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303 Merrick Rd. Lynbrook, NY 11563
866-679-7437
Fee Schedule
The prices listed are the total cost for the according procedure. There are no surprise costs
CODE | PROCEDURE | WHAT YOU'LL PAY WITH UFT DIRECT ACCESS | TYPICAL CHARGE (WITHOUT UFT DA) | SAVINGS |
|---|---|---|---|---|
D0150 | Comprehensive Oral Examination | $45 | $120 | $75 |
D0210 | X-Rays Full Mouth | $50 | $187 | $137 |
D0220 | Periapical X-Ray First Film | $6 | $41 | $35 |
D0240 | Occlusal Film | $15 | $57 | $42 |
D0270 | X-Ray 1 Bitewing | $6 | $41 | $35 |
D0330 | Panoamic Film | $50 | $160 | $110 |
D1110 | Prophylaxis | $45 | $101 | $56 |
D1120 | Prophylaxis - Child | $45 | $73 | $28 |
D1351 | Sealant | $30 | $61 | $31 |
D1510 | Space Maintainer - Fixed | $300 | $442 | $142 |
D2140 | Amalgam - One Surface - Permanent or Primary | $55 | $200 | $145 |
D2150 | Amalgam - Two Surfaces - Permanent or Primary | $65 | $251 | $186 |
D2160 | Amalgam - Three Surfaces - Permanent or Primary | $75 | $307 | $232 |
D2330 | Resin - One Surface | $70 | $236 | $166 |
D2335 | Resin - 4+ Surfaces or Incisal Edge | $85 | $400 | $315 |
D2510 | Inlay - Metallic - One Surface | $150 | $1,178 | $1,028 |
D2520 | Inlay - Metallic - Two Surfaces | $175 | $1,268 | $1,093 |
D2530 | Inlay - Metallic - Three or More Surfaces | $200 | $1,350 | $1,150 |
D2710 | Crown - Resin (Laboratory) | $250 | $1,288 | $1,038 |
D2721 | Crown - Resin With Base Metal | $370 | $1,412 | $1,042 |
D2740 | Crown - Porcelain/Ceramic Substrate | $425 | $1,606 | $1,181 |
D2751 | Crown - Porc. Fused To Base Metal | $475 | $1,468 | $993 |
D2781 | Crown - 3/4 Cast Base Metal | $325 | $1,446 | $1,121 |
D2791 | Crown - Full Cast Base Metal | $350 | $1,453 | $1,103 |
D2920 | Recement Crown | $15 | $155 | $140 |
D2930 | Prefabricated SS Crown-Primary | $150 | $380 | $230 |
D2951 | Pin Support Per Tooth | $12 | $104 | $92 |
D2952 | Cast Post & Core | $125 | $574 | $449 |
D2954 | Prefab Post & Core | $60 | $480 | $420 |
D2960 | Labial Laminate | $215 | $890 | $675 |
D3110 | Pulp Cap-Direct | $10 | $117 | $107 |
D3220 | Vital Pulpotomy | $35 | $283 | $248 |
D3310 | Root Canal Therapy - Anterior Tooth | $275 | $1,063 | $788 |
D3320 | Root Canal Therapy - Bicuspid Tooth | $350 | $1,209 | $859 |
D3330 | Root Canal Therapy - Molar Tooth | $525 | $1,466 | $941 |
D3346 | Retreatment - RCT - Anterior | $550 | $1,221 | $671 |
D3347 | Retreatment of RCT - Bicuspid | $700 | $1,385 | $685 |
D3348 | Retreatment RCT - Molar | $1,050 | $1,648 | $598 |
D3410 | Apicoectomy - First Root | $275 | $987 | $712 |
D3426 | Apicoectomy - Each Additional RT | $425 | $560 | $135 |
D3430 | Retrograde Filling | $75 | $387 | $312 |
D3450 | Root Resection | $100 | $671 | $571 |
D3920 | Hemisection | $100 | $634 | $534 |
D4210 | Gingivectomy or Gingivoplasty | $110 | $857 | $747 |
D4249 | Crown Lengthening | $110 | $1,071 | $961 |
D4260 | Osseous Surgery - Per Quadrant | $350 | $1,501 | $1,151 |
D4261 | Osseous Surgery 1-3 Teeth | $200 | $1,221 | $1,021 |
