225.00
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$282.00
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01515 | Space maintainer; fixed bilateral |
$248.00
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$310.00
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00210 | Intra-oral complete x-ray series – once every 3 years |
$110.00
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$129.00
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00330 | Panoramic film |
$110.00
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$129.00
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RESTORATIVE PROCEDURES
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MPD Savings Price
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Others expect to pay
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02140 | Amalgam filling; 1 surface; permanent |
$105.00
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$127.00
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02150 | Amalgam filling; 2 surfaces; permanent |
$130.00
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$195.00
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02160 | Amalgam filling; 3 surfaces; permanent |
$160.00
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$235.00
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02161 | Amalgam filling; 4 or more surfaces; permanent |
$200.00
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$303.00
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02330 | Resin filling; 1 surface; anterior |
$105.00
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$127.00
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02331 | Resin filling; 2 surfaces; anterior |
$130.00
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$195.00
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02332 | Resin filling; 3 surfaces; anterior |
$160.00
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$235.00
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02335 | Resin filling; 4 or more surfaces; anterior |
$200.00
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$303.00
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02391 | Resin filling; 1 surface; posterior |
$135.00
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$210.00
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02392 | Resin filling; 2 surfaces; posterior |
$175.00
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$259.00
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02393 | Resin filling; 3 surfaces; posterior |
$190.00
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$290.00
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02394 | Resin filling; 4 or more surfaces |
$215.00
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$305.00
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02740 | Crown; ceramic |
$925.00
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$1290.00
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02750 | Crown; porcelain fused to high noble |
$925.00
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$1290.00
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02751 | Crown, porcelain fused to predominantly base metal |
$925.00
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$1175.00
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02752 | Crown; porcelain fused to noble |
$925.00
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$1290.00
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06066 | Crown;
for implant; porcelain/metal; plus cost of surgery |
$1400.00
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$1470.00
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02954 | Prefabicated
post and core; cost in addition to crown |
$225.00
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$266.00
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02920 | Recement crown |
$100.00
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$115.00
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02930 | Prefabricated stainless steel crown – #1 tooth |
$121.00
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$185.00
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02940 | Prefabricated stainless steel crown – #2 tooth |
$144.00
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$200.00
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02940 | Sedative
filling; in additional cost |
$70.00
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$86.00
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ENDODONTIAL PROCEDURES
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03110 | Pulp cap; Direct; excluding final restoration |
$50.00
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$70.00
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03120 | Pulp cap; indirect; excluding final restoration |
$50.00
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$70.00
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03220 | Therapeutic pulpotomy; excluding final restoration |
$170.00
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$199.00
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03321 | Pulpal debridement |
$150.00
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$199.00
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03310 | Root canal; anterior; excluding final restoration |
$750.00
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$789.00
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03320 | Root canal; bi-cuspid; excluding final restoration |
$800.00
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$900.00
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03330 | Root canal; molar; excluding restoration |
$900.00
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$1075.00
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PERIODONTAL PROCEDURES
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04210 | Gingivectomy; upper; per quadrant |
$300.00
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$559.00
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04211 | Gingivectomy; per tooth |
$70.00
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$99.00
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04260 | Osseous surgery; flap entry, close, per quadrant |
$454.00
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$613.00
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04341 | Periodontal scaling; root planning, per quadrant |
$160.00
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$194.00
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PROSTHODONTICS
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05110 | Denture; complete upper; including 6 months post-insertion care |
$1000.00
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$1320.00
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05410 | Adjustments after six months |
$70.00
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$65.00
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05110 | Denture; complete lower; including 6 months post-insertion care |
$1000.00
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$1320.00
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05410 | Adjustments after six months |
$70.00
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$65.00
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05130 | Denture; immediate upper; includes six months post insertion care. Does not include required future rebasing/relining procedure(s) or a complete new denture at a later date. |
$1100.00
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$1499.00
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05410 | Adjustments after six months |
$70.00
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$85.00
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05211 | Partial; upper; acrylic base; including conventional clasps and rests |
$950.00
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$1027.00
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05212 | Partial; lower; acrylic base; including conventional clasps and rests |
$950.00
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$1027.00
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05213 | Partial; upper; predominantly cast base acrylic saddles, including conventional clasps and rests |
$1050.00
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$1450.00
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05214 | Partial; lower; predominantly cast base acrylic saddles, including conventional clasps and rests |
$1050.00
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$1450.00
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05525/26 | Partial; upper/lower; flexible base; clasps/rests |
$1050.00
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$1450.00
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ORAL SURGERY
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07140 | Extraction; simple, single tooth |
200.00
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$280.00
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07111 | Extraction; primary (child) |
$190.00
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$260.00
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07130 | Extraction; root removal, root exposed |
$200.00
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$270.00
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07210 | Extraction; surgical removal of erupted tooth |
$280.00
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$375.00
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07220 | Extraction; impacted, soft tissue |
$300.00
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$415.00
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07230 | Extraction; impacted partial boney |
$350.00
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$450.00
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07240 | Extraction; impacted, complete boney |
$500.00
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$550.00
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ADDITIONAL GENERAL SERVICES
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09110 | Palliative care |
$125.00
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$145.00
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03960 | Bleaching; per case |
$300.00
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$350.00
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00016 | Cancelled appointment w/o 24 hours notice; per every scheduled 30 minutes cancelled |
$35.00
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$50.00
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