ADA Dental Fee Survey 2013

Data Trends in
Dentistry
Dental Fees
Results from the 2013
Survey of Dental Fees
2013 Survey of Dental Fees
Table of Contents
General Practitioners
National..................................................................................................................................................................................................................... 3
New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) .............................................................................. 17
Middle Atlantic (New Jersey, New York, Pennsylvania) ........................................................................................................................................... 24
East North Central (Illinois, Indiana, Michigan, Ohio, Wisconsin) ............................................................................................................................. 34
West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota) ........................................................................ 46
South Atlantic (Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, Washington D.C., West Virginia) ....................... 56
East South Central (Alabama, Kentucky, Mississippi, Tennessee) .......................................................................................................................... 67
West South Central (Arkansas, Louisiana, Oklahoma, Texas) ................................................................................................................................. 76
Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming) ......................................................................................... 86
Pacific (Alaska, California, Hawaii, Oregon, Washington) ........................................................................................................................................ 97
Specialists
Oral and Maxillofacial Surgeons ............................................................................................................................................................................... 109

Endodontists ............................................................................................................................................................................................................. 113
Orthodontists and Dentofacial Orthopedists ............................................................................................................................................................. 117
Pediatric Dentists ...................................................................................................................................................................................................... 118
Periodontists ............................................................................................................................................................................................................. 124
Prosthodontists ......................................................................................................................................................................................................... 128
Appendix
Methodology ............................................................................................................................................................................................................. 134

Glossary.................................................................................................................................................................................................................... 136
Survey Instrument..................................................................................................................................................................................................... 138
Important Note: The survey data should not be interpreted as constituting a fee schedule in any way, and should not be used for that purpose.
Dentists must establish their own fees based on their individual practice and market considerations. The American Dental Association discourages
dentists from engaging in any unlawful concerted activity regarding fees or otherwise.
Copyright © 2014 American Dental Association.

General Practitioners - National
Percentile Fees
Average Standard Median
Procedure Fee Deviation 10th 25th 50th 75th 80th 85th 90th 95th Number of
Code Description of Service $ $ $ $ $ $ $ $ $ $ Responses
Periodic oral evaluation — established
D0120 patient 45.61 11.90 32 39 45 51 54 57 60 67 1,235
D0140 Limited oral evaluation - problem focused 64.41 18.35 42 52 65 75 78 81 86 95 1,209

Oral evaluation for a patient under three
years of age and counseling with primary
D0145 caregiver 52.87 18.40 30 40 50 64 67 71 77 83 598
Comprehensive oral evaluation - new or
D0150 established patient 72.92 20.60 49 60 74 85 88 92 97 105 1,218
Detailed and extensive oral evaluation -
D0160 problem focused, by report 103.81 54.33 45 63 96 143 150 160 171 198 782
Re-evaluation - limited, problem focused
(established patient; not post-operative
D0170 visit) 51.48 27.17 0 39 54 69 72 76 82 91 795
Comprehensive periodontal evaluation -
D0180 new or established patient 80.51 25.45 50 62 79 95 99 103 111 125 815
D0190 Screening of a patient 48.18 21.33 22 35 47 60 65 75 79 85 87
D0191 Assessment of a patient 50.48 21.43 25 35 50 60 70 75 81 95 83
Intraoral - complete series of radiographic
D0210 images 123.70 24.54 95 106 122 140 144 149 154 168 1,147
Intraoral - periapical first radiographic
D0220 image 26.59 7.05 18 22 26 30 31 32 35 40 1,227
Intraoral - periapical each additional
D0230 radiographic image 21.29 6.24 13 18 21 25 26 27 29 30 1,213
D0272 Bitewings - two radiographic images 42.00 9.22 30 36 41 47 48 50 54 60 1,173
D0273 Bitewings - three radiographic images 51.12 11.26 38 44 50 58 60 62 66 71 683
D0274 Bitewings - four radiographic images 59.67 12.32 45 51 59 66 69 72 75 83 1,166
Vertical bitewings - 7 to 8 radiographic
D0277 images 92.65 24.86 61 75 90 105 111 120 125 138 541
D0330 Panoramic radiographic image 104.65 19.78 80 92 102 116 120 125 130 142 954
D0350 Oral/facial photographic images 42.66 34.52 0 0 45 69 73 78 85 98 510
Source: American Dental Association, Health Policy Institute, 2013 Survey of Dental Fees. Copyright © 2014 American Dental Association. 3
Percentile Fees
Cone beam — 3D image reconstruction
using existing data, includes multiple
D0363 images 331.24 109.82 180 275 350 400 410 432 450 505 80
Collection and preparation of saliva
D0417 sample for laboratory diagnostic testing 98.48 63.90 25 40 90 150 155 165 178 224 42
D0418 Analysis of saliva sample 114.23 39.73 65 95 124 150 150 151 160 180 36
Adjunctive pre-diagnostic test that aids in
D0431 detection of mucosal abnormalities 56.18 25.38 22 40 59 69 72 75 76 95 167
D0470 Diagnostic casts 94.07 32.07 55 72 91 112 118 125 135 150 885
D1110 Prophylaxis - adult 85.38 18.31 65 74 84 95 98 103 109 120 1,236
D1120 Prophylaxis - child 63.08 14.10 46 54 62 70 74 77 81 90 1,211
D1206 Topical fluoride varnish 35.86 11.03 23 29 35 42 45 46 50 55 889
D1208 Topical application of fluoride 33.71 8.98 23 28 34 40 40 42 45 50 899
Tobacco counseling for the control and
D1320 prevention of oral disease 30.70 33.52 0 0 25 55 63 73 80 90 385
D1330 Oral hygiene instructions 24.07 24.78 0 0 23 45 49 52 56 65 647
D1351 Sealant - per tooth 49.31 11.15 35 42 48 55 57 60 64 70 1,144
Preventive resin restoration in a moderate
to high caries risk patient - permanent
D1352 tooth 87.78 41.67 45 56 80 105 116 127 150 170 309
D1510 Space maintainer - fixed - unilateral 290.44 62.55 215 250 288 325 339 350 367 398 796
D1515 Space maintainer - fixed - bilateral 387.57 91.71 272 325 386 442 454 472 500 552 750
Amalgam - one surface, primary or
D2140 permanent 125.29 32.43 86 102 122 144 150 155 166 185 1,005
Amalgam - two surfaces, primary or
D2150 permanent 155.11 39.56 105 127 151 178 185 192 207 225 1,001
Amalgam - three surfaces, primary or
D2160 permanent 186.24 49.01 125 150 183 215 222 232 250 278 996
Amalgam - four or more surfaces, primary
D2161 or permanent 220.72 59.54 148 180 217 254 265 278 296 326 980
Resin-based composite - one surface,
D2330 anterior 148.77 35.36 108 125 145 167 175 180 190 215 1,201
Percentile Fees
Resin-based composite - two surfaces,
D2331 anterior 182.30 43.83 130 152 180 205 214 224 236 260 1,208
Resin-based composite - three surfaces,
D2332 anterior 218.73 54.65 150 180 215 250 258 272 288 321 1,211
Resin-based composite - four or more
surfaces or involving incisal angle
D2335 (anterior) 267.00 69.29 181 220 265 304 316 330 350 395 1,199
D2390 Resin-based composite crown, anterior 362.53 140.44 191 265 350 443 462 492 525 606 588
D2391 posterior 162.97 37.84 120 139 160 181 189 195 209 235 1,179
D2392 posterior 208.81 50.94 150 175 205 235 245 255 271 301 1,186
D2393 posterior 253.22 61.89 175 210 250 290 300 315 328 362 1,181
D2394 surfaces, posterior 298.47 73.66 200 249 297 342 352 370 390 436 1,140
D2520 Inlay - metallic - two surfaces 802.57 221.11 536 638 793 934 980 1,025 1,092 1,213 561
D2543 Onlay - metallic - three surfaces 933.51 207.71 675 790 925 1,052 1,093 1,150 1,206 1,300 566
D2620 Inlay - porcelain/ceramic - two surfaces 873.52 215.53 600 725 874 992 1,019 1,075 1,148 1,250 587
D2642 Onlay - porcelain/ceramic - two surfaces 938.40 211.86 652 800 936 1,050 1,100 1,136 1,200 1,300 593
D2643 Onlay - porcelain/ceramic - three surfaces 983.96 201.34 720 850 980 1,100 1,137 1,175 1,225 1,310 612
Onlay - porcelain/ceramic - four or more
D2644 surfaces 1,017.43 200.87 760 900 1,000 1,148 1,177 1,204 1,250 1,393 633
Inlay - resin-based composite - two
D2651 surfaces 775.18 237.23 473 600 768 910 950 985 1,075 1,200 409
Onlay - resin-based composite - two
D2662 surfaces 823.52 240.03 510 650 831 977 1,000 1,061 1,113 1,220 391
Onlay - resin-based composite - three
D2663 surfaces 857.78 224.46 562 689 864 996 1,047 1,080 1,140 1,246 396
Onlay - resin-based composite - four or
D2664 more surfaces 898.45 227.33 600 743 900 1,041 1,075 1,114 1,200 1,275 410
D2710 Crown, resin-based composite (indirect) 685.84 294.01 309 442 681 885 930 994 1,075 1,190 491
Percentile Fees
D2740 Crown - porcelain/ceramic substrate 1,070.31 197.20 849 941 1,045 1,195 1,221 1,270 1,309 1,442 1,076
Crown - porcelain fused to high noble
D2750 metal 1,049.56 190.39 832 922 1,017 1,152 1,200 1,250 1,295 1,395 1,114
Crown - porcelain fused to predominantly
D2751 base metal 962.25 166.50 760 850 945 1,050 1,099 1,138 1,200 1,278 700
D2752 Crown - porcelain fused to noble metal 1,002.56 176.61 799 885 980 1,100 1,148 1,195 1,250 1,313 863
D2780 Crown - 3/4 cast high noble metal 1,032.56 200.14 796 900 995 1,165 1,200 1,236 1,295 1,400 524
D2783 Crown - 3/4 porcelain/ceramic 1,041.77 194.14 800 914 1,010 1,160 1,200 1,234 1,295 1,393 466
D2790 Crown - full cast high noble metal 1,069.39 200.15 842 935 1,036 1,200 1,225 1,269 1,325 1,450 1,040
Provisional crown – further treatment or
completion of diagnosis necessary prior to
D2799 final impression 312.85 168.85 70 200 325 418 448 474 502 591 646
D2920 Recement crown 96.32 26.75 64 80 95 110 115 120 130 147 1,166
Prefabricated porcelain/ceramic crown –
D2929 primary tooth 270.21 117.68 125 185 257 350 350 365 400 515 94
Prefabricated stainless steel crown -
D2930 primary tooth 249.10 63.47 175 205 250 280 294 303 328 370 795
D2931 permanent tooth 291.89 81.61 193 240 288 331 345 360 399 450 708
D2940 Protective restoration 104.40 31.81 69 85 100 120 125 132 145 165 836
D2950 Core buildup, including any pins 243.10 56.61 171 200 247 275 285 297 310 345 1,145
Post and core in addition to crown;
D2952 indirectly fabricated 358.38 95.04 245 295 350 410 425 447 474 525 912
Prefabricated post and core in addition to
D2954 crown 299.81 68.75 210 251 300 340 350 361 385 425 1,095
D2961 Labial veneer (resin laminate) - laboratory 825.41 263.25 485 643 830 975 1,009 1,061 1,130 1,295 557
Labial veneer (porcelain laminate) -
D2962 laboratory 1,050.16 223.29 787 900 1,010 1,190 1,217 1,275 1,334 1,458 1,020
D2970 Temporary crown (fractured tooth) 268.70 110.63 129 187 260 341 360 383 406 459 810
Inlay repair necessitated by restorative
D2981 material failure 219.28 92.52 120 145 195 298 300 312 337 400 79
Percentile Fees
Onlay repair necessitated by restorative
Veneer repair necessitated by restorative
Resin infiltration of incipient smooth
D2990 surface lesions 143.06 92.20 50 74 125 185 198 225 250 337 67
Pulp cap - direct (excluding final
D3110 restoration) 72.95 26.43 43 56 71 85 90 95 100 125 859
Pulp cap - indirect (excluding final
D3120 restoration) 70.87 27.74 40 51 68 85 90 95 101 125 782
Therapeutic pulpotomy (excluding final
restoration) - removal of pulp coronal to
the dentinocemental junction and
D3220 application of medicament 168.75 54.64 100 135 166 200 207 220 232 263 1,002
Pulpal debridement, primary and
D3221 permanent teeth 175.47 67.15 95 135 175 214 225 240 254 282 716
Partial pulpotomy for apexogenesis -
permanent tooth with incomplete root
D3222 development 204.50 95.02 100 131 180 250 280 298 340 398 148
Pulpal therapy (resorbable filling) -
anterior, primary tooth (excluding final
D3230 restoration) 214.61 82.26 118 155 204 265 275 292 308 348 443
posterior, primary tooth (excluding final
D3240 restoration) 236.57 94.63 113 166 235 300 305 324 350 394 450
Endodontic therapy, anterior tooth
D3310 (excluding final restoration) 682.75 138.68 511 587 675 751 785 810 864 945 1,071
Endodontic therapy, bicuspid tooth
D3320 (excluding final restoration) 795.21 151.21 610 699 785 881 900 940 990 1,062 1,069
Endodontic therapy, molar (excluding final
D3330 restoration) 964.72 170.13 768 850 950 1,061 1,098 1,125 1,188 1,274 1,033
Treatment of root canal obstruction; non-
D3331 surgical access 400.70 244.23 130 200 361 510 559 616 672 850 172
Percentile Fees
Incomplete endodontic therapy;