D4263 | Osseous Graft - Per Site | $110 | $885 | $775 |
D4341 | Perio Treatment Per Quad | $35 | $363 | $328 |
D4910 | Periondontal Maintenance | $70 | $193 | $123 |
D5110 | Complete Upper Denture | $475 | $2,335 | $1,860 |
D5130 | Immediate Full Upper Denture | $475 | $2,591 | $2,116 |
D5140 | Immediate Full Lower Denture | $475 | $2,599 | $2,124 |
D5211 | Upper Partial - Acrylic Base W/Clasps | $375 | $1,901 | $1,526 |
D5212 | Lower Partial Acylic W/Clasps | $375 | $1,901 | $1,526 |
D5213 | Upper Partial - Cast Metal | $475 | $2,508 | $2,033 |
D5214 | Lower Partial - Cast Metal | $475 | $2,528 | $2,053 |
D5281 | Removable Unilateral | $275 | $1,368 | $1,093 |
D5510 | Repair Full Denture Base | $90 | $300 | $210 |
D5630 | Repair or Replace Broken Clasp | $63 | $379 | $316 |
D5640 | Replace Broken Tooth | $65 | $267 | $202 |
D5650 | Add Tooth to Denture | $90 | $320 | $230 |
D5730 | Reline Complete Maxillary Denture (Chairside) | $85 | $527 | $442 |
D5731 | Reline Complete Mandibular Denture (Chairside) | $85 | $524 | $439 |
D5740 | Reline Maxillary Partial Denture (Chairside) | $85 | $519 | $434 |
D5741 | Reline Mandibular Partial Denture (Chairside) | $85 | $520 | $435 |
D5750 | Reline Upper Denture-Lab | $165 | $647 | $482 |
D5751 | Reline Comp Lower Denture-Lab | $165 | $667 | $502 |
D5760 | Reline Partial Upper-Lab. | $165 | $660 | $495 |
D5761 | Reline Partial Lower-Lab. | $165 | $660 | $495 |
D6010 | Endosteal Implant | $1,200 | $2,671 | $1,471 |
D6241 | Pontic - Porc. Fused to Base Metal | $375 | $1,468 | $1,093 |
D6545 | Maryland Bridge Retainer | $150 | $1,171 | $1,021 |
D6980 | Fixed Partial Denture Repair Necessitated by resto | $50 | $536 | $486 |
D7140 | Extraction Erupted Tooth or Exposed Root | $55 | $254 | $199 |
D7210 | Surgical Extraction | $145 | $392 | $247 |
D7220 | Removal - Soft Tissue Impacted | $120 | $447 | $327 |
D7230 | Removal - Partial Bony Impacted | $200 | $558 | $358 |
D7240 | Removal - Complete Bony Impacted | $300 | $679 | $379 |
D7250 | Removal of Residual Roots | $120 | $427 | $307 |
D7260 | Closure of Oral Antral Fistula | $65 | $1,358 | $1,293 |
D7280 | Surg. Exp-Imo/Unerup (Ortho) | $150 | $663 | $513 |
D7285 | Biopsy Hard Tissue | $55 | $600 | $545 |
D7286 | Biopsy Soft Tissue | $55 | $463 | $408 |
D7310 | Alveolectomy | $65 | $419 | $354 |
D7320 | Alveolectomy - Per Quad. - No Ext. | $65 | $616 | $551 |
D7450 | Cyst/Tumor Removal < 1.25 CM | $65 | $835 | $770 |
D7960 | Frenulectomy | $65 | $634 | $569 |
D8080 | Initial Ortho App-Adolescent | $675 | $7,154 | $6,479 |
D8670 | Active Ortho Treat Per Month | $60 | $358 | $298 |
D8680 | Ortho Retention (Remove App, Constr/Place Retainer) | $300 | $667 | $367 |
D9110 | Palliative Treatment | $30 | $180 | $150 |
D9220 | General Anesthesia | $85 | '- | '- |
D9221 | General Anesthesia Additional | $85 | '- | '- |
D9230 | Analgesia | $35 | $107 | $72 |
D9310 | Specialist Consultation | $75 | $177 | $102 |
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