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
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MPD Savings Price
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Higher Prices Elsewhere
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| 00120 | Regular Routine Examination |
$50.00
|
$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
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| 00210 | Intra-oral complete x-ray series – once every 3 years |
$110.00
|
$129.00
|
| 00330 | Panoramic film |
$110.00
|
$129.00
|
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RESTORATIVE PROCEDURES
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|
MPD Savings Price
|
Others expect to pay
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| 02140 | Amalgam filling; 1 surface; permanent |
$105.00
|
$127.00
|
| 02150 | Amalgam filling; 2 surfaces; permanent |
$130.00
|
$195.00
|
| 02160 | Amalgam filling; 3 surfaces; permanent |
$160.00
|
$235.00
|
| 02161 | Amalgam filling; 4 or more surfaces; permanent |
$200.00
|
$303.00
|
| 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 |
$925.00
|
$1290.00
|
| 02750 | Crown; porcelain fused to high noble |
$925.00
|
$1290.00
|
| 02751 | Crown, porcelain fused to predominantly base metal |
$925.00
|
$1175.00
|
| 02752 | Crown; porcelain fused to noble |
$925.00
|
$1290.00
|
| 06066 | Crown;
for implant; porcelain/metal; plus cost of surgery |
$1400.00
|
$1470.00
|
| 02954 | Prefabicated
post and core; cost in addition to crown |
$225.00
|
$266.00
|
| 02920 | Recement crown |
$100.00
|
$115.00
|
| 02930 | Prefabricated stainless steel crown – #1 tooth |
$121.00
|
$185.00
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| 02940 | Prefabricated stainless steel crown – #2 tooth |
$144.00
|
$200.00
|
| 02940 | Sedative
filling; in additional cost |
$70.00
|
$86.00
|
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ENDODONTIAL PROCEDURES
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| 03110 | Pulp cap; Direct; excluding final restoration |
$50.00
|
$70.00
|
| 03120 | Pulp cap; indirect; excluding final restoration |
$50.00
|
$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 |
$750.00
|
$789.00
|
| 03320 | Root canal; bi-cuspid; excluding final restoration |
$800.00
|
$900.00
|
| 03330 | Root canal; molar; excluding restoration |
$900.00
|
$1075.00
|
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PERIODONTAL PROCEDURES
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| 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
|
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PROSTHODONTICS
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| 05110 | Denture; complete upper; including 6 months post-insertion care |
$1000.00
|
$1320.00
|
| 05410 | Adjustments after six months |
$70.00
|
$65.00
|
| 05110 | Denture; complete lower; including 6 months post-insertion care |
$1000.00
|
$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. |
$1100.00
|
$1499.00
|
| 05410 | Adjustments after six months |
$70.00
|
$85.00
|
| 05211 | Partial; upper; acrylic base; including conventional clasps and rests |
$950.00
|
$1027.00
|
| 05212 | Partial; lower; acrylic base; including conventional clasps and rests |
$950.00
|
$1027.00
|
| 05213 | Partial; upper; predominantly cast base acrylic saddles, including conventional clasps and rests |
$1050.00
|
$1450.00
|
| 05214 | Partial; lower; predominantly cast base acrylic saddles, including conventional clasps and rests |
$1050.00
|
$1450.00
|
| 05525/26 | Partial; upper/lower; flexible base; clasps/rests |
$1050.00
|
$1450.00
|
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ORAL SURGERY
|
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| 07140 | Extraction; simple, single tooth |
200.00
|
$280.00
|
| 07111 | Extraction; primary (child) |
$190.00
|
$260.00
|
| 07130 | Extraction; root removal, root exposed |
$200.00
|
$270.00
|
| 07210 | Extraction; surgical removal of erupted tooth |
$280.00
|
$375.00
|
| 07220 | Extraction; impacted, soft tissue |
$300.00
|
$415.00
|
| 07230 | Extraction; impacted partial boney |
$350.00
|
$450.00
|
| 07240 | Extraction; impacted, complete boney |
$500.00
|
$550.00
|
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ADDITIONAL GENERAL SERVICES
|
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| 09110 | Palliative care |
$125.00
|
$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
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