D3332 inoperable, unrestorable or fractured tooth 304.11 189.81 0 176 322 425 450 467 505 604 386
Retreatment of previous root canal
D3346 therapy - anterior 774.15 182.32 550 650 762 875 903 946 1,020 1,118 597
D3347 therapy - bicuspid 887.81 198.08 650 750 881 1,000 1,025 1,068 1,140 1,251 580
D3348 therapy - molar 1,053.76 220.12 788 900 1,045 1,180 1,207 1,260 1,350 1,445 575
Apexification/recalcification/pulpal
regeneration - initial visit (apical
closure/calcific repair of perforations, root
D3351 resorption, pulp spa 285.14 112.65 130 200 299 355 369 388 411 475 356
regeneration - interim medication
D3352 replacement 196.11 84.78 96 135 189 250 259 274 290 366 306
regeneration - final visit (includes
D3353 completed root canal therapy) 413.55 196.97 132 275 421 538 565 593 655 729 294
Pulpal regeneration - (completion of
regenerative treatment in an immature
permanent tooth with a necrotic pulp);
D3354 does not include final res 250.80 130.90 96 128 265 318 409 432 440 448 35
Apicoectomy/periradicular surgery -
D3410 anterior 613.76 216.26 339 465 600 730 777 810 880 962 416
D3421 bicuspid (first root) 668.60 225.67 382 500 670 795 834 895 946 1,050 314
Apicoectomy/periradicular surgery - molar
D3425 (first root) 738.10 244.69 419 543 750 888 932 995 1,045 1,190 274
Gingivectomy or gingivoplasty - four or
more contiguous teeth or tooth bounded
D4210 spaces per quadrant 515.44 170.41 275 400 514 625 650 684 726 806 697
Percentile Fees
Gingivectomy or gingivoplasty - one to
three contiguous teeth or tooth bounded
Gingivectomy or gingivoplasty to allow
access for restorative procedure, per
D4212 tooth 204.13 111.57 70 125 189 267 285 312 350 425 179
Gingival flap procedure, including root
planing – four or more contiguous teeth or
D4240 tooth bounded spaces per quadrant 607.49 217.70 333 450 615 749 779 810 888 950 514
planing – one to three contiguous teeth or
D4249 Clinical crown lengthening - hard tissue 638.08 226.33 349 479 648 778 808 832 902 1,009 585
Osseous surgery (including flap entry and

closure) - four or more contiguous teeth
D4260 or tooth bounded spaces per quadrant 937.35 313.73 542 727 924 1,135 1,190 1,217 1,288 1,484 423

closure) - one to three contiguous teeth or
D4261 tooth bounded spaces per quadrant 668.65 260.09 340 467 660 845 877 916 979 1,085 335
Bone replacement graft - first site in
D4263 quadrant 498.17 200.02 256 350 475 650 684 710 767 840 379
Bone replacement graft — each additional
D4264 site in quadrant 365.44 165.93 165 238 345 495 510 540 580 666 295
Guided tissue regeneration — resorbable
D4266 barrier, per site 531.09 258.02 210 306 482 761 788 825 862 985 250
Guided tissue regeneration —
nonresorbable barrier, per site (includes
D4267 membrane removal) 653.02 311.08 263 400 650 900 945 977 1,010 1,155 200
Subepithelial connective tissue graft
D4273 procedures, per tooth 932.23 283.51 569 745 943 1,100 1,124 1,199 1,272 1,535 191
D4275 Soft tissue allograft 854.58 283.19 531 654 848 972 1,010 1,100 1,213 1,400 123
Percentile Fees
Free soft tissue graft procedure (including
donor site surgery), first tooth or
D4277 edentulous tooth position in graft 747.51 232.35 410 525 784 919 991 995 1,000 1,200 55
D4321 Provisional splinting - extracoronal 353.77 150.18 150 261 359 450 467 496 520 600 634
Periodontal scaling and root planing - four
D4341 or more teeth per quadrant 232.45 47.96 175 200 230 258 267 278 295 312 1,092
Periodontal scaling and root planing - one
D4342 to three teeth per quadrant 161.75 44.06 105 133 159 186 195 202 217 245 991
Full mouth debridement to enable
D4355 comprehensive evaluation and diagnosis 157.32 43.75 100 127 155 184 190 200 209 237 1,055
Localized delivery of antimicrobial agents
via a controlled release vehicle into
D4381 diseased crevicular tissue, per tooth 80.86 50.66 35 42 63 109 129 144 157 178 765
D4910 Periodontal maintenance 127.97 28.03 92 108 126 145 150 155 165 176 1,058
D5110 Complete denture - maxillary 1,468.82 384.95 998 1,200 1,450 1,692 1,760 1,836 1,950 2,133 1,179
D5120 Complete denture - mandibular 1,472.96 390.93 1,000 1,200 1,450 1,700 1,761 1,837 1,955 2,158 1,179
D5130 Immediate denture - maxillary 1,559.31 411.55 1,050 1,275 1,530 1,800 1,850 1,950 2,041 2,285 1,139
D5140 Immediate denture - mandibular 1,560.70 414.79 1,050 1,275 1,528 1,800 1,852 1,950 2,041 2,300 1,139
Maxillary partial denture - resin base
(including any conventional clasps, rests,
D5211 and teeth) 1,111.42 393.70 640 850 1,061 1,350 1,400 1,500 1,606 1,876 1,054
Mandibular partial denture - resin base
D5212 and teeth) 1,120.39 393.71 650 850 1,076 1,350 1,415 1,500 1,626 1,876 1,053
Maxillary partial denture - cast metal
framework with resin denture bases
D5213 and teeth) 1,547.22 383.31 1,050 1,297 1,520 1,779 1,839 1,900 2,000 2,223 1,158
Mandibular partial denture - cast metal
D5214 and teeth) 1,552.66 388.21 1,050 1,298 1,523 1,785 1,850 1,902 2,000 2,242 1,160
Maxillary partial denture - flexible base
D5225 (including any clasps, rests, and teeth) 1,340.29 368.10 888 1,071 1,341 1,552 1,600 1,680 1,800 2,000 729
Percentile Fees
Mandibular partial denture - flexible base

D5510 Repair broken complete denture base 188.41 63.79 111 149 183 221 234 250 270 300 1,023
Replace missing or broken teeth -
D5520 complete denture (each tooth) 162.56 51.30 100 125 160 191 200 209 225 260 1,051
D5610 Repair resin denture base 181.08 55.81 110 149 177 210 220 233 250 282 997
D5640 Replace broken teeth - per tooth 161.97 51.06 95 125 160 189 199 209 225 259 1,052
D5650 Add tooth to existing partial denture 194.97 56.17 125 155 191 225 239 250 266 295 1,068
D5660 Add clasp to existing partial denture 232.30 70.16 145 180 230 275 288 300 317 355 1,013
D5710 Rebase complete maxillary denture 499.10 138.73 323 400 495 585 600 631 670 737 783
Reline complete maxillary denture
D5730 (chairside) 303.03 107.87 175 238 301 369 383 400 424 475 964
Reline complete mandibular denture
D5731 (chairside) 299.87 106.34 175 234 300 365 378 397 420 465 955
D5750 (laboratory) 407.26 108.08 275 345 410 473 485 500 529 585 1,134
D5751 (laboratory) 408.24 108.40 275 349 410 473 487 500 535 586 1,126
Surgical placement of implant body:
D6010 endosteal implant 1,787.97 376.92 1,275 1,540 1,800 2,000 2,021 2,150 2,225 2,500 404
Surgical placement of interim implant
body for transitional prosthesis: endosteal
D6012 implant 1,466.15 429.21 850 1,200 1,500 1,750 1,800 1,850 2,100 2,206 61
D6051 Interim abutment 475.59 228.53 250 350 414 650 675 700 795 800 43
Implant/abutment supported removable
D6053 denture for completely edentulous arch 2,235.28 963.12 1,100 1,603 2,185 2,786 2,939 3,175 3,400 4,000 432
Connecting bar - implant supported or
D6055 abutment supported 2,014.72 1,297.99 524 853 1,800 2,812 3,000 3,200 3,613 4,500 409
Prefabricated abutment — includes
D6056 modification and placement 629.86 219.02 385 475 600 762 800 850 900 1,000 712
Custom fabricated abutment - includes
D6057 placement 776.51 240.09 487 600 760 925 970 1,000 1,061 1,200 776
Percentile Fees
Abutment supported porcelain fused to
D6059 metal crown (high noble metal) 1,291.87 307.41 924 1,060 1,258 1,475 1,519 1,597 1,700 1,850 835
Implant supported porcelain fused to
metal crown (titanium, titanium alloy, high
D6066 noble metal) 1,355.57 353.15 931 1,100 1,300 1,553 1,620 1,716 1,821 2,015 710
Abutment supported retainer for porcelain

D6069 fused to metal FPD (high noble metal) 1,296.67 303.22 936 1,087 1,270 1,470 1,500 1,600 1,692 1,850 508
Implant supported retainer for porcelain
fused to metal FPD (titanium, titanium
D6076 alloy, or high noble metal) 1,358.14 367.36 905 1,100 1,320 1,600 1,656 1,758 1,850 2,000 349
Implant maintenance procedures,
including removal of prosthesis, cleansing
of prosthesis and abutments and
D6080 reinsertion of prosthesis 170.95 124.47 0 77 155 262 285 300 329 375 442
D6104 Bone graft at time of implant placement 461.16 227.99 200 270 420 600 650 699 785 945 74
D6205 Pontic - indirect resin based composite 858.30 278.78 500 700 876 1,006 1,075 1,124 1,200 1,300 156
D6210 Pontic - cast high noble metal 1,032.94 200.25 800 900 1,000 1,150 1,196 1,234 1,295 1,400 887
Pontic - porcelain fused to high noble
D6240 metal 1,029.80 192.85 800 900 998 1,150 1,195 1,224 1,282 1,370 1,064
Pontic - porcelain fused to predominantly
D6241 base metal 955.85 191.65 740 822 944 1,053 1,100 1,144 1,200 1,295 678
D6245 Pontic - porcelain/ceramic 1,052.96 195.33 830 920 1,025 1,170 1,200 1,250 1,295 1,400 806
Provisional pontic — further treatment or
Retainer - cast metal for resin bonded
D6545 fixed prosthesis 626.65 298.38 294 405 575 812 885 935 1,002 1,146 653
D6710 Crown - indirect resin based composite 875.34 308.57 450 700 899 1,032 1,075 1,127 1,167 1,310 161
D6750 metal 1,049.78 191.57 834 924 1,009 1,159 1,200 1,248 1,300 1,394 1,041
D6751 base metal 957.75 184.08 750 832 942 1,050 1,100 1,150 1,200 1,300 638
D6790 Crown - full cast high noble metal 1,046.04 195.52 812 910 1,007 1,167 1,200 1,250 1,300 1,400 936
Percentile Fees
Provisional retainer crown - further
treatment or completion of diagnosis
D6793 necessary prior to final impression 428.89 255.57 150 230 385 550 600 681 800 987 310
D6930 Recement fixed partial denture 142.06 42.65 88 112 143 165 175 180 196 214 996
Extraction, coronal remnants - deciduous
D7111 tooth 112.06 36.99 69 85 110 132 137 146 155 178 900
Extraction, erupted tooth or exposed root
D7140 (elevation and/or forceps removal) 156.39 42.82 105 125 150 179 187 195 210 236 1,181
Surgical removal of erupted tooth
requiring removal of bone and/or
sectioning of tooth, and including
D7210 elevation of mucoperiosteal flap 253.35 58.54 180 215 250 285 295 305 330 350 1,039
D7220 Removal of impacted tooth - soft tissue 290.48 68.00 201 245 288 330 344 355 375 407 777
D7230 Removal of impacted tooth - partially bony 363.30 84.85 255 300 358 411 425 445 470 517 690
Removal of impacted tooth - completely
D7240 bony 432.69 103.11 300 360 426 492 514 542 575 610 551
Surgical removal of residual tooth roots
D7250 (cutting procedure) 264.82 75.25 173 210 265 302 320 336 360 400 757
Coronectomy - intentional partial tooth
D7251 removal 328.79 157.34 145 232 300 421 431 454 489 600 63
D7286 Biopsy of oral tissue - soft 263.54 95.92 144 191 258 325 347 363 394 425 520
D7287 Exfoliative cytological sample collection 162.99 59.17 95 120 156 194 200 210 240 258 123
Brush biopsy - transepithelial sample
D7288 collection 161.12 62.34 85 120 155 200 206 220 244 278 265
Alveoloplasty in conjunction with
extractions - four or more teeth or tooth
D7310 spaces, per quadrant 257.02 84.93 150 200 250 303 316 328 360 400 600
Alveoloplasty not in conjunction with
D7410 Excision of benign lesion up to 1.25 cm 313.47 142.25 150 220 300 383 410 435 500 578 347
Excision of malignant tumor - lesion
D7440 diameter up to 1.25 cm 456.74 303.90 140 235 363 623 677 744 790 1,082 73
Percentile Fees
Removal of benign odontogenic cyst or
D7450 tumor - lesion diameter up to 1.25 cm 390.87 216.73 163 237 328 507 571 600 684 800 174
D7880 Occlusal orthotic device, by report 680.86 309.71 325 471 625 894 940 995 1,100 1,208 414
D7910 Suture of recent small wounds up to 5 cm 220.93 111.91 83 130 220 295 304 312 346 408 316
Bone replacement graft for ridge
D7953 preservation – per site 422.61 184.37 222 298 392 500 549 600 685 775 245
Frenulectomy (frenectomy or frenotomy) -
separate procedure not incidental to
D7960 another 368.21 124.04 203 275 375 447 458 488 505 585 563
D7970 Excision of hyperplastic tissue - per arch 370.86 158.28 165 250 379 480 511 538 575 630 393
Limited orthodontic treatment of the
D8020 transitional dentition 1,937.80 1,050.30 506 1,029 2,004 2,533 2,794 3,046 3,407 3,835 161
D8030 adolescent dentition 2,361.24 1,231.74 650 1,430 2,455 3,257 3,500 3,600 3,900 4,300 186
Limited orthodontic treatment of the adult
D8040 dentition 2,711.97 1,331.42 935 1,622 2,813 3,580 3,790 4,000 4,300 4,871 275
Interceptive orthodontic treatment of the
D8050 primary dentition 2,108.33 1,121.16 800 1,200 2,200 2,709 2,995 3,203 3,500 4,000 134
Comprehensive orthodontic treatment of
D8070 the transitional dentition 4,766.01 1,029.09 3,500 4,000 4,800 5,413 5,518 5,775 6,000 6,286 146
D8080 the adolescent dentition 4,937.86 898.11 3,767 4,344 4,950 5,405 5,500 5,717 5,900 6,500 222
D8090 the adult dentition 5,130.28 836.75 4,150 4,500 5,035 5,511 5,670 5,900 6,064 6,365 321
Periodic orthodontic treatment visit (as
D8670 part of contract) 241.73 217.58 75 125 200 260 269 313 345 587 64
Orthodontic treatment (alternative billing
D8690 to a contract fee) 272.86 106.75 163 218 258 299 328 347 384 542 38
D8692 Replacement of lost or broken retainer 255.06 114.02 110 158 250 330 350 360 400 489 323
Palliative (emergency) treatment of dental
D9110 pain - minor procedure 110.68 43.98 58 81 106 132 142 150 165 198 1,094
Percentile Fees
D9120 Fixed partial denture sectioning 144.90 73.75 65 90 125 191 205 233 250 279 491
Local anesthesia in conjunction with
D9215 operative or surgical procedures 29.93 28.29 0 0 28 50 56 60 66 79 405
Inhalation of nitrous oxide/analgesia,
D9230 anxiolysis 52.77 28.05 10 35 52 72 75 78 85 99 703
Intravenous conscious sedation/analgesia
D9241 - first 30 minutes 323.88 110.98 175 242 325 398 407 432 483 500 106

