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 | $109.00 |
| D0150 | Comprehensive oral evaluation – new or established patient | $100.00 |
| D0210 | Intraoral – complete series of radiographic images | $154.00 |
| D0274 | Bitewings – four radiographic images | $73.00 |
| D0120 | Periodic oral evaluation – established patient | $61.00 |
| D0220 | Intraoral – periapical first radiographic image | $33.00 |
| D0230 | Intraoral – periapical each additional radiographic image | $30.00 |
| D0140 | Limited oral evaluation – problem focused | $82.00 |
| D2391 | Resin-based composite – one surface, posterior | $204.00 |
| D2392 | Resin-based composite – two surfaces, posterior | $264.00 |
| D4910 | Periodontal maintenance | $155.00 |
| D4341 | Periodontal scaling and root planing – four or more teeth per quadrant | $296.00 |
| D4342 | Periodontal scaling and root planing – one to three teeth per quadrant | $209.00 |
| D2740 | Crown – porcelain/ceramic substrate | $1,307.00 |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | $320.00 |
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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