D0120 Periodic Oral Evaluation – $65
D0140 Limited Oral Evaluation – $85
D0210 Intraoral Complete Series – $133
D0220 Intraoral-Periapical X-ray – $31
D0230 Intraoral Periapical Xray add’l – $31
D0272 Bitewing X-rays- 2 films – $48
D1110 Adult Prophylaxis (Over age 12) – $93
D1120 Prophylaxis Child – $73
D1206 Topical Fluoride Varnish – $42
D1208 Topical Application of Fluoride – $33
D1351 Sealant – $80
D2391 1 Surface Posterior Resin Composite – $179
D2392 2 Surface Posterior Resin Composite – $230
D7140 Extraction – $150
D9230 Analgesia (Nitrous Oxide) – $60