D9242 - each additional 15 minutes 68.30 74.06 0 0 56 131 147 152 161 185 163
D9248 Non-intravenous conscious sedation 176.87 155.68 0 0 180 304 325 350 375 405 226
Consultation (diagnostic service provided
by dentist or physician other than
D9310 requesting dentist or physician) 83.97 52.54 0 50 84 110 120 131 150 174 646
D9410 House/extended care facility call 172.88 87.16 69 100 160 225 235 250 290 340 275
D9420 Hospital or ambulatory surgical center call 209.50 111.61 88 117 190 280 300 320 350 408 242
Office visit for observation (during
regularly scheduled hours) - no other
D9430 services performed 57.07 31.88 0 40 60 75 79 83 94 103 627
Office visit - after regularly scheduled
D9440 hours 139.35 51.89 75 100 137 171 180 192 200 235 781
Case presentation, detailed and extensive
D9450 treatment planning 128.50 82.53 50 75 119 150 160 180 250 300 184
Therapeutic parenteral drug, single
D9610 administration 48.37 43.37 0 0 43 82 88 97 104 120 251
Other drugs and/or medicaments, by
D9630 report 27.43 20.25 0 15 25 39 44 48 54 66 426
D9910 Application of desensitizing medicament 48.35 20.83 25 35 47 60 62 67 75 87 819
Application of desensitizing resin for
D9911 cervical and/or root surface, per tooth 53.49 32.00 12 33 50 72 76 84 94 110 546
D9920 Behavior management, by report 94.69 54.27 35 50 83 138 147 153 160 184 200
Percentile Fees
Treatment of complications (post-
surgical) - unusual circumstances, by
D9930 report 102.06 41.43 50 73 100 125 132 145 155 172 338
D9940 Occlusal guard, by report 477.22 156.35 275 375 475 575 600 630 678 750 1,091
D9941 Fabrication of athletic mouthguard 197.31 118.17 65 109 180 250 275 300 360 450 796
D9951 Occlusal adjustment - limited 132.21 64.68 50 84 126 174 182 197 211 250 814
D9952 Occlusal adjustment - complete 485.71 246.02 162 295 495 646 682 736 795 895 702
External bleaching - per arch - performed
D9972 in office 275.55 128.71 150 185 250 345 362 400 469 540 621
D9974 Internal bleaching - per tooth 227.26 87.89 102 175 225 280 295 303 325 373 689
External bleaching for home application,
per arch; includes materials and
D9975 fabrication of custom trays 236.66 110.01 100 150 210 300 345 350 395 450 649
General Practitioners - New England Division
(Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)
Percentile Fees
D0120 patient 47.88 10.63 35 40 45 55 56 59 61 71 78
D0140 Limited oral evaluation - problem focused 77.42 17.54 55 67 75 87 90 93 100 110 76
D0145 caregiver 60.43 23.63 35 45 55 72 77 84 98 110 35
D0150 established patient 85.64 19.44 65 75 86 98 99 100 103 120 75
D0170 visit) 54.38 29.56 0 44 57 70 74 79 85 90 45
D0210 images 141.93 21.73 119 125 140 154 160 162 165 190 75
D0220 image 31.00 5.83 25 27 30 33 35 35 37 44 77
D0230 radiographic image 25.08 5.91 18 22 25 28 28 30 33 38 76
D0272 Bitewings - two radiographic images 47.86 8.71 38 42 48 52 53 57 60 65 74
D0274 Bitewings - four radiographic images 67.63 12.54 52 60 67 74 76 77 85 90 78
D1110 Prophylaxis - adult 96.73 13.00 82 88 95 104 105 109 110 117 77
D1120 Prophylaxis - child 73.16 13.32 58 65 72 80 82 85 90 97 75
D1351 Sealant - per tooth 57.21 11.29 45 50 55 65 65 68 73 77 76
Percentile Fees
D2140 permanent 140.97 25.33 105 125 140 155 162 165 170 185 65
D2150 permanent 178.53 32.95 131 160 175 199 210 215 224 225 64
D2160 permanent 213.75 41.64 158 190 206 240 248 253 264 286 64
D2161 or permanent 254.24 51.18 194 220 245 291 300 308 320 327 63
D2330 anterior 161.10 29.41 129 143 160 176 180 190 195 215 77
D2331 anterior 201.29 38.40 160 178 198 225 227 236 250 285 78
D2332 anterior 246.60 52.20 185 215 239 278 285 298 305 365 78
D2335 (anterior) 309.19 73.83 228 260 300 345 360 387 425 475 77
D2391 posterior 175.04 34.75 132 155 175 195 200 205 219 244 78
D2392 posterior 231.50 48.62 175 205 225 250 269 290 298 316 78
D2393 posterior 283.70 60.62 216 247 278 320 325 350 369 396 77
D2394 surfaces, posterior 339.85 72.91 259 297 331 383 397 405 425 496 75
D2543 Onlay - metallic - three surfaces 1,086.90 248.60 743 935 1,031 1,260 1,263 1,300 1,300 1,560 31
D2643 Onlay - porcelain/ceramic - three surfaces 1,091.09 247.23 800 950 1,028 1,245 1,250 1,282 1,300 1,710 33
D2644 surfaces 1,183.26 243.43 890 1,000 1,168 1,300 1,360 1,400 1,616 1,710 38
D2740 Crown - porcelain/ceramic substrate 1,275.45 198.31 1,005 1,150 1,269 1,350 1,400 1,500 1,560 1,710 69
Percentile Fees
D2750 metal 1,259.94 182.08 1,050 1,132 1,250 1,340 1,395 1,440 1,525 1,616 72
D2751 base metal 1,143.69 216.62 875 964 1,138 1,300 1,323 1,340 1,400 1,556 35
D2752 Crown - porcelain fused to noble metal 1,204.29 164.37 1,000 1,084 1,200 1,300 1,325 1,340 1,400 1,525 49
D2790 Crown - full cast high noble metal 1,277.02 221.66 1,011 1,138 1,255 1,350 1,400 1,467 1,560 1,822 58
D2920 Recement crown 111.83 22.99 85 94 110 125 125 140 145 150 76
D2930 primary tooth 293.82 74.93 200 250 300 325 350 375 410 436 38
D2950 Core buildup, including any pins 293.66 56.78 210 260 299 325 330 350 364 390 70
D2954 crown 355.09 66.25 268 313 350 389 398 420 444 460 70
D2961 Labial veneer (resin laminate) - laboratory 986.60 285.24 693 834 1,000 1,138 1,179 1,216 1,400 1,510 30
D2962 laboratory 1,179.37 223.71 928 1,017 1,162 1,300 1,340 1,370 1,500 1,580 60
D3110 restoration) 79.44 19.93 60 65 79 90 93 99 107 111 52
D3120 restoration) 80.44 26.13 52 61 82 92 95 97 100 115 43
D3220 application of medicament 203.10 52.99 136 175 197 228 249 255 276 298 59
Percentile Fees
D3310 (excluding final restoration) 829.03 131.95 639 739 823 923 929 968 989 1,033 60
D3320 (excluding final restoration) 958.03 152.80 750 849 960 1,050 1,065 1,096 1,144 1,200 63
D3330 restoration) 1,163.60 159.55 950 1,050 1,180 1,250 1,295 1,305 1,375 1,434 58
D4249 Clinical crown lengthening - hard tissue 894.00 268.78 581 741 808 1,025 1,136 1,178 1,230 1,520 35
D4341 or more teeth per quadrant 256.23 41.17 204 231 259 279 286 299 302 318 70
D4355 comprehensive evaluation and diagnosis 168.31 42.46 111 140 167 190 190 208 225 247 61
D4910 Periodontal maintenance 131.59 27.34 98 114 131 146 150 156 165 185 66
D5110 Complete denture - maxillary 1,666.16 408.69 1,139 1,416 1,676 1,910 1,999 2,005 2,183 2,300 70
D5120 Complete denture - mandibular 1,711.14 458.06 1,200 1,418 1,691 1,973 2,000 2,128 2,200 2,692 72
D5130 Immediate denture - maxillary 1,784.94 484.67 1,112 1,500 1,800 2,048 2,174 2,250 2,325 2,661 67
D5140 Immediate denture - mandibular 1,789.85 479.98 1,112 1,500 1,797 2,024 2,174 2,250 2,325 2,661 68
D5211 and teeth) 1,201.72 406.69 710 909 1,223 1,475 1,506 1,621 1,746 1,955 60
Percentile Fees
D5212 and teeth) 1,216.70 417.15 720 900 1,250 1,500 1,512 1,600 1,766 1,967 63
D5213 and teeth) 1,761.14 463.43 1,225 1,465 1,696 2,000 2,122 2,200 2,325 2,805 71
D5214 and teeth) 1,759.75 462.48 1,225 1,468 1,680 2,000 2,122 2,200 2,325 2,863 72
D5225 (including any clasps, rests, and teeth) 1,537.29 372.19 1,100 1,295 1,506 1,680 1,793 1,900 1,910 2,522 38

D5510 Repair broken complete denture base 215.98 58.01 150 165 210 250 263 275 300 311 66
D5520 complete denture (each tooth) 192.75 49.44 137 150 185 225 240 250 257 280 69
D5640 Replace broken teeth - per tooth 189.84 49.67 137 152 182 219 232 250 256 280 67
D5650 Add tooth to existing partial denture 219.05 49.93 150 184 220 259 260 275 276 282 66
D5660 Add clasp to existing partial denture 247.92 68.76 150 190 258 297 300 311 329 351 63
D5730 (chairside) 350.48 127.56 200 300 352 396 417 458 525 600 58
D5731 (chairside) 355.86 123.61 200 302 355 391 400 458 525 600 56
D5750 (laboratory) 479.28 132.86 315 399 457 549 595 600 686 737 68
D5751 (laboratory) 478.38 132.81 315 399 456 549 595 600 686 737 68
D6056 modification and placement 717.13 210.48 475 522 710 808 869 900 1,000 1,094 55
Percentile Fees
D6057 placement 886.46 247.79 615 736 850 1,000 1,100 1,150 1,200 1,300 61
D6059 metal crown (high noble metal) 1,504.37 277.34 1,240 1,297 1,440 1,600 1,694 1,759 1,903 2,144 57
D6066 noble metal) 1,514.73 309.25 1,240 1,297 1,442 1,645 1,755 1,815 1,998 2,144 41

D6069 fused to metal FPD (high noble metal) 1,422.13 278.91 1,150 1,250 1,388 1,600 1,620 1,699 1,850 1,998 31
D6210 Pontic - cast high noble metal 1,235.57 208.77 975 1,100 1,205 1,340 1,350 1,466 1,500 1,636 47
D6240 metal 1,248.62 198.15 1,047 1,130 1,234 1,340 1,350 1,450 1,560 1,636 63
D6241 base metal 1,101.42 219.22 850 975 1,053 1,242 1,260 1,300 1,500 1,500 38
D6245 Pontic - porcelain/ceramic 1,230.28 205.93 968 1,100 1,246 1,340 1,348 1,400 1,470 1,710 50
D6750 metal 1,258.26 192.74 1,041 1,129 1,240 1,346 1,398 1,450 1,560 1,635 65
D6751 base metal 1,079.58 193.52 850 964 1,100 1,234 1,242 1,269 1,300 1,340 31
D7111 tooth 123.98 33.70 79 99 125 138 146 150 166 195 52
D7140 (elevation and/or forceps removal) 180.46 44.25 138 150 177 200 205 225 250 275 71
D7210 elevation of mucoperiosteal flap 309.44 58.77 235 272 304 350 350 370 375 405 52
Percentile Fees
D9110 pain - minor procedure 124.18 39.56 75 99 125 146 158 160 165 195 66
D9440 hours 151.82 50.66 80 132 154 180 190 198 218 236 38
D9940 Occlusal guard, by report 526.23 141.31 371 450 500 600 608 685 700 800 66
D9972 in office 320.79 126.40 199 250 295 360 375 401 475 650 34
General Practitioners - Middle Atlantic Division
(New Jersey, New York, Pennsylvania)
Percentile Fees
D0120 patient 46.44 14.93 29 39 45 54 60 60 65 75 153
D0145 caregiver 53.08 21.41 28 38 52 63 65 71 77 83 65
D0170 visit) 50.36 29.08 0 35 52 70 75 76 85 96 85
D0210 images 123.13 27.44 88 100 125 140 150 150 158 175 138
D0220 image 24.60 8.10 15 20 25 30 30 30 35 39 156
D0277 images 93.78 29.24 69 80 87 103 104 120 128 180 37
Percentile Fees
D1352 tooth 84.75 46.48 30 50 79 97 101 150 150 185 36
D2140 permanent 122.52 39.39 75 91 120 146 150 155 180 199 122
D2150 permanent 152.37 49.08 95 115 150 177 186 200 220 252 122
D2160 permanent 185.72 59.31 115 140 185 218 230 250 275 304 119
D2161 or permanent 223.12 77.18 135 165 214 259 278 300 325 375 117
D2330 anterior 145.66 42.55 95 115 140 171 175 185 191 225 143
D2331 anterior 177.46 53.12 115 140 175 205 216 230 250 275 146
D2332 anterior 216.25 68.36 135 160 211 252 275 285 310 350 146
D2335 (anterior) 265.56 88.56 165 200 250 315 328 360 400 445 145
D2391 posterior 162.69 47.00 110 125 158 180 192 205 219 275 135
D2392 posterior 205.70 64.29 131 155 190 235 255 276 300 344 139
D2393 posterior 245.98 77.87 155 188 230 290 313 331 346 405 140
Percentile Fees
D2644 surfaces 1,007.25 242.06 700 840 990 1,148 1,174 1,225 1,400 1,450 76
D2651 surfaces 817.78 271.76 510 630 788 935 985 1,095 1,200 1,433 49
D2662 surfaces 893.95 273.96 525 719 867 1,000 1,095 1,200 1,200 1,300 43
D2663 surfaces 882.98 222.60 575 739 900 985 1,000 1,095 1,200 1,295 42
D2664 more surfaces 943.49 240.78 600 770 960 1,041 1,100 1,200 1,399 1,400 49
D2710 Crown, resin-based composite (indirect) 756.73 347.78 300 500 775 935 999 1,100 1,200 1,295 45
D2740 Crown - porcelain/ceramic substrate 1,089.40 224.44 825 940 1,054 1,239 1,279 1,300 1,425 1,500 120
D2750 metal 1,073.97 208.72 825 931 1,039 1,214 1,275 1,295 1,340 1,495 132
D2751 base metal 957.03 174.16 750 815 943 1,050 1,099 1,195 1,200 1,292 73
D2752 Crown - porcelain fused to noble metal 1,009.09 200.24 775 880 989 1,100 1,195 1,225 1,300 1,400 97
D2780 Crown - 3/4 cast high noble metal 1,023.42 178.88 792 900 1,030 1,100 1,135 1,200 1,255 1,425 38
D2783 Crown - 3/4 porcelain/ceramic 998.73 186.61 764 889 989 1,093 1,143 1,200 1,215 1,310 45
D2920 Recement crown 96.94 32.43 56 75 95 113 120 127 142 160 147
Percentile Fees
D2930 primary tooth 252.77 77.84 160 198 245 287 300 350 375 410 64
D2954 crown 313.64 83.18 200 260 300 350 385 400 429 475 129
D2962 laboratory 1,063.34 244.12 800 918 1,025 1,200 1,240 1,260 1,334 1,555 111
D3110 restoration) 79.18 33.12 45 55 75 94 100 110 125 158 87
D3120 restoration) 77.51 35.03 45 50 74 91 95 100 141 158 77
D3230 restoration) 224.29 80.58 135 160 219 253 273 288 320 360 35
D3240 restoration) 252.28 98.97 135 182 250 300 301 353 395 436 40
Percentile Fees
D3320 (excluding final restoration) 816.07 190.13 600 675 800 900 950 996 1,095 1,220 134
D3330 restoration) 1,002.21 213.94 774 850 963 1,100 1,150 1,204 1,298 1,450 130

D3347 therapy - bicuspid 911.94 224.99 680 750 900 968 1,015 1,100 1,200 1,475 64
D3348 therapy - molar 1,055.92 226.04 800 900 1,040 1,150 1,218 1,275 1,375 1,500 65
D3410 anterior 612.75 226.96 382 500 590 725 760 812 880 950 51
D3421 bicuspid (first root) 695.03 209.93 400 565 680 780 880 990 1,000 1,050 31
D3425 (first root) 741.57 251.77 400 550 749 860 882 1,000 1,098 1,250 30
Percentile Fees


