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 1/31/2019

PREVENTATIVE PROCEDURES

MPD Savings Prices versus Typical Prices without MPD Savings

   
MPD Savings Price
Higher Prices Elsewhere
00120 Regular Routine Examination
$40.00
$90.00
00140 Limited oral examination; problem focused
$100.00
$125.00
00460 Pulp vitality test
$25.00
$45.00
01110 *Cleaning. Youth or adult
$75.00
$109.00
01120 *Cleaning. Child
$55.00
$84.00
*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
$50.00
01351 Sealant – per tooth
$30.00
$54.00
01360 Infection control. Each visit
$5.00
$14.00
01510 Space maintainer; fixed unilateral
$225.00
$282.00
01515 Space maintainer; fixed bilateral
$248.00
$310.00
00210 Intra-oral complete x-ray series – once every 3 years
$100.00
$129.00
00330 Panoramic film
$100.00
$129.00
RESTORATIVE PROCEDURES
MPD Savings Price
Others expect to pay
02140 Amalgam filling; 1 surface; permanent
$74.00
$88.00
02150 Amalgam filling; 2 surfaces; permanent
$84.00
$109.00
02160 Amalgam filling; 3 surfaces; permanent
$100.00
$127.00
02161 Amalgam filling; 4 or more surfaces; permanent
$120.00
$163.00
02330 Resin filling; 1 surface; anterior
$105.00
$127.00
02331 Resin filling; 2 surfaces; anterior
$130.00
$195.00
02332 Resin filling; 3 surfaces; anterior
$160.00
$235.00
02335 Resin filling; 4 or more surfaces; anterior
$200.00
$303.00
02391 Resin filling; 1 surface; posterior
$135.00
$210.00
02392 Resin filling; 2 surfaces; posterior
$175.00
$259.00
02393 Resin filling; 3 surfaces; posterior
$190.00
$290.00
02394 Resin filling; 4 or more surfaces
$215.00
$305.00
02740 Crown; ceramic
$915.00
$1290.00
02750 Crown; porcelain fused to high noble
$915.00
$1290.00
02751 Crown, porcelain fused to predominantly base metal
$880.00
$1175.00
02752 Crown; porcelain fused to noble
$915.00
$1290.00
06066 Crown; for implant; porcelain/metal; plus cost of surgery
$1220.00
$1470.00
02954 Prefabicated post and core; cost in addition to crown
$200.00
$266.00
02920 Recement crown
$85.00
$115.00
02930 Prefabricated stainless steel crown – #1 tooth
$121.00
$185.00
02940 Prefabricated stainless steel crown – #2 tooth
$144.00
$200.00
02940 Sedative filling; in additional cost
$70.00
$86.00
ENDODONTIAL PROCEDURES
03110 Pulp cap; Direct; excluding final restoration
$45.00
$70.00
03120 Pulp cap; indirect; excluding final restoration
$45.00
$70.00
03220 Therapeutic pulpotomy; excluding final restoration
$170.00
$199.00
03321 Pulpal debridement
$150.00
$199.00
03310 Root canal; anterior; excluding final restoration
$700.00
$789.00
03320 Root canal; bi-cuspid; excluding final restoration
$725.00
$900.00
03330 Root canal; molar; excluding restoration
$890.00
$1075.00
PERIODONTAL PROCEDURES
04210 Gingivectomy; upper; per quadrant
$300.00
$559.00
04211 Gingivectomy; per tooth
$70.00
$99.00
04260 Osseous surgery; flap entry, close, per quadrant
$454.00
$613.00
04341 Periodontal scaling; root planning, per quadrant
$160.00
$194.00
PROSTHODONTICS
05110 Denture; complete upper; including 6 months post-insertion care
$975.00
$1320.00
05410 Adjustments after six months
$70.00
$65.00
05110 Denture; complete lower; including 6 months post-insertion care
$975.00
$1320.00
05410 Adjustments after six months
$70.00
$65.00
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.
$1050.00
$1499.00
05410 Adjustments after six months
$70.00
$85.00
05211 Partial; upper; acrylic base; including conventional clasps and rests
$900.00
$1027.00
05212 Partial; lower; acrylic base; including conventional clasps and rests
$900.00
$1027.00
05213 Partial; upper; predominantly cast base acrylic saddles, including conventional clasps and rests
$1000.00
$1450.00
05214 Partial; lower; predominantly cast base acrylic saddles, including conventional clasps and rests
$1000.00
$1450.00
05525/26 Partial; upper/lower; flexible base; clasps/rests
$1000.00
$1450.00
ORAL SURGERY
07140 Extraction; simple, single tooth
175.00
$280.00
07111 Extraction; primary (child)
$160.00
$260.00
07130 Extraction; root removal, root exposed
$175.00
$270.00
07210 Extraction; surgical removal of erupted tooth
$260.00
$375.00
07220 Extraction; impacted, soft tissue
$275.00
$415.00
07230 Extraction; impacted partial boney
$310.00
$450.00
07240 Extraction; impacted, complete boney
$425.00
$550.00
ADDITIONAL GENERAL SERVICES
09110 Palliative care
$100.00
$145.00
03960 Bleaching; per case
$300.00
$350.00
00016 Cancelled appointment w/o 24 hours notice; per every scheduled 30 minutes cancelled
$35.00
$50.00