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Sample Dental Fee Schedule

This is the AmeriPlan® Teal Fee Schedule. For a more in-depth search of dentists and their fee schedules, click here.

Questions? Chart terms explained

Sample General Dentist Procedures Dental Office Fees up to* Plan Fees Plan Savings
up to*

Periodic Oral Exam $60 $12 80%
Initial Oral Exam $100 $32 68%
  Intraoral Complete Series $122 $50 59%
  Panoramic $110 $50 55%
Regular Teeth Cleaning $95 $42 56%
Deep Teeth Cleaning $215 $75 65%
Amalgam Filling (Silver Colored):
  1 Surface (Primary or Permanent)
$130 $60 54%
  2 Surfaces (Primary or Permanent) $160 $70 56%
Composite Filling (Tooth Colored):
  1 Surface (Anterior) $150 $72 52%
  2 Surfaces (Anterior) $190 $88 54%
Root Canal:
  Anterior $690 $325 53%
  Bicuspid $800 $375 53%
Porcelain Crown with High Noble Metal $1050 $515 51%
Orthodontic Braces** by General Dentist:
  Children (under 19) $5,000 $2,100 58%
  Adults (19 and over) $5,500 $2,250 59%

*Source: National Dental Advisory Services 2003
Dental Economics, Annual Dental Fee Survey 2003
**Invisalign Braces may not be included

TREATMENT BY SPECIALISTS (Orthodontists, Periodontists, Endodontists, Prosthodontists, Pedodontists, Oral Surgeons) - Members will receive a 25% discount off the participating specialist's usual and customary fees.

The above fee schedule apply to the major metropolitan areas of California, Connecticut, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvannia, Utah, Virginia, Washington, Wisconsin and the entire state of Rhode Island.

Different fees may apply in other areas of the above states. To locate Plan dentists and their Fee Schedules, click here.



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