D4261 tooth bounded spaces per quadrant 710.10 338.62 350 395 666 1,000 1,025 1,050 1,085 1,238 31
D4263 quadrant 489.50 194.49 250 352 479 600 620 685 785 895 34
D5110 Complete denture - maxillary 1,462.63 456.14 915 1,100 1,438 1,725 1,800 1,850 1,960 2,500 150
D5120 Complete denture - mandibular 1,463.33 459.10 915 1,100 1,413 1,750 1,800 1,850 1,976 2,500 150
D5130 Immediate denture - maxillary 1,521.89 474.93 950 1,195 1,469 1,800 1,875 1,995 2,103 2,500 136
D5140 Immediate denture - mandibular 1,537.11 499.75 950 1,200 1,475 1,802 1,888 1,995 2,150 2,550 137
D5211 and teeth) 1,183.95 458.53 600 885 1,118 1,405 1,500 1,670 1,825 2,000 124
Percentile Fees
D5212 and teeth) 1,191.48 454.01 625 885 1,167 1,453 1,500 1,650 1,825 2,000 128
D5213 and teeth) 1,506.38 412.14 950 1,200 1,500 1,797 1,850 1,904 2,000 2,320 141
D5214 and teeth) 1,506.04 414.31 950 1,200 1,500 1,797 1,850 1,904 2,000 2,320 141

D5226 (including any clasps, rests, and teeth) 1,366.98 438.79 875 998 1,334 1,538 1,750 1,850 1,961 2,201 88
D5730 (chairside) 293.55 124.32 150 200 284 361 375 408 441 490 121
D5731 (chairside) 287.21 124.76 150 200 275 350 375 409 428 550 118
D5750 (laboratory) 383.31 125.80 225 300 385 460 470 497 510 595 131
D5751 (laboratory) 385.25 125.59 223 300 391 462 473 497 512 595 130
Percentile Fees
D6053 denture for completely edentulous arch 2,146.33 1,032.55 800 1,489 2,000 2,700 2,900 3,325 3,500 3,800 43
D6055 abutment supported 2,090.75 1,247.64 680 1,000 1,550 3,112 3,244 3,494 3,750 4,297 36
D6057 placement 803.09 250.12 550 600 775 950 980 1,000 1,050 1,247 99
D6066 noble metal) 1,379.59 429.66 900 1,000 1,310 1,695 1,775 1,895 2,015 2,200 75

D6240 metal 1,061.99 231.54 775 893 1,025 1,225 1,292 1,342 1,375 1,495 119
D6241 base metal 951.21 219.20 700 796 950 1,055 1,100 1,213 1,250 1,375 72
Percentile Fees
D6750 metal 1,086.27 235.27 800 900 1,029 1,282 1,300 1,350 1,425 1,500 119
D6751 base metal 966.97 226.74 725 800 950 1,099 1,174 1,247 1,350 1,390 71
D7111 tooth 128.63 49.74 70 92 125 150 161 176 200 238 97
D7240 bony 461.73 114.98 310 400 464 550 575 600 608 615 41
D7960 another 392.50 150.06 225 281 375 485 500 550 595 701 38
D8090 the adult dentition 5,219.38 1,057.28 4,000 4,500 5,100 5,720 6,000 6,000 6,600 8,000 37
Percentile Fees
D9230 anxiolysis 58.10 31.65 15 40 60 75 80 90 95 100 63
D9440 hours 133.66 60.78 68 87 125 160 175 195 200 262 71
D9630 report 32.80 24.91 0 15 29 49 53 60 70 75 35
D9952 Occlusal adjustment - complete 419.41 276.87 125 210 353 600 625 665 750 1,000 71
D9972 in office 299.59 138.27 155 200 250 380 400 450 490 600 83
General Practitioners - East North Central Division
(Illinois, Indiana, Michigan, Ohio, Wisconsin)
Percentile Fees
D0120 patient 43.99 8.45 33 40 45 49 50 50 53 57 234

D0145 caregiver 50.72 17.98 28 37 50 64 68 71 74 80 100
D0170 visit) 47.41 27.05 0 35 53 66 69 72 77 88 138
D0210 images 122.56 24.22 93 106 121 137 142 147 153 168 224
D0220 image 25.85 5.83 18 23 26 30 30 31 32 35 232
D0277 images 85.34 18.89 55 75 90 98 100 102 107 110 86
Percentile Fees
D1352 tooth 88.74 32.57 56 62 80 105 115 120 127 151 42
D2140 permanent 118.93 25.06 90 100 120 135 140 145 150 160 190
D2150 permanent 147.42 30.28 110 128 147 168 175 180 186 196 189
D2160 permanent 176.13 37.89 129 148 177 202 210 216 222 231 188
D2161 or permanent 209.16 47.40 148 175 210 245 250 257 271 284 186
D2330 anterior 140.45 26.85 108 121 142 159 163 168 172 182 232
D2331 anterior 173.41 32.86 130 150 174 195 201 209 215 227 230
D2332 anterior 208.41 42.62 155 180 207 237 245 255 262 277 230
D2335 (anterior) 259.76 61.75 185 219 258 298 309 317 330 361 228
D2391 posterior 155.83 30.25 120 135 155 175 180 188 194 200 224
Percentile Fees
D2392 posterior 199.84 40.50 150 174 198 226 235 242 251 261 223
D2393 posterior 242.57 50.37 175 205 246 280 285 297 305 320 224
D2620 Inlay - porcelain/ceramic - two surfaces 849.48 188.18 595 699 850 975 991 1,019 1,097 1,200 115
D2644 surfaces 992.00 170.78 750 900 995 1,105 1,143 1,177 1,210 1,275 119
D2651 surfaces 806.74 227.25 512 650 814 944 965 1,008 1,128 1,215 80
D2662 surfaces 841.40 216.17 524 683 880 977 995 1,051 1,105 1,235 73
D2663 surfaces 866.66 203.39 600 714 900 996 1,004 1,056 1,105 1,235 76
D2664 more surfaces 915.22 188.57 675 760 945 1,032 1,068 1,098 1,133 1,244 78
D2710 Crown, resin-based composite (indirect) 684.99 264.57 347 471 676 865 920 966 1,059 1,105 98
D2750 metal 1,007.37 145.37 837 905 995 1,100 1,133 1,155 1,197 1,275 209
D2751 base metal 953.75 149.52 760 865 941 1,045 1,071 1,100 1,171 1,244 118
D2752 Crown - porcelain fused to noble metal 981.19 142.47 818 895 975 1,057 1,097 1,124 1,160 1,240 161
D2780 Crown - 3/4 cast high noble metal 989.98 155.95 780 895 992 1,098 1,150 1,160 1,186 1,275 90
D2783 Crown - 3/4 porcelain/ceramic 1,005.08 149.89 795 916 995 1,125 1,145 1,155 1,195 1,301 79
Percentile Fees
D2920 Recement crown 96.29 22.94 70 84 95 107 113 115 123 135 214
D2930 primary tooth 251.61 59.83 175 211 258 284 291 300 320 350 152
D2954 crown 304.02 60.76 221 269 308 340 350 359 378 397 209
D2961 Labial veneer (resin laminate) - laboratory 801.84 237.97 485 600 822 950 985 1,008 1,077 1,215 100
D2962 laboratory 1,000.52 198.58 760 876 985 1,141 1,175 1,200 1,244 1,310 189
D3110 restoration) 71.30 24.35 39 58 71 83 85 90 97 103 161
D3120 restoration) 67.32 23.25 36 50 68 81 85 89 95 103 155
D3230 restoration) 218.12 85.65 114 154 204 275 282 296 300 372 75
Percentile Fees
D3240 restoration) 247.94 97.51 118 171 244 312 322 327 345 391 72
D3310 (excluding final restoration) 671.89 110.74 540 600 671 733 761 780 800 850 204
D3330 restoration) 945.51 130.79 789 859 942 1,016 1,046 1,080 1,100 1,155 197

D3346 therapy - anterior 766.02 161.06 552 670 774 875 914 938 985 1,030 112
D3348 therapy - molar 1,050.59 209.41 746 922 1,045 1,177 1,200 1,246 1,361 1,417 109
D3352 replacement 180.02 75.85 82 124 183 234 256 260 267 309 47
D3410 anterior 589.52 196.08 336 465 567 700 728 775 814 938 71
D3421 bicuspid (first root) 641.04 213.58 347 455 660 780 785 840 927 962 57
D3425 (first root) 730.67 234.09 419 496 761 893 930 971 1,036 1,065 46
Percentile Fees
D4212 tooth 198.98 118.93 68 131 181 255 283 289 306 408 40
D4249 Clinical crown lengthening - hard tissue 643.40 235.84 333 490 660 798 821 831 896 990 108


D4263 quadrant 472.36 179.83 231 330 483 598 639 650 678 767 61
Percentile Fees
D5211 and teeth) 1,097.08 372.63 645 809 1,050 1,350 1,385 1,500 1,586 1,745 190
D5212 and teeth) 1,098.78 371.14 645 822 1,050 1,350 1,379 1,485 1,580 1,745 186
D5213 and teeth) 1,512.87 337.89 1,000 1,304 1,500 1,730 1,785 1,842 1,900 2,043 219
D5214 and teeth) 1,517.73 340.35 1,013 1,315 1,500 1,747 1,800 1,850 1,905 2,052 220

Percentile Fees
D5730 (chairside) 312.33 107.00 175 248 330 385 398 405 422 465 173
D5731 (chairside) 309.15 104.33 175 235 330 385 396 400 419 439 171
D5750 (laboratory) 413.69 95.14 288 350 420 476 490 510 526 552 218
D5751 (laboratory) 414.43 95.47 288 350 423 476 490 510 526 552 218
D6053 denture for completely edentulous arch 2,443.83 1,138.64 1,000 1,748 2,500 3,000 3,075 3,510 3,946 4,940 71
D6057 placement 755.47 235.99 450 580 741 924 964 990 1,063 1,173 154
D6066 noble metal) 1,308.09 304.95 936 1,085 1,260 1,500 1,575 1,610 1,745 1,870 129

D6076 alloy, or high noble metal) 1,253.98 333.48 818 985 1,243 1,474 1,575 1,656 1,758 1,817 58
Percentile Fees
D6210 Pontic - cast high noble metal 991.58 146.83 825 899 990 1,095 1,112 1,150 1,195 1,245 166
D6240 metal 992.98 145.53 819 900 987 1,095 1,105 1,150 1,192 1,244 204
D6241 base metal 958.54 172.43 745 855 945 1,050 1,100 1,143 1,201 1,275 113
D6253 final impression 514.06 316.20 150 250 428 800 839 875 932 1,075 53
D6750 metal 1,009.56 141.00 840 923 994 1,103 1,134 1,155 1,195 1,250 194
D6751 base metal 952.69 161.82 750 851 942 1,044 1,060 1,120 1,150 1,244 113
D6790 Crown - full cast high noble metal 1,001.02 145.35 828 899 995 1,098 1,134 1,155 1,200 1,248 177
D6793 necessary prior to final impression 454.70 284.80 175 218 408 623 678 710 950 1,020 56
D7111 tooth 110.09 28.65 75 95 111 130 135 140 148 155 162
Percentile Fees
D7240 bony 427.54 94.59 295 364 426 492 510 525 550 590 101
D7288 collection 161.03 57.24 75 135 160 195 208 219 225 230 63
D7880 Occlusal orthotic device, by report 668.81 296.46 305 461 623 888 964 1,011 1,089 1,181 80
D7960 another 380.26 119.29 218 300 393 450 465 485 500 540 101
D8040 dentition 2,689.68 1,207.65 1,001 1,600 2,813 3,580 3,600 3,985 4,219 4,458 47
D8070 the transitional dentition 4,653.85 835.99 3,600 4,000 4,728 5,245 5,305 5,769 5,800 6,000 33
Percentile Fees
D9230 anxiolysis 48.78 26.77 0 30 55 67 70 75 79 90 125
D9440 hours 138.90 45.82 75 105 140 175 180 190 199 200 145
Case presentation, detailed and extensive
D9450 treatment planning 138.25 75.22 55 92 130 158 163 244 250 300 32
D9630 report 26.69 19.17 0 15 24 38 41 46 54 61 80
Percentile Fees
D9930 report 105.58 40.81 45 80 100 136 139 147 151 172 65
D9972 in office 267.00 107.48 150 195 250 334 362 395 400 450 102
General Practitioners - West North Central Division
(Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota)
Percentile Fees
D0120 patient 43.27 7.55 35 39 42 49 49 50 53 55 118

D0145 caregiver 48.24 15.48 32 39 45 55 59 62 68 85 70
D0170 visit) 51.04 26.75 25 40 50 63 65 69 72 85 83
D0210 images 116.12 19.33 92 103 118 129 131 135 140 147 111
D0220 image 24.90 4.36 20 22 25 28 29 30 30 32 120
D0277 images 81.84 14.61 62 71 79 94 97 99 101 104 57
Percentile Fees
D2140 permanent 113.93 21.35 89 99 111 127 131 134 142 154 110
D2150 permanent 142.50 28.81 109 122 141 160 164 166 177 189 110
D2160 permanent 171.98 36.75 130 149 169 190 199 206 219 232 110
D2161 or permanent 208.47 46.00 154 179 200 234 251 256 265 279 109
D2330 anterior 134.67 22.47 108 119 132 153 155 161 163 169 119
D2331 anterior 167.76 32.19 120 148 164 190 193 204 215 222 119
D2332 anterior 201.43 42.43 147 174 194 229 233 251 266 280 119
D2335 (anterior) 243.00 52.51 178 208 239 280 287 298 312 321 119
D2391 posterior 146.01 25.28 110 129 144 168 170 174 177 182 119
D2392 posterior 191.42 40.60 140 165 187 225 227 235 243 264 119
D2393 posterior 233.93 53.02 165 201 230 275 283 292 303 324 119
Percentile Fees
D2520 Inlay - metallic - two surfaces 758.85 186.02 550 636 738 860 900 918 955 1,189 54
D2543 Onlay - metallic - three surfaces 859.75 184.02 612 721 850 975 1,002 1,044 1,056 1,189 51
D2620 Inlay - porcelain/ceramic - two surfaces 824.45 181.34 603 684 812 955 987 1,025 1,066 1,139 60
D2642 Onlay - porcelain/ceramic - two surfaces 880.96 178.24 645 714 914 995 1,024 1,052 1,136 1,179 57
D2644 surfaces 954.91 160.26 750 847 950 1,054 1,075 1,160 1,196 1,220 56
D2651 surfaces 745.27 216.60 473 594 754 854 855 887 1,075 1,220 37
D2662 surfaces 804.48 215.11 535 650 767 964 975 1,056 1,070 1,220 31
D2663 surfaces 846.38 207.85 535 755 842 994 1,024 1,056 1,075 1,220 32
D2664 more surfaces 883.24 200.38 605 750 858 1,056 1,062 1,065 1,092 1,220 34
D2710 Crown, resin-based composite (indirect) 616.11 284.99 210 400 650 850 855 885 974 1,106 37
D2740 Crown - porcelain/ceramic substrate 987.18 146.17 800 883 973 1,097 1,120 1,148 1,194 1,278 108
D2750 metal 971.58 141.81 800 859 965 1,055 1,090 1,121 1,140 1,229 101
D2751 base metal 896.54 133.77 728 802 875 968 1,011 1,044 1,078 1,128 72
D2790 Crown - full cast high noble metal 989.37 149.44 805 880 972 1,087 1,115 1,194 1,200 1,247 99
D2920 Recement crown 88.73 24.16 60 74 85 101 104 110 120 134 116
D2930 primary tooth 233.01 57.71 168 197 228 259 266 275 300 328 96
Percentile Fees
D2954 crown 276.32 64.06 190 235 275 312 324 339 352 384 108
D2962 laboratory 982.39 200.36 757 840 924 1,098 1,150 1,207 1,249 1,412 98
D3110 restoration) 68.49 23.93 41 55 64 84 85 90 94 107 88
D3120 restoration) 65.25 24.03 37 50 60 76 84 87 97 107 81
D3230 restoration) 190.46 80.36 111 130 176 241 245 250 279 316 46
D3240 restoration) 212.56 90.86 118 150 195 277 293 300 305 316 45
Percentile Fees
D3330 restoration) 895.02 147.61 717 799 880 995 1,000 1,058 1,098 1,155 105

