Fee Disclosure for Top 15 Procedures

Fee Disclosure for Top 15 Procedures

In 2017, the Colorado state legislature passed Senate Bill (SB) 65, which requires all healthcare providers and facilities to publish a list of cash pay prices (fees). Below you will find our top 15 procedures and the associated fees based on the cash-pay, non-discounted fees.

Code Description Fee
D1110 Prophylaxis – Adult $101.00
D0150 Comprehensive oral evaluation – new or established patient $75.00
D0210 Intraoral – complete series of radiographic images $129.00
D0274 Bitewings – four radiographic images $60.00
D0120 Periodic oral evaluation – established patient $50.00
D0220 Intraoral – periapical first radiographic image $27.00
D0230 Intraoral – periapical each additional radiographic image $21.00
D0140 Limited oral evaluation – problem focused $75.00
D2391 Resin-based composite – one surface, posterior $170.00
D2392 Resin-based composite – two surfaces, posterior $216.00
D4910 Periodontal maintenance $138.00
D4341 Periodontal scaling and root planing – four or more teeth per quadrant $255.00
D4342 Periodontal scaling and root planing – one to three teeth per quadrant $180.00
D2740 Crown – porcelain/ceramic substrate $1,260.00
D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth   $248.00
“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.”

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