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%
X-Rays:
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.

NOTICE TO RESIDENTS OF Connecticut, Illinois, Indiana, Nevada, Oklahoma, South Carolina, and Utah: This website
is not authorized for use in your State. To view the website authorized in our State, CLICK HERE.