D3347 therapy - bicuspid 806.57 190.56 567 673 788 894 921 974 997 1,250 51
D3348 therapy - molar 984.29 213.24 710 834 942 1,100 1,120 1,151 1,155 1,424 51
D3410 anterior 524.06 182.55 307 389 500 630 645 660 836 871 35

D4260 or tooth bounded spaces per quadrant 847.70 246.94 594 683 835 982 1,000 1,072 1,116 1,393 33
Percentile Fees
D5211 and teeth) 1,030.74 352.45 578 820 980 1,245 1,297 1,372 1,460 1,680 108
D5212 and teeth) 1,040.38 350.85 600 820 983 1,253 1,312 1,380 1,460 1,680 106
D5213 and teeth) 1,525.25 316.50 1,150 1,323 1,485 1,760 1,799 1,890 1,950 2,116 117
D5214 and teeth) 1,527.83 318.00 1,150 1,323 1,485 1,779 1,850 1,890 1,950 2,116 117

Percentile Fees
D5730 (chairside) 293.70 116.39 175 235 299 351 375 390 409 471 96
D5731 (chairside) 286.19 111.46 168 229 291 349 367 385 400 471 95
D5750 (laboratory) 397.81 96.63 275 336 390 451 480 495 540 564 113
D5751 (laboratory) 402.51 104.17 275 336 390 458 483 514 542 587 113
D6056 modification and placement 574.05 184.27 356 458 550 683 703 750 839 945 65
D6057 placement 724.61 200.42 473 578 700 852 885 946 960 1,045 66
D6066 noble metal) 1,241.31 289.74 900 1,040 1,205 1,380 1,417 1,565 1,680 1,817 62

Percentile Fees
D6240 metal 955.93 139.12 789 850 950 1,053 1,087 1,098 1,132 1,208 94
D6241 base metal 897.95 137.07 725 805 885 1,002 1,025 1,044 1,066 1,128 74
D6245 Pontic - porcelain/ceramic 979.92 145.62 800 870 950 1,087 1,125 1,150 1,195 1,234 87
D6545 fixed prosthesis 548.12 263.89 289 346 525 687 713 775 858 1,085 65
D6750 metal 976.61 133.46 795 880 980 1,067 1,089 1,107 1,137 1,220 90
D6751 base metal 904.17 141.62 719 810 882 968 1,025 1,065 1,096 1,165 64
D7111 tooth 99.43 28.51 65 80 95 121 125 132 138 146 93
D7240 bony 396.35 91.33 288 320 394 449 450 470 494 599 51
Percentile Fees
D7880 Occlusal orthotic device, by report 602.91 269.49 315 390 550 725 807 953 977 1,100 45
D7960 another 328.40 122.32 175 243 333 375 410 440 474 548 57
D9230 anxiolysis 47.86 22.44 19 39 50 64 65 70 71 81 80
Percentile Fees
D9440 hours 123.12 37.75 68 98 126 150 153 157 169 182 78
D9630 report 23.46 18.50 0 10 22 34 35 44 45 72 39
D9972 in office 276.85 136.19 150 170 243 343 356 420 468 590 52
General Practitioners - South Atlantic Division
(Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, Washington D.C., West Virginia)
Percentile Fees
D0120 patient 43.44 11.79 30 39 45 50 50 53 55 58 172

D0145 caregiver 54.99 19.24 30 41 55 70 72 76 80 83 71
D0170 visit) 48.39 27.49 0 31 51 70 71 75 79 90 112
D0210 images 121.32 21.54 92 105 120 138 142 145 150 154 157
D0220 image 26.15 5.49 20 24 26 29 30 30 33 35 169
D0277 images 88.96 20.12 65 76 87 100 102 109 119 123 80
Percentile Fees
D1352 tooth 84.80 37.38 43 56 78 110 125 127 145 148 44
D2140 permanent 126.59 27.73 95 109 125 143 148 152 165 174 122
D2150 permanent 157.78 36.27 110 136 156 180 185 191 198 214 123
D2160 permanent 188.94 42.52 135 166 188 212 218 228 240 259 121
D2161 or permanent 221.15 50.31 147 190 221 252 260 277 285 315 119
D2330 anterior 148.56 31.04 110 131 147 168 174 176 185 198 167
D2331 anterior 181.04 36.35 134 160 182 199 207 217 230 244 167
D2332 anterior 219.59 50.50 150 195 218 247 252 269 285 306 169
D2335 (anterior) 270.68 67.58 175 235 270 307 318 333 348 390 169
D2391 posterior 161.75 29.59 125 145 160 180 185 190 196 211 160
Percentile Fees
D2392 posterior 205.84 44.78 150 182 203 228 238 244 253 281 164
D2393 posterior 253.17 55.04 185 222 250 283 293 301 321 332 162
D2520 Inlay - metallic - two surfaces 872.00 198.75 638 757 870 971 1,000 1,025 1,075 1,200 67
D2643 Onlay - porcelain/ceramic - three surfaces 1,000.88 186.55 785 895 993 1,105 1,137 1,160 1,247 1,310 94
D2644 surfaces 1,032.51 180.72 839 927 1,000 1,129 1,183 1,200 1,279 1,312 98
D2651 surfaces 830.94 222.47 500 764 862 920 953 985 1,000 1,121 52
D2662 surfaces 896.82 217.10 624 803 900 994 1,008 1,069 1,090 1,205 51
D2663 surfaces 939.94 208.91 630 855 954 1,050 1,080 1,103 1,145 1,251 49
D2664 more surfaces 964.10 214.50 680 868 960 1,090 1,133 1,140 1,216 1,295 50
D2710 Crown, resin-based composite (indirect) 725.65 337.86 330 422 741 985 1,000 1,034 1,150 1,250 62
D2750 metal 1,080.49 174.77 890 953 1,049 1,196 1,228 1,260 1,310 1,385 157
D2751 base metal 995.38 148.65 821 895 976 1,088 1,100 1,150 1,212 1,300 89
D2752 Crown - porcelain fused to noble metal 1,044.93 184.04 850 900 1,003 1,150 1,200 1,277 1,305 1,360 110
Percentile Fees
D2920 Recement crown 94.42 24.51 61 81 93 102 109 115 125 145 158
D2930 primary tooth 269.92 62.41 200 229 260 303 324 340 360 395 93
D2954 crown 298.81 54.58 227 270 303 331 340 351 364 378 152
D2962 laboratory 1,082.57 216.28 863 938 1,050 1,200 1,254 1,312 1,350 1,487 150
D3110 restoration) 70.84 27.84 39 55 70 81 85 90 93 107 123
D3120 restoration) 69.29 27.96 38 51 70 81 84 90 93 138 113
D3230 restoration) 250.33 89.64 145 195 251 288 300 310 346 480 57
Percentile Fees
D3240 restoration) 270.25 102.87 150 203 262 327 343 350 400 489 57
D3330 restoration) 983.43 152.76 800 890 975 1,094 1,104 1,126 1,150 1,253 134

D3348 therapy - molar 1,092.63 202.71 850 1,000 1,092 1,200 1,221 1,253 1,266 1,500 59
D3410 anterior 676.59 207.77 400 580 684 790 840 863 932 1,034 54
D3425 (first root) 815.76 230.09 500 730 820 924 932 1,000 1,045 1,232 33
Percentile Fees


D4263 quadrant 527.09 201.00 290 350 519 695 710 728 788 859 57
D4273 procedures, per tooth 1,002.35 238.75 700 898 976 1,147 1,207 1,250 1,280 1,456 34
Percentile Fees
D5211 and teeth) 1,063.09 389.42 636 752 1,000 1,265 1,340 1,405 1,504 1,700 156
D5212 and teeth) 1,086.75 384.93 650 844 1,052 1,267 1,369 1,448 1,540 1,700 153
D5213 and teeth) 1,561.26 384.20 1,087 1,286 1,545 1,800 1,850 1,937 2,040 2,215 159
D5214 and teeth) 1,570.08 388.90 1,087 1,300 1,557 1,800 1,850 1,950 2,050 2,310 158

D5730 (chairside) 301.28 93.35 175 237 315 357 381 395 408 435 133
Percentile Fees
D5731 (chairside) 298.39 93.15 172 235 305 356 379 394 406 425 130
D5750 (laboratory) 399.76 104.50 250 345 405 468 482 500 512 550 153
D5751 (laboratory) 397.50 102.98 250 345 400 468 480 494 512 550 149
D6057 placement 814.98 257.23 475 605 802 1,000 1,040 1,050 1,124 1,205 106
D6066 noble metal) 1,360.93 340.69 950 1,100 1,350 1,530 1,590 1,700 1,738 1,895 102

D6240 metal 1,074.99 176.54 885 951 1,040 1,196 1,205 1,250 1,310 1,375 145
Percentile Fees
D6241 base metal 1,017.85 212.29 795 893 985 1,106 1,145 1,200 1,300 1,400 87
D6750 metal 1,091.84 176.23 900 953 1,050 1,200 1,236 1,277 1,325 1,395 148
D6751 base metal 1,018.30 199.65 813 890 984 1,102 1,142 1,223 1,298 1,420 80
D7111 tooth 111.15 30.87 72 89 114 131 135 140 150 167 128
D7240 bony 438.24 78.82 325 399 450 495 500 514 528 550 76
Percentile Fees
D7288 collection 150.97 47.45 92 110 152 181 191 200 205 208 30
D7880 Occlusal orthotic device, by report 788.48 340.29 382 543 698 995 1,092 1,160 1,208 1,500 64
D7960 another 387.15 114.33 250 310 395 450 460 492 521 600 75
D8040 dentition 2,668.82 1,379.40 788 1,548 3,073 3,500 3,700 3,800 4,293 5,000 44
D9230 anxiolysis 61.81 31.35 0 42 67 80 82 88 103 120 97
Percentile Fees
D9440 hours 134.48 49.32 75 100 135 165 169 182 192 210 113
D9630 report 28.29 19.86 4 16 25 37 45 49 50 57 73
D9930 report 98.37 39.26 57 70 95 120 124 131 132 150 41
D9972 in office 271.52 112.37 150 200 250 303 346 364 473 505 88
General Practitioners - East South Central Division
(Alabama, Kentucky, Mississippi, Tennessee)
Percentile Fees
D0120 patient 39.32 9.48 26 33 40 45 47 49 50 53 94

D0145 caregiver 44.72 18.35 25 30 40 63 64 64 65 81 47
D0170 visit) 47.60 20.04 20 40 50 62 64 68 70 78 55
D0210 images 114.31 24.36 80 96 114 130 132 135 145 165 78
D0220 image 23.03 5.53 16 19 23 27 27 29 29 32 93
D0277 images 85.69 18.59 61 74 88 95 96 98 98 120 32
Percentile Fees
D2140 permanent 107.59 26.75 70 85 110 128 130 134 143 153 78
D2150 permanent 134.22 36.70 85 107 136 153 159 167 175 197 77
D2160 permanent 158.96 47.29 100 125 160 183 190 195 210 268 78
D2161 or permanent 182.42 52.96 120 141 181 211 217 235 243 282 76
D2330 anterior 133.05 33.16 90 110 132 150 155 156 170 186 88
D2331 anterior 158.79 39.03 103 134 158 180 187 192 200 219 89
D2332 anterior 188.30 48.68 125 155 185 216 223 238 242 258 91
D2335 (anterior) 226.82 57.67 151 184 225 263 280 294 300 315 89
D2391 posterior 141.63 32.31 95 120 140 160 165 172 184 190 90
D2392 posterior 177.73 37.29 128 152 179 207 214 216 223 234 88
D2393 posterior 213.35 45.71 145 180 220 254 256 261 270 283 88
Percentile Fees
D2520 Inlay - metallic - two surfaces 714.47 210.02 468 508 692 856 898 935 990 1,150 36
D2543 Onlay - metallic - three surfaces 844.10 199.96 561 689 855 987 997 1,044 1,045 1,200 31
D2620 Inlay - porcelain/ceramic - two surfaces 803.45 174.19 500 700 823 930 935 975 1,000 1,100 38
D2642 Onlay - porcelain/ceramic - two surfaces 882.85 150.21 640 792 895 990 1,018 1,021 1,045 1,101 34
D2644 surfaces 929.71 166.39 660 840 930 1,036 1,058 1,138 1,150 1,268 38
D2710 Crown, resin-based composite (indirect) 569.95 259.45 250 325 599 790 855 880 927 940 37
D2740 Crown - porcelain/ceramic substrate 963.65 150.17 775 850 972 1,064 1,090 1,109 1,169 1,251 80
D2750 metal 940.34 137.49 750 856 938 1,012 1,055 1,091 1,130 1,175 80
D2751 base metal 905.00 131.05 740 800 900 982 1,000 1,050 1,093 1,150 57
D2752 Crown - porcelain fused to noble metal 894.68 140.17 700 792 900 969 1,000 1,026 1,093 1,135 69
D2920 Recement crown 82.06 21.25 57 68 78 94 96 101 107 115 89
D2930 primary tooth 224.07 51.23 154 185 219 252 260 265 282 331 59
D2954 crown 266.15 57.86 180 225 264 303 311 325 337 353 80
Percentile Fees
D2961 Labial veneer (resin laminate) - laboratory 723.43 215.95 394 558 768 900 912 925 950 1,014 40
D2962 laboratory 952.70 175.09 750 840 940 1,067 1,100 1,108 1,177 1,252 74
D3110 restoration) 64.62 23.50 41 50 64 80 81 84 88 100 69
D3120 restoration) 62.58 22.51 35 47 63 75 80 82 86 100 59
D3240 restoration) 233.50 71.43 150 184 243 280 299 321 323 331 32
D3330 restoration) 889.67 136.02 700 775 890 980 991 1,025 1,082 1,140 75
D3346 therapy - anterior 689.00 160.42 483 580 700 774 800 815 845 995 41
D3347 therapy - bicuspid 790.90 153.17 594 689 777 904 921 954 995 1,066 40
D3348 therapy - molar 938.57 170.92 735 812 913 1,077 1,114 1,132 1,143 1,200 42
D3410 anterior 478.43 147.23 283 379 486 578 612 623 691 730 30
Percentile Fees
D5130 Immediate denture - maxillary 1,380.02 433.46 855 1,100 1,310 1,548 1,715 1,751 1,800 2,300 85
D5140 Immediate denture - mandibular 1,378.94 435.51 860 1,100 1,305 1,575 1,730 1,753 1,800 2,300 84
D5211 and teeth) 954.40 319.05 560 747 900 1,158 1,200 1,268 1,400 1,515 83
D5212 and teeth) 955.53 319.70 560 747 900 1,158 1,200 1,266 1,400 1,515 83
Percentile Fees
D5213 and teeth) 1,334.94 362.22 875 1,124 1,323 1,497 1,600 1,640 1,732 1,876 88
D5214 and teeth) 1,349.69 384.87 875 1,147 1,328 1,500 1,600 1,650 1,747 1,880 89

D5730 (chairside) 284.99 91.12 175 210 282 350 360 375 396 435 67
D5731 (chairside) 274.33 95.29 153 200 275 335 359 374 381 426 67
D5750 (laboratory) 358.92 88.40 231 300 371 420 430 450 469 498 89
D5751 (laboratory) 358.76 88.44 231 300 369 421 430 450 469 498 89
D6053 denture for completely edentulous arch 1,811.51 873.11 900 1,200 1,625 2,309 2,500 2,800 3,200 3,212 41
Percentile Fees
D6057 placement 716.69 201.77 450 575 718 828 856 891 980 1,100 54
D6059 metal crown (high noble metal) 1,109.61 192.50 850 950 1,118 1,206 1,250 1,300 1,376 1,395 61
D6066 noble metal) 1,123.63 252.73 843 923 1,098 1,267 1,323 1,402 1,445 1,636 60

D6240 metal 925.70 148.45 725 805 904 1,005 1,075 1,090 1,131 1,169 84
D6241 base metal 875.31 144.49 690 752 868 981 995 1,030 1,050 1,169 52
D6545 fixed prosthesis 493.58 211.63 300 350 425 620 675 730 750 885 43
D6750 metal 938.47 148.54 740 845 941 1,000 1,050 1,093 1,150 1,230 78
D6751 base metal 885.04 145.82 680 795 890 951 993 1,045 1,131 1,169 49
Percentile Fees
D7111 tooth 96.31 32.62 64 75 91 113 122 126 130 150 58
D7240 bony 386.12 90.15 265 320 374 450 465 479 484 576 33
D7960 another 343.24 105.72 214 259 343 420 442 450 462 502 41
D9230 anxiolysis 48.43 21.38 22 30 50 62 68 73 75 82 67
Percentile Fees
D9440 hours 110.22 38.79 68 75 111 137 145 150 157 190 54
D9630 report 25.29 20.33 0 12 19 35 39 43 48 85 38
D9972 in office 287.34 157.39 130 175 250 385 464 499 525 595 41
General Practitioners - West South Central Division
(Arkansas, Louisiana, Oklahoma, Texas)
Percentile Fees
D0120 patient 41.16 10.52 30 35 42 47 48 50 51 60 97

D0145 caregiver 51.52 15.29 33 35 51 64 65 67 68 82 33
D0170 visit) 43.81 25.00 0 33 50 60 64 68 70 85 58
D0210 images 111.10 20.89 86 98 110 122 125 132 135 145 86
D0220 image 23.21 5.31 15 20 24 27 27 28 30 31 95
D0277 images 82.64 19.55 59 70 84 96 98 100 105 119 55
Percentile Fees
D2140 permanent 116.38 29.74 85 93 117 132 140 145 155 172 77
D2150 permanent 145.61 34.67 101 124 149 165 172 177 185 212 77
D2160 permanent 177.38 44.88 122 150 176 200 206 221 230 272 77
D2161 or permanent 218.27 60.07 150 175 210 250 258 270 288 334 75
D2330 anterior 142.02 29.80 110 120 140 160 165 166 176 186 92
D2331 anterior 173.85 35.16 132 151 173 191 196 206 218 241 93
D2332 anterior 210.89 46.51 152 178 210 239 247 250 275 287 94
D2335 (anterior) 259.71 61.97 190 220 258 298 300 315 334 375 93
D2391 posterior 152.56 31.43 118 132 150 170 176 182 186 195 90
D2392 posterior 195.80 40.37 145 170 195 220 227 231 243 265 90
D2393 posterior 242.79 50.60 175 205 245 272 284 295 310 327 89
Percentile Fees
D2644 surfaces 971.68 159.24 752 895 972 1,093 1,150 1,156 1,200 1,217 38
D2662 surfaces 759.68 193.47 554 625 792 923 930 940 965 1,093 31
D2710 Crown, resin-based composite (indirect) 665.45 231.11 350 500 659 825 880 925 995 1,093 38
D2750 metal 981.74 173.50 775 875 960 1,055 1,100 1,148 1,200 1,250 87
D2751 base metal 943.81 151.78 785 825 915 987 1,080 1,141 1,167 1,247 63
D2920 Recement crown 86.85 24.04 60 73 87 96 98 104 113 130 91
D2930 primary tooth 227.65 54.94 160 185 232 251 260 278 300 350 77
Percentile Fees
D2954 crown 286.68 62.65 211 247 284 314 323 327 354 435 80
D2962 laboratory 1,028.84 198.52 800 898 1,000 1,144 1,182 1,200 1,307 1,400 81
D3110 restoration) 65.48 22.96 38 51 66 74 78 79 87 105 73
D3120 restoration) 62.45 22.32 35 48 62 75 76 80 88 105 71
D3230 restoration) 199.92 52.67 125 160 206 234 239 245 268 298 38
D3240 restoration) 224.84 69.46 107 193 246 273 276 278 300 350 37
D3330 restoration) 899.84 150.20 746 798 883 970 995 1,015 1,082 1,174 86

Percentile Fees
D3347 therapy - bicuspid 875.26 217.29 600 754 850 953 1,000 1,055 1,100 1,400 53
D3348 therapy - molar 1,033.40 262.11 710 865 985 1,137 1,219 1,254 1,350 1,550 53
D3410 anterior 585.71 231.05 363 421 580 659 684 705 830 1,082 35


D4263 quadrant 492.25 182.01 222 363 495 601 631 688 735 822 36
Percentile Fees
D5211 and teeth) 1,014.69 336.73 600 825 1,000 1,193 1,239 1,350 1,435 1,500 87
D5212 and teeth) 1,020.20 343.05 600 830 997 1,200 1,300 1,380 1,458 1,500 86
D5213 and teeth) 1,443.09 308.86 1,026 1,220 1,500 1,627 1,687 1,750 1,839 1,860 90
D5214 and teeth) 1,447.13 311.70 1,025 1,220 1,500 1,627 1,736 1,761 1,850 1,860 89

Percentile Fees
D5730 (chairside) 273.11 102.19 150 210 278 340 350 375 390 450 74
D5731 (chairside) 271.12 93.84 150 218 275 327 344 375 385 407 76
D5750 (laboratory) 380.93 111.80 275 312 382 453 474 480 490 565 88
D5751 (laboratory) 384.78 111.58 275 320 391 455 475 483 490 565 85
D6057 placement 699.34 147.44 500 600 690 788 800 806 909 963 41
D6066 noble metal) 1,278.52 278.19 900 1,100 1,252 1,453 1,500 1,515 1,647 1,700 48

Percentile Fees
D6240 metal 956.82 145.11 775 865 950 1,049 1,054 1,093 1,141 1,217 85
D6241 base metal 914.13 152.35 730 803 898 1,018 1,058 1,100 1,144 1,165 55
D6750 metal 980.22 159.08 785 852 974 1,055 1,093 1,119 1,172 1,280 83
D6751 base metal 930.06 159.76 781 810 924 1,018 1,093 1,104 1,150 1,200 54
D7111 tooth 99.42 28.92 70 78 98 119 120 125 131 140 72
D7240 bony 406.96 80.21 300 345 404 455 460 477 488 578 52
Percentile Fees
D7880 Occlusal orthotic device, by report 713.82 263.07 385 518 715 895 980 1,014 1,100 1,190 39
D7960 another 357.27 126.45 200 286 363 414 444 455 475 615 52
D8040 dentition 2,466.00 1,406.14 1,250 1,500 2,176 3,300 3,300 3,500 3,800 3,914 31
D9230 anxiolysis 48.51 19.00 25 36 46 60 65 69 75 80 71
D9440 hours 131.67 47.90 75 95 130 161 175 182 195 206 63
D9630 report 30.64 18.97 10 16 29 44 46 50 50 64 44
Percentile Fees
D9972 in office 248.11 142.75 100 160 200 299 314 400 495 595 57
General Practitioners - Mountain Division
(Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming)
Percentile Fees
D0120 patient 45.57 8.90 34 40 45 52 53 55 57 59 89

D0145 caregiver 52.41 16.08 35 40 51 67 69 71 73 81 51
D0170 visit) 50.23 23.02 23 40 50 62 65 72 77 80 66
D0210 images 120.56 18.85 96 108 121 131 134 140 144 153 80
D0220 image 24.92 5.41 18 21 25 28 29 31 31 35 88
D0277 images 85.45 20.91 52 72 88 99 99 104 108 120 51
Percentile Fees
D1352 tooth 77.61 43.00 35 40 75 100 105 118 132 145 33
D2140 permanent 126.19 31.32 85 104 124 147 152 157 160 174 68
D2150 permanent 156.57 37.31 113 126 159 180 188 196 200 228 68
D2160 permanent 188.21 47.52 133 150 188 210 223 239 250 282 68
D2161 or permanent 224.28 58.25 162 180 220 254 266 284 298 331 67
D2330 anterior 145.40 30.62 106 124 145 163 172 176 179 200 87
D2331 anterior 179.97 39.52 130 150 178 205 207 215 220 251 87
D2332 anterior 220.59 52.22 160 182 220 249 251 260 274 309 87
D2335 (anterior) 266.16 67.23 190 209 256 296 301 319 345 406 87
D2391 posterior 160.45 32.74 118 139 162 178 184 189 195 200 87
D2392 posterior 208.90 46.24 152 176 211 234 245 249 252 268 88
D2393 posterior 251.78 53.86 187 213 252 288 297 305 315 335 87
Percentile Fees
D2644 surfaces 1,007.81 173.11 761 890 995 1,148 1,181 1,196 1,210 1,350 59
D2651 surfaces 749.00 197.05 480 597 763 882 915 944 981 999 30
D2662 surfaces 796.85 194.65 530 688 801 943 995 1,040 1,041 1,102 33
D2663 surfaces 825.85 183.98 562 688 845 940 1,014 1,059 1,068 1,117 33
D2664 more surfaces 838.69 185.76 600 690 855 940 989 1,051 1,105 1,170 35
D2710 Crown, resin-based composite (indirect) 683.05 214.73 396 542 708 850 873 885 899 950 41
D2750 metal 993.59 168.34 752 875 989 1,098 1,126 1,181 1,221 1,288 83
D2751 base metal 926.13 161.89 710 810 897 1,000 1,071 1,126 1,150 1,220 61
D2783 Crown - 3/4 porcelain/ceramic 1,005.21 163.47 760 916 988 1,162 1,181 1,196 1,220 1,221 48
D2920 Recement crown 92.33 22.30 60 79 90 105 108 115 117 125 84
Percentile Fees
D2930 primary tooth 238.90 47.82 179 194 242 269 283 290 300 328 73
D2954 crown 287.06 62.52 200 232 295 326 338 345 361 371 85
D2961 Labial veneer (resin laminate) - laboratory 806.40 189.22 541 675 825 975 983 993 1,044 1,078 47
D2962 laboratory 1,047.16 199.49 799 902 1,036 1,175 1,200 1,217 1,300 1,400 76
D3110 restoration) 70.46 24.90 44 52 67 85 89 95 98 110 72
D3120 restoration) 67.79 25.16 45 55 64 80 85 88 93 105 67
D3230 restoration) 213.13 69.68 135 164 198 278 297 305 308 321 38
D3240 restoration) 229.18 82.99 105 166 229 299 300 305 343 345 44
Percentile Fees
D3330 restoration) 918.31 152.51 720 800 900 1,005 1,044 1,061 1,123 1,188 81

D3347 therapy - bicuspid 845.74 163.57 639 721 835 943 975 1,010 1,088 1,152 58
D3348 therapy - molar 1,002.58 170.02 798 895 965 1,118 1,183 1,200 1,269 1,290 55
D3352 replacement 185.31 94.13 80 132 163 226 228 260 290 389 36
D3410 anterior 620.51 190.55 356 549 619 757 795 805 818 904 39
D3421 bicuspid (first root) 650.32 191.12 434 500 653 800 818 882 890 926 31
D3425 (first root) 746.45 241.32 476 561 725 925 1,000 1,063 1,064 1,100 31
Percentile Fees


D4263 quadrant 485.80 186.87 275 350 436 652 684 700 767 786 46
D4266 barrier, per site 540.81 287.48 200 320 500 775 788 868 890 1,012 31
Percentile Fees
D5211 and teeth) 1,115.13 374.71 745 850 1,082 1,300 1,377 1,454 1,552 1,753 77
D5212 and teeth) 1,117.10 375.39 745 850 1,097 1,316 1,384 1,454 1,552 1,753 78
D5213 and teeth) 1,492.58 314.03 1,044 1,263 1,535 1,686 1,725 1,751 1,910 1,950 88
D5214 and teeth) 1,496.49 312.40 1,050 1,263 1,541 1,686 1,725 1,753 1,910 1,950 88

Percentile Fees
D5730 (chairside) 293.84 94.45 168 241 299 349 355 366 410 465 76
D5731 (chairside) 294.26 93.85 168 241 298 355 364 375 412 465 77
D5750 (laboratory) 395.80 87.31 275 335 400 450 459 475 515 544 82
D5751 (laboratory) 396.54 88.89 275 335 399 450 459 495 515 551 82
D6057 placement 695.52 207.90 435 550 675 842 850 907 950 1,010 69
D6059 metal crown (high noble metal) 1,228.60 289.60 850 995 1,209 1,415 1,478 1,575 1,600 1,785 72
D6066 noble metal) 1,304.70 306.39 850 1,100 1,306 1,510 1,555 1,620 1,700 1,785 66

Percentile Fees
D6240 metal 981.36 169.43 750 884 960 1,098 1,122 1,175 1,204 1,247 85
D6241 base metal 928.09 147.63 750 810 925 983 1,032 1,100 1,150 1,200 57
D6245 Pontic - porcelain/ceramic 1,003.50 175.11 769 900 978 1,110 1,143 1,169 1,200 1,250 74
D6545 fixed prosthesis 676.93 267.14 305 480 691 855 950 1,025 1,098 1,113 57
D6750 metal 998.23 166.05 775 887 986 1,125 1,150 1,169 1,220 1,250 82
D6751 base metal 937.36 156.67 750 858 925 1,010 1,098 1,145 1,153 1,227 53
D6793 necessary prior to final impression 476.18 317.67 133 223 412 650 867 900 952 1,112 34
D7111 tooth 110.40 33.28 72 89 110 127 135 138 150 164 78
D7240 bony 403.08 88.98 294 328 395 468 477 500 513 590 59
Percentile Fees
D7288 collection 166.47 53.22 105 123 167 200 211 214 253 271 30
D7880 Occlusal orthotic device, by report 762.93 351.56 412 550 621 901 1,037 1,128 1,177 1,550 30
D7960 another 344.39 97.75 196 276 367 401 412 443 458 500 62
D9230 anxiolysis 51.30 22.45 27 36 55 69 70 75 77 85 64
D9440 hours 137.38 56.70 79 100 131 166 177 193 199 228 72
D9630 report 28.66 18.92 6 15 27 39 43 53 55 60 41
Percentile Fees
D9930 report 101.06 43.21 39 65 110 125 130 145 148 165 32
D9972 in office 255.44 135.84 112 150 223 300 333 399 490 499 62
General Practitioners - Pacific Division
(Alaska, California, Hawaii, Oregon, Washington)
Percentile Fees
D0120 patient 53.37 13.84 38 45 55 63 65 67 70 75 200
D0145 caregiver 56.48 17.26 38 45 55 65 68 75 80 82 126
D0170 visit) 61.85 27.12 28 47 63 78 82 86 91 105 153
D0210 images 134.73 25.12 103 118 132 150 152 160 170 184 198
D0220 image 32.40 8.17 24 26 30 39 40 42 45 47 197
D0277 images 114.75 25.42 75 100 117 130 135 138 142 156 117
Percentile Fees
D1352 tooth 96.12 46.44 51 60 81 120 132 150 178 192 65
D2140 permanent 144.11 37.74 98 119 141 170 175 185 195 221 173
D2150 permanent 173.87 44.47 120 140 175 201 210 216 229 252 171
D2160 permanent 207.14 56.67 140 166 200 235 250 266 291 325 171
D2161 or permanent 239.23 65.48 160 192 240 275 292 300 325 365 168
D2330 anterior 174.55 40.88 129 146 170 199 208 225 240 250 196
D2331 anterior 211.05 51.97 150 175 200 240 250 268 295 314 199
D2332 anterior 244.60 59.60 170 204 240 277 295 303 328 365 197
D2335 (anterior) 289.45 64.22 200 247 285 332 345 352 372 412 192
D2391 posterior 190.47 42.44 143 160 183 217 229 235 250 275 196
D2392 posterior 240.98 54.45 179 200 236 272 285 295 312 341 197
D2393 posterior 288.79 64.93 200 245 285 326 336 350 375 417 195
Percentile Fees
D2643 Onlay - porcelain/ceramic - three surfaces 1,031.76 230.08 753 900 1,010 1,170 1,200 1,234 1,300 1,495 111
D2644 surfaces 1,061.57 222.85 716 925 1,053 1,200 1,235 1,270 1,370 1,474 111
D2651 surfaces 722.97 242.08 445 535 700 902 940 980 1,031 1,170 91
D2662 surfaces 764.22 264.91 459 566 720 922 1,024 1,089 1,140 1,213 89
D2663 surfaces 825.29 257.74 520 615 790 1,044 1,050 1,114 1,193 1,275 93
D2664 more surfaces 861.97 262.41 525 641 860 1,060 1,090 1,160 1,213 1,307 91
D2710 Crown, resin-based composite (indirect) 710.52 308.64 330 450 690 941 995 1,075 1,114 1,200 107
D2750 metal 1,110.87 208.02 896 951 1,080 1,214 1,273 1,313 1,400 1,500 193
D2751 base metal 986.61 175.20 775 877 980 1,098 1,105 1,187 1,250 1,300 132
D2752 Crown - porcelain fused to noble metal 1,044.32 180.85 850 922 1,005 1,150 1,187 1,240 1,275 1,412 153
D2920 Recement crown 107.19 28.75 76 89 100 121 125 135 147 162 191
Percentile Fees
D2930 primary tooth 255.19 66.40 175 219 250 290 295 317 343 375 143
D2954 crown 302.91 75.32 206 250 302 350 362 377 395 434 182
D2961 Labial veneer (resin laminate) - laboratory 834.53 323.51 424 570 827 1,048 1,086 1,115 1,307 1,400 116
D2962 laboratory 1,103.02 249.67 780 928 1,085 1,275 1,300 1,361 1,418 1,500 181
D3110 restoration) 81.66 26.63 50 61 80 95 98 101 120 135 134
D3120 restoration) 83.19 31.26 45 60 82 101 105 120 123 151 116
D3222 development 185.80 83.53 100 125 170 225 250 250 280 350 54
D3230 restoration) 200.08 79.33 107 143 185 250 252 276 299 343 100
D3240 restoration) 212.08 91.66 105 145 191 272 292 310 350 373 98
Percentile Fees
D3320 (excluding final restoration) 825.92 151.35 650 735 818 900 950 990 1,020 1,080 173
D3330 restoration) 1,005.75 165.04 810 900 995 1,100 1,111 1,160 1,213 1,278 167

D3348 therapy - molar 1,092.36 220.89 830 910 1,082 1,225 1,258 1,312 1,390 1,461 115
D3352 replacement 208.38 87.99 100 130 211 275 285 306 336 375 79
D3410 anterior 643.24 233.83 356 464 606 780 810 890 946 1,096 83
D3425 (first root) 741.18 250.62 396 541 742 900 950 995 1,050 1,190 66
Percentile Fees
D4212 tooth 245.22 101.83 144 183 226 329 345 362 372 425 32


D4263 quadrant 495.84 204.15 260 339 470 668 700 750 790 850 79
D4267 membrane removal) 643.23 277.14 315 450 589 863 900 987 1,000 1,107 52
Percentile Fees
D5211 and teeth) 1,238.74 402.98 760 950 1,200 1,500 1,560 1,609 1,882 2,000 169
D5212 and teeth) 1,242.05 404.67 760 950 1,200 1,524 1,571 1,639 1,777 2,000 170
D5213 and teeth) 1,690.39 419.91 1,234 1,408 1,630 1,900 2,000 2,050 2,293 2,479 185
D5214 and teeth) 1,699.36 431.70 1,234 1,408 1,631 1,916 2,000 2,100 2,299 2,500 186
Percentile Fees

D5730 (chairside) 315.18 102.89 198 250 300 375 387 413 446 500 166
D5731 (chairside) 314.66 102.31 198 250 300 375 380 403 443 498 165
D5750 (laboratory) 437.11 104.96 315 380 440 494 500 525 565 622 192
D5751 (laboratory) 437.09 104.20 320 380 440 494 500 525 565 622 192
D6057 placement 816.77 259.51 500 640 785 950 1,027 1,060 1,200 1,295 126
D6066 noble metal) 1,520.40 390.92 1,100 1,246 1,430 1,800 1,850 1,900 2,093 2,231 127
Percentile Fees

D6076 alloy, or high noble metal) 1,512.74 398.04 1,020 1,170 1,485 1,815 1,895 1,945 2,020 2,228 69
D6205 Pontic - indirect resin based composite 977.43 304.49 638 750 941 1,195 1,200 1,255 1,316 1,500 30
D6240 metal 1,074.16 213.98 842 925 1,049 1,200 1,243 1,295 1,350 1,495 185
D6241 base metal 961.44 210.63 718 812 946 1,096 1,108 1,152 1,198 1,300 130
D6750 metal 1,092.60 206.63 860 950 1,049 1,204 1,250 1,300 1,360 1,500 182
D6751 base metal 958.49 193.57 745 812 925 1,072 1,100 1,122 1,187 1,300 123
D7111 tooth 118.82 44.65 67 82 112 147 151 171 184 209 160
Percentile Fees
D7240 bony 461.08 124.69 320 378 443 536 550 589 638 682 122
D7288 collection 171.72 75.23 76 121 169 210 244 265 273 286 46
D7450 tumor - lesion diameter up to 1.25 cm 374.12 222.63 165 225 320 462 500 600 695 800 51
D7960 another 364.43 128.13 206 261 350 458 490 500 519 590 110
Percentile Fees
D8040 dentition 2,751.41 1,348.36 800 1,929 2,900 3,600 3,900 4,000 4,586 5,085 59
D8050 primary dentition 2,099.45 1,136.73 800 1,029 2,200 3,000 3,000 3,328 3,340 4,200 31
D8080 the adolescent dentition 5,290.71 1,066.72 4,000 4,800 5,143 5,600 5,800 6,500 6,680 7,800 38
D9230 anxiolysis 50.81 32.00 0 35 50 75 75 80 86 100 108

Percentile Fees
D9440 hours 162.96 55.12 98 120 161 200 209 215 243 250 147
D9630 report 24.35 23.01 0 8 19 33 38 50 60 67 60
D9930 report 109.36 41.96 54 75 108 137 150 160 167 175 88
D9972 in office 279.42 127.92 150 184 250 350 374 400 450 540 102
Oral and Maxillofacial Surgeons - National
Percentile Fees
D0120 patient 66.30 26.62 35 45 60 90 90 95 100 110 67
D0170 visit) 66.69 35.31 30 47 61 92 95 100 110 138 55
D0220 image 28.90 8.77 18 24 28 35 36 39 40 45 115
Cone beam — 3D image reconstruction
using existing data, includes multiple
D0363 images 282.81 103.07 141 225 285 350 350 375 400 500 37
Cone beam CT capture and interpretation
with field of view of both jaws, with or
D0367 without cranium 309.76 87.28 200 250 300 350 351 364 400 515 37
D3410 anterior 676.87 202.10 425 555 661 800 805 874 933 1,106 67
D3421 bicuspid (first root) 734.28 227.95 440 590 700 850 897 909 1,019 1,231 61
D3425 (first root) 821.27 264.20 525 672 761 975 1,000 1,016 1,153 1,394 62
Percentile Fees
D4263 quadrant 500.33 237.50 243 350 438 562 706 750 895 968 46
D4267 membrane removal) 630.21 291.58 265 400 575 948 995 1,000 1,004 1,037 33
D6057 placement 644.69 270.34 350 477 660 800 800 800 900 1,192 36
D7111 tooth 126.95 47.63 75 95 111 150 165 175 198 220 108
Percentile Fees
D7240 bony 455.47 87.07 356 392 445 513 529 550 585 603 152
Coronectomy - intentional partial tooth
D7251 removal 470.48 128.37 330 376 457 550 579 600 609 700 63
D7410 Excision of benign lesion up to 1.25 cm 527.93 294.30 250 323 439 693 750 776 900 1,110 108
Excision of malignant tumor - lesion
D7440 diameter up to 1.25 cm 835.75 570.45 275 438 672 1,005 1,228 1,357 1,763 2,100 48
D7450 tumor - lesion diameter up to 1.25 cm 608.92 262.32 325 450 575 700 772 831 950 1,200 109
Mandible - open reduction (teeth
D7630 immobilized, if present) 3,772.81 1,510.47 2,000 2,550 3,700 4,800 5,115 5,500 5,764 6,250 73
Mandible - closed reduction (teeth
D7640 immobilized, if present) 2,875.58 1,209.33 1,500 2,124 2,539 3,500 3,680 3,800 4,000 5,500 74
D7730 Mandible - open reduction 4,183.99 1,482.25 2,500 3,188 4,000 4,931 5,233 5,700 5,988 6,750 72
D7740 Mandible - closed reduction 2,873.88 1,149.07 1,500 2,124 2,610 3,561 3,700 3,838 4,300 5,000 73
D7880 Occlusal orthotic device, by report 845.53 318.55 500 601 786 1,050 1,150 1,229 1,287 1,500 45
D7910 Suture of recent small wounds up to 5 cm 449.55 286.66 240 259 342 598 607 665 858 1,135 56
D7960 another 465.70 166.38 285 350 428 550 624 665 700 757 128
Percentile Fees
D9230 anxiolysis 91.73 37.09 51 65 85 110 116 125 150 182 118
D9241 - first 30 minutes 364.39 93.70 250 295 350 420 435 450 500 540 122

D9440 hours 163.83 69.13 85 100 160 229 234 242 250 275 42
Endodontists - National
Percentile Fees
D0120 patient 87.27 50.14 0 60 88 125 136 140 150 155 33
D0170 visit) 68.69 52.82 0 25 65 100 111 123 125 170 51
D0220 image 25.86 9.40 15 22 25 30 32 35 35 40 125
D2140 permanent 131.75 44.83 84 100 120 152 160 176 200 225 59
D2150 permanent 162.58 48.91 93 126 170 190 198 200 228 253 40
D2160 permanent 199.43 56.85 115 167 206 240 243 248 263 275 35
D2161 or permanent 214.63 56.74 115 190 225 260 268 275 275 276 30
D2330 anterior 150.83 46.22 95 120 150 176 181 197 218 236 63
D2331 anterior 185.03 41.44 115 168 185 210 218 221 240 265 39
D2332 anterior 224.65 51.31 160 200 233 250 255 265 275 315 34
D2391 posterior 166.73 40.56 113 140 170 193 200 200 218 250 59
D2392 posterior 216.65 25.15 182 200 218 235 240 241 250 258 34
Percentile Fees
D2954 crown 329.39 88.00 220 275 315 385 395 400 410 450 49
D3110 restoration) 157.64 81.74 68 90 140 210 225 250 300 320 77
D3120 restoration) 141.16 76.77 68 80 124 189 200 225 250 310 58
D3222 development 392.68 184.31 200 262 365 450 500 515 735 800 62
D3230 restoration) 370.51 213.07 190 230 290 500 531 575 700 829 45
D3240 restoration) 436.04 283.30 190 231 315 538 695 797 900 1,045 48
D3310 (excluding final restoration) 922.89 195.34 695 790 900 1,050 1,095 1,125 1,167 1,250 179
D3320 (excluding final restoration) 1,042.89 203.41 810 890 1,030 1,195 1,200 1,245 1,295 1,350 177
D3330 restoration) 1,208.03 227.53 945 1,017 1,195 1,350 1,395 1,450 1,495 1,590 179

Percentile Fees
D3346 therapy - anterior 1,052.52 203.77 820 900 1,043 1,178 1,248 1,293 1,322 1,365 170
D3347 therapy - bicuspid 1,176.37 219.78 925 1,005 1,160 1,300 1,350 1,395 1,450 1,542 170
D3348 therapy - molar 1,352.97 246.67 1,065 1,155 1,325 1,538 1,565 1,600 1,680 1,750 171
D3352 replacement 222.03 90.37 121 150 210 282 300 303 340 385 111
Pulpal regeneration - (completion of
regenerative treatment in an immature
permanent tooth with a necrotic pulp);
D3354 does not include final res 579.86 230.07 300 415 525 748 800 900 908 1,000 36
D3410 anterior 984.11 218.34 725 825 976 1,143 1,195 1,205 1,274 1,350 158
D3421 bicuspid (first root) 1,083.33 242.57 820 909 1,055 1,245 1,286 1,350 1,400 1,500 159
D3425 (first root) 1,210.16 265.64 920 1,000 1,163 1,365 1,450 1,500 1,595 1,660 158
Percentile Fees
D9230 anxiolysis 97.72 51.60 45 75 95 109 115 125 150 250 67
D9440 hours 192.52 83.98 100 125 183 253 260 300 313 335 48
Orthodontists and Dentofacial Orthopedists - National
Percentile Fees
D0120 patient 32.18 39.14 0 0 20 53 59 71 90 95 45

D8020 transitional dentition 2,065.39 887.69 900 1,495 2,000 2,685 2,800 3,000 3,250 3,500 166
D8030 adolescent dentition 2,506.14 982.00 1,200 1,800 2,500 3,200 3,427 3,500 3,900 4,000 167
D8040 dentition 3,156.95 1,003.10 2,000 2,500 3,070 3,680 3,800 4,130 4,500 4,900 165
D8050 primary dentition 2,249.98 952.55 1,000 1,500 2,200 2,975 3,037 3,200 3,400 3,850 134
D8060 transitional dentition 2,526.28 910.75 1,500 1,800 2,500 3,200 3,356 3,500 3,750 4,130 185
Periodic orthodontic treatment visit (as
D8670 part of contract) 161.90 55.37 100 125 150 190 200 200 250 283 87
Orthodontic treatment (alternative billing
D8690 to a contract fee) 209.55 89.18 130 150 180 215 295 350 350 402 33
D9940 Occlusal guard, by report 528.80 266.27 200 350 485 660 760 900 1,000 1,000 49
Pediatric Dentists - National
Percentile Fees
D0120 patient 49.75 11.83 35 43 50 55 59 63 65 70 119
D0145 caregiver 64.76 23.21 40 48 65 75 80 85 92 108 101
D0170 visit) 53.10 27.99 0 37 56 75 75 84 86 90 82
D0210 images 127.29 32.45 84 108 127 144 150 155 168 183 97
D0220 image 28.39 8.78 18 23 28 32 35 37 40 47 118
Percentile Fees
D1352 tooth 88.95 28.15 54 60 95 107 115 120 125 126 39
D2140 permanent 130.27 30.50 85 114 133 151 159 161 168 175 88
D2150 permanent 160.70 38.07 110 140 162 183 190 200 212 223 88
D2160 permanent 190.94 44.92 132 165 190 218 224 237 249 270 86
D2161 or permanent 222.99 52.68 155 180 222 259 267 280 284 308 81
D2330 anterior 148.50 34.81 99 128 149 168 170 179 198 220 118
D2331 anterior 180.97 38.26 128 157 185 203 210 216 230 260 116
D2332 anterior 218.91 53.67 150 181 219 248 250 265 277 325 116
D2335 (anterior) 282.91 81.23 182 235 277 329 340 350 393 439 116
D2391 posterior 161.47 32.13 115 140 163 182 186 190 197 223 115
D2392 posterior 203.83 41.38 145 172 202 236 240 243 253 271 115
D2393 posterior 243.44 52.54 170 210 245 280 292 297 308 328 114
Percentile Fees
D2920 Recement crown 78.80 26.62 45 55 80 100 103 109 117 120 88
D2930 primary tooth 257.36 49.93 187 224 259 287 297 305 320 336 108
D3110 restoration) 73.97 25.25 42 55 75 87 90 101 105 113 102
D3120 restoration) 72.18 26.72 40 54 71 85 91 98 111 115 99
D3230 restoration) 230.88 66.89 150 183 220 275 280 301 306 375 78
D3240 restoration) 252.38 89.77 144 181 245 312 326 330 348 437 79
D3330 restoration) 889.19 197.21 550 780 936 1,049 1,066 1,075 1,078 1,129 37
Percentile Fees
D3352 replacement 188.47 74.38 101 128 190 235 258 275 280 301 36
D7111 tooth 111.80 30.52 70 88 110 137 139 145 150 152 83
D7240 bony 378.06 108.30 257 281 391 450 470 475 539 560 34
Percentile Fees
D7960 another 398.00 107.15 262 312 396 461 475 495 535 579 48
D8020 transitional dentition 1,624.03 1,145.16 448 666 1,410 2,430 2,550 2,708 3,128 3,340 40
D8030 adolescent dentition 1,892.60 1,205.21 531 850 1,785 2,749 2,846 3,000 3,370 3,407 30
D8050 primary dentition 1,608.33 803.14 638 937 1,424 2,380 2,500 2,595 2,761 2,916 40
D8060 transitional dentition 1,914.33 1,076.97 600 995 1,599 2,849 3,000 3,148 3,500 3,749 46
D9230 anxiolysis 57.57 26.14 27 40 55 70 75 82 89 115 90
D9440 hours 156.92 56.17 86 117 150 197 202 221 245 260 75
Percentile Fees
D9972 in office 222.27 82.64 103 172 210 295 300 330 350 356 45
Periodontists - National
Percentile Fees
D0120 patient 69.05 37.56 35 45 60 88 101 109 125 150 83
D0170 visit) 75.89 43.98 0 50 78 100 120 124 135 140 64
D0210 images 136.60 30.81 96 115 135 155 160 165 175 180 87
D0220 image 26.88 7.82 17 23 27 31 31 34 35 40 88
D0277 images 98.84 30.19 60 81 96 119 120 125 140 160 37
D4210 spaces per quadrant 851.33 332.23 485 625 800 985 1,050 1,213 1,349 1,500 91
Percentile Fees
D4211 spaces per quadrant 548.89 281.65 220 325 478 750 810 850 900 1,050 91
D4212 tooth 565.86 294.87 296 350 486 670 809 884 979 1,250 37
D4240 tooth bounded spaces per quadrant 947.32 284.24 650 788 878 1,050 1,092 1,210 1,379 1,500 79
D4241 tooth bounded spaces per quadrant 727.51 264.02 425 529 700 850 874 1,050 1,190 1,253 79
D4249 Clinical crown lengthening - hard tissue 994.58 263.37 700 850 958 1,100 1,199 1,234 1,283 1,550 95

D4260 or tooth bounded spaces per quadrant 1,310.98 334.39 900 1,100 1,249 1,500 1,644 1,700 1,800 1,900 98

D4261 tooth bounded spaces per quadrant 1,013.79 279.99 750 850 969 1,155 1,221 1,283 1,350 1,544 91
D4263 quadrant 530.84 198.45 322 400 494 620 670 750 802 973 97
D4267 membrane removal) 645.11 341.56 310 414 531 864 975 1,041 1,100 1,300 72
D4273 procedures, per tooth 1,215.02 299.88 876 995 1,175 1,375 1,435 1,500 1,610 1,800 97
D4275 Soft tissue allograft 1,220.49 325.00 850 975 1,250 1,405 1,491 1,500 1,610 1,700 57
Percentile Fees
Free soft tissue graft procedure (including
donor site surgery), first tooth or
D4277 edentulous tooth position in graft 1,077.03 256.97 750 885 1,063 1,258 1,283 1,320 1,350 1,500 86
D7111 tooth 152.28 82.64 81 95 135 176 195 210 250 375 39
D7240 bony 523.20 142.46 336 442 511 587 625 650 708 800 30
Percentile Fees
D7310 spaces, per quadrant 466.64 266.34 246 273 356 636 720 803 850 1,200 39
D7320 spaces, per quadrant 595.86 242.47 346 424 540 750 808 877 972 1,165 37
D7953 preservation – per site 631.20 301.26 324 398 526 836 875 980 1,046 1,165 56
D7960 another 499.58 157.32 300 395 490 595 608 660 715 788 66
D9230 anxiolysis 70.29 33.97 35 50 72 85 88 93 105 150 56
Prosthodontists - National
Percentile Fees
D0120 patient 63.24 28.87 35 42 51 82 85 95 100 125 58
D0170 visit) 59.77 44.92 0 25 61 90 95 100 125 150 39
D0210 images 151.46 39.95 109 122 146 175 180 185 200 250 54
D0220 image 28.77 8.17 20 23 28 32 33 38 40 44 53
D2140 permanent 149.30 44.31 93 120 150 177 183 188 198 231 40
D2150 permanent 189.15 53.79 133 150 182 223 233 244 250 290 40
D2160 permanent 223.74 60.70 160 180 220 250 278 299 300 345 39
D2161 or permanent 268.51 73.71 180 218 260 300 338 350 375 400 37
Percentile Fees
D2330 anterior 193.64 65.56 121 151 178 220 224 235 288 375 55
D2331 anterior 236.82 77.65 150 180 225 275 286 302 336 414 55
D2332 anterior 276.07 80.56 188 220 265 330 345 350 391 425 54
D2335 (anterior) 336.54 99.59 225 268 325 406 425 430 475 503 48
D2391 posterior 206.09 68.33 135 160 200 230 247 279 305 350 55
D2392 posterior 253.26 73.71 175 200 245 290 318 325 341 395 53
D2393 posterior 298.87 78.27 204 244 293 346 365 385 391 450 52
D2520 Inlay - metallic - two surfaces 1,252.24 610.17 695 810 1,102 1,496 1,568 1,800 1,875 2,650 33
D2543 Onlay - metallic - three surfaces 1,392.05 417.27 875 1,192 1,275 1,600 1,749 1,785 1,875 2,475 37
D2620 Inlay - porcelain/ceramic - two surfaces 1,268.89 493.44 725 862 1,203 1,600 1,650 1,750 1,800 2,475 38
D2642 Onlay - porcelain/ceramic - two surfaces 1,377.62 486.48 800 1,100 1,365 1,650 1,750 1,800 1,875 2,475 37
D2643 Onlay - porcelain/ceramic - three surfaces 1,497.61 414.37 1,045 1,200 1,446 1,768 1,800 1,850 2,000 2,475 36
D2644 surfaces 1,493.35 421.19 1,040 1,200 1,400 1,749 1,785 1,800 1,875 2,500 37
D2740 Crown - porcelain/ceramic substrate 1,482.15 372.09 1,045 1,200 1,488 1,699 1,750 1,800 1,875 2,000 48
D2750 metal 1,526.19 471.31 1,040 1,176 1,500 1,785 1,800 1,850 2,000 2,475 54
D2752 Crown - porcelain fused to noble metal 1,440.27 388.45 950 1,139 1,450 1,650 1,785 1,800 1,875 2,000 37
D2780 Crown - 3/4 cast high noble metal 1,447.35 407.05 1,000 1,139 1,400 1,600 1,650 1,800 1,800 2,475 31
D2783 Crown - 3/4 porcelain/ceramic 1,573.43 549.38 1,018 1,219 1,556 1,800 1,800 1,850 2,175 2,650 30
Percentile Fees
D2920 Recement crown 126.12 52.65 65 92 125 150 166 175 189 250 57
D2952 indirectly fabricated 570.02 276.27 325 374 493 688 719 750 780 1,250 52
D2954 crown 413.04 164.88 250 298 365 500 550 598 650 750 46
D2962 laboratory 1,479.08 422.64 1,050 1,198 1,475 1,660 1,800 1,850 1,875 2,475 52
D5110 Complete denture - maxillary 2,666.39 1,001.77 1,580 2,000 2,450 3,400 3,500 3,500 4,400 4,500 57
D5120 Complete denture - mandibular 2,702.22 1,003.05 1,580 2,000 2,475 3,475 3,500 3,586 4,400 4,500 58
D5130 Immediate denture - maxillary 2,685.23 1,034.46 1,500 2,040 2,500 3,200 3,586 4,000 4,000 4,500 57
D5140 Immediate denture - mandibular 2,696.05 1,045.34 1,500 2,020 2,500 3,250 3,586 4,000 4,062 4,500 56
D5211 and teeth) 1,793.33 1,071.56 750 960 1,498 2,104 2,500 3,475 3,500 4,000 46
D5212 and teeth) 1,812.17 1,068.13 750 950 1,500 2,104 2,500 3,475 3,500 4,000 46
D5213 and teeth) 2,625.89 1,029.92 1,276 1,910 2,500 3,421 3,500 3,700 4,000 4,500 56
Percentile Fees
D5214 and teeth) 2,651.98 1,017.69 1,276 1,975 2,500 3,465 3,500 3,700 4,000 4,500 57
D5710 Rebase complete maxillary denture 686.60 324.36 300 410 650 911 945 954 1,024 1,343 48
D5730 (chairside) 439.79 164.72 275 340 422 500 550 577 708 750 48
D5731 (chairside) 433.35 166.18 275 325 408 500 525 575 708 750 48
D5750 (laboratory) 626.63 257.86 342 409 588 791 854 890 917 1,125 56
D5751 (laboratory) 627.09 256.56 350 415 582 779 854 900 950 1,125 57
D6053 denture for completely edentulous arch 3,550.31 1,718.94 1,511 2,500 3,500 4,250 4,500 5,097 5,750 7,500 32
D6055 abutment supported 3,098.81 1,919.03 1,060 1,483 3,000 4,354 4,500 4,976 5,750 7,500 32
D6056 modification and placement 650.91 264.17 400 495 595 750 850 950 1,000 1,060 43
D6057 placement 888.78 366.45 500 612 800 1,100 1,100 1,200 1,500 1,500 46
D6066 noble metal) 2,024.52 789.74 1,350 1,545 1,812 2,375 2,475 2,500 2,750 4,000 44
Percentile Fees

D6210 Pontic - cast high noble metal 1,462.51 418.36 950 1,100 1,500 1,700 1,749 1,800 1,900 2,175 43
D6240 metal 1,454.80 389.60 995 1,176 1,467 1,650 1,749 1,800 1,900 2,175 54
D6245 Pontic - porcelain/ceramic 1,447.05 423.28 980 1,139 1,425 1,655 1,750 1,850 1,900 2,475 39
D6545 fixed prosthesis 969.31 630.97 300 538 762 1,253 1,350 1,700 1,700 2,500 32
D6750 metal 1,440.44 370.78 985 1,139 1,463 1,665 1,749 1,800 1,875 2,000 54
D6790 Crown - full cast high noble metal 1,453.04 389.73 984 1,143 1,488 1,675 1,733 1,800 1,875 2,150 52
D9440 hours 156.71 60.55 95 121 150 192 200 223 250 285 38
D9940 Occlusal guard, by report 670.76 295.61 350 450 618 800 890 900 1,000 1,400 55
Percentile Fees
D9952 Occlusal adjustment - complete 659.45 354.23 246 400 595 860 911 975 1,000 1,252 40
D9972 in office 327.50 131.58 180 228 300 400 400 425 500 600 34
Methodology
In accordance with a directive from the 1976 House of Delegates, the Survey Center is responsible for periodically
gathering and disseminating information regarding dental fees in the United States. The American Dental
Association’s (ADA) survey of fees charged by general practitioners and specialists is limited to the publication of
statistics gathered from a nationwide random sample of dentists, who were asked to record the fee most often
charged for each of 238 different dental procedures. The survey data should not be interpreted as
constituting a fee schedule in any way, and should not be used for that purpose. Dentists must establish
their own fees based on their individual practice and market considerations.
The procedure codes on the 2013 Survey of Dental Fees survey instrument and presented in the tables of this
report were taken from CDT 2013, the reference manual published by the ADA. The previous Survey of Dental
Fees used codes based on the 2011 edition of the manual; therefore, care should be taken when comparing data
in this report with data from previous ADA Surveys of Dental Fees or reports from other sources. CDT 2013
contains numerous updates and modifications to procedure codes, descriptors and common dental terms.
In this report, data for general practitioners are presented separately for each of the nine U.S. Census Divisions
and for the nation as a whole. Following the general practitioner data, national statistics are presented for six
dental specialties. The sample design used to select specialists did not provide a sufficient number of specialists
to allow for analysis by specialty at the divisional level. Statistics presented for each procedure include the number
of respondents, average, standard deviation and percentiles. The Glossary (separate page) includes definitions of
these statistics, all of which help indicate how fee answers varied for a given procedure in our survey. To ensure
statistical validity, at least 30 responses must have been received for each reported procedure. In both the general
practitioner and specialty sections, only those procedures that received 30 or more responses are included in this
report.
Sampling
The 2013 Survey of Dental Fees sample was selected from the ADA’s national sampling frame of active private
practitioners (“the population”), which includes member and non-member dentists. The sample, representing 7.4%
of the population, was a simple random probability sample of 13,052 dentists in private practice, of whom
approximately 60% were general practitioners and 40% were specialists.
Among active private practitioners in the sampling frame, specialists comprise only 18.5% of the total population.
To ensure enough responses from specialists to report reliable national data, specialists were oversampled with
respect to their proportion in the population. General practitioners from the New England and East South Central
divisions were also oversampled to ensure a sufficient number of responses.
Representativeness was determined by checking for statistically significant differences between the sample and
population on the following demographic characteristics using chi-square statistics and T-tests: division, primary
occupation, secondary occupation, specialty, race, ownership status, age, and graduation year. No statistically
significant differences were found between any of