Fee Discolsure 2022
LAKEWOOD
- D6010 Surgical place implant: $2150
- D4260 Osseous Surgery 4+ per quad/D4261 Osseous surgery 1-3 quad:
$1255/Quad or $1090/Quad
- D4910 Periodontal maintenance: $162
- D0140 Limited oral evaluation: $175
- D7953 Bone Repl Grft Ridge prsv/site: $495
- D4273 Connective tissue graft: $965
- D4277 Free soft tissue graft: $905
- D7210 Extract, erupted tooth: $355
- D0364 CT Capture, Limited View: $365
- D0180 Comprehensive Perio Evaluation: $230
- D3330 Endo Therapy- Molar: $ 1405
- D4341/ D4342 Perio Scale/Root Pln 4+ per quad/ Perio Scale/Root Pln 1-3th
quad: $255/quad or $165/quad
- D4263 Bone replace graft: $710
- D4249 Clinic crown lengthen-hard tissue: $905
- Periodic oral evaluation: $95
FRISCO
- D6010 Surgical place implant: $2150
- D3330 Endo Therapy- Molar: $ 1405
- D4260 Osseous Surgery 4+ per quad/D4261 Osseous surgery 1-3 quad:
$1255/Quad or $1090/Quad
- D0140 Limited oral evaluation: $175
- D7953 Bone Repl Grft Ridge prsv/site: $495
- D0364 CT Capture, Limited View: $365
- D4273 Connective tissue graft: $965
- D7210 Extract, erupted tooth: $355
- D3348 Retreat: $1650
- D0180 Comprehensive Perio Evaluation: $230
- D4277 Free soft tissue graft: $905
- D4910 Periodontal maintenance: $162
- D4341/ D4342 Perio Scale/Root Pln 4+ per quad/ Perio Scale/Root Pln 1-3th
quad: $255/quad or $165/quad
- D7952 Sinus Augment: $950
- D4263 Bone replace graft: $710
The health care price listed for any given health care service is an estimate. Actual charges for
the health care service are dependent on the circumstances, including any complications or
exceptional treatment, at the time the service is rendered.
If you are covered by health insurance or a dental plan, you are strongly encouraged to consult
with your insurer or plan to determine accurate information about your financial responsibility
for a particular health care service provided by a health care provider at this office. If you are not
covered by health insurance or a dental plan, you are strongly encouraged to contact our billing
office at [insert telephone number] to discuss payment options prior to receiving a health care
service from a health care provider at this office since posted health care prices may not reflect
the actual amount of your financial responsibility.