Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Dental Implants Surgical placement of implant body. 1800 700 -61% D6010 Bone graft 1cc. (only if necessary). 824 260 -68% D6104 Membrane (only if necessary). 420 195 -54% Temporary healing denture maxilla or mandibula. 1799 325 -82% D5130/D5120 Single tooth implant Crown with prefabricated abutment. 1557 700 -55% D6060/D6066 Single tooth implant Crown with custom abutment. 1703 780 -54% D6063/D6065 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Crowns, Veneers and Single Restorations Temporary Crown. 495 60 -88% D2799 100% Porcelain Crown CAD CAM technology. 1200 445 -63% D2740 100% Porcelain Crown E-Max. 1200 410 -66% D2740 Zirconia Crown CAD CAM technology. 1500 475 -68% D2740 Metal-Porcelain Crown (high noble-metal). 1266 450 -64% D2750 Metal-Porcelain Crown (base metal). 1000 350 -65% D2751 Complete gold cast Crown 1320 345 -74% D2790 Metal-Porcelain crown with milling guide plane. (base metal). 1000 380 -62% D2751 Porcelain veneer. 1200 450 -63% D2962 Temporary veneer. 779 75 -90% D2960 Fiber glass post and core build up 381 160 -58% D2954 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Crown and Bridges Temporary Crown. (Retainer or pontic). 853 60 -93% D2799/D6253 100% Porcelain Crown CAD CAM technology (Retainer or pontic). 1450 450 -69% D2740/D6245 100% Porcelain Crown E-Max. (Retainer or pontic). 1260 420 -67% D2740/D6245 Zirconia Crown CAD CAM technology. (Retainer or pontic) 1500 475 -68% D2740/D6245 Metal-Porcelain Crown. High noble-metal. (Retainer or pontic). 1273 480 -62% D2750/D6240 Metal-Porcelain Crown. Non-noble metal (Retainer or pontic). 1187 325 -73% D2751/D6241 Complete gold cast Crown . (Retainer or pontic). 1320 345 -74% D2790/D6210 Metal-Porcelain Crown with milling guide plane. Non-noble metal. (Retainer or pontic). 1187 380 -68% D2751/D6241 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code In –lays / On-lays In-lay E-Max. (100% porcelain). 1141 260 -77% D2630 On-lay E-Max. (100% porcelain). 1236 275 -78% D2644 Gold cast in-lay + weight in gold 1092 220 -80% D2530 Gold cast on-lay + weight in gold 1192 235 -80% D2544 In-lay SR Nexco (lab composite). 1079 180 -83% D2652 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Composite resin fillings. Composite resin filling anterior or posterior tooth one surface 168 90 -46% D2330 Composite resin filling anterior or posterior tooth two surfaces 210 95 -55% D2331 Composite resin filling anterior or posterior tooth three surfaces 281 110 -61% D2332 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Endodontic. Root canal treatment anterior tooth. 833 180 -78% D3310 Root canal treatment bicuspid tooth. 949 210 -78% D3320 Root canal treatment molar tooth. 1168 250 -79% D3330 Root canal re treatment anterior tooth. 948 270 -72% D3346 Root canal re treatment bicuspid tooth. 1073 300 -72% D3347 Root canal re treatment molar tooth. 1274 330 -74% D3348 Fiber glass post and core build up. 381 160 -58% D2954 Core build up. 302 88 -71% D2950 Apicoetomy-Anterior 779 385 -51% D3410 Apicoetomy-Bicuspid (First Root) 874 420 -52% D3421 Apicoetomy-Molar (First root) 969 450 -54% D3425 Apicoetomy-Additional Root 487 220 -55% D3426 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Extractions Simple extractions. 185 50 -73% D7140 Complicated extraction. 300 80 -73% D7210 Surgical extraction. 500 210 -58% D7240 Third molar extraction. 500 210 -58% D7240 Removal of residual tooth roots. 344 80 -77% D7250 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Dental cleaning and Whitennig. General dental cleaning adult 270 120 -56% D1110 Boost Whitenning both arch 732 200 -73% D9972 Dental Procedure US Prices Salud Oral Preferred SAVINGS ADA Code Periodontics Consultation / Per visit $90.00 $50.00 -44% D0120 Prophylaxis / Per mouth $140.00 $120.00 -14% D110 Deep cleaning / Per cuadrant $286.00 $175.00 -39% D4341 Deep cleaning / Per sexant $220.00 $158.00 -28% D4341 Deep cleaning / 1,2,3 teeth $210.00 $110.00 -48% D4342 Open curettage / Per cuadrant $621.00 $240.00 -61% D4240 Open curettage / per sexant $570.00 $200.00 -65% D4240 Open curettage / 1,2,3 teeth $517.00 $180.00 -65% D4241 Bone replacement graft / Per site $770.00 $265.00 -66% D4263 Crown lengthening with osteotomy / Per tooth $250.00 $170.00 -32% D4249 Crown lengthening without osteotomy / Per tooth $210.00 $105.00 -50% D4249 Crown lengthening for an esthetic smile / Per arch $1000.00 $525.00 -48% D4249 Gingivectomy / Per arch $1000.00 $380.00 -62% D4210 Frenulectomy / Per site $502.00 $240.00 -52% D7960 Excisional biopsy reduced injury / Per site $380.00 $170.00 -55% D7410 Excisional biopsy wide injury/ Per site $469.00 $240.00 -49% D7410 Lip repositioning / Per site $6500.00 $750.00 -88% Vestibuloplasty / Per site $1413.00 $555.00 -61% D7340 Vestibuloplasty with free gingival graft / Per site $2723.00 $555.00 -80% D7350 Pedicle soft tissue graft / Per cuadrant $928.00 $440.00 -53% D4270 Pedicle soft tissue graft / Per tooth $385.00 $140.00 -64% D4270 Pedicle soft tissue graft / 2 Teeth $530.00 $250.00 -53% D4270 Pedicle soft tissue graft / 3-4 Teeth $720.00 $350.00 -51% D4270 Root coverage with conective tissue graft / Per gingival recession $1209.00 $500.00 -59% D4273 Prophylactic free gingival graft / Per site $876.00 $300.00 -66% D4278 Terapeutic free gingival graft / Per gingival recession $1055.00 $300.00 -72% D4277 Distal wedge / Per site $744.00 $185.00 -75% D4274 Alveoloplasty without extractions / Per site $570.00 $300.00 -47% D7320 Abscess drainage / Per tooth $271.00 $90.00 -67% D7510 Corticotomy for orthodontic treatment / Per arch $1350.00 $780.00 -42% D7297 Autogenus conective tissue graft procedure in endetuLus zone / Per arch $550.00 $250.00 -55% D4283 Surgical Access of unerupted tooth / Per tooth $400.00 $210.00 -48% D7280 Exploratory surgery / Per area $517.00 $140.00 -73% D4241 Third molar extraction / Per tooth $500.00 $210.00 -58% D7240 Simple extraction / Per tooth $185.00 $50.00 -73% D7140 Root amputation / Per root $418.00 $210.00 -50% D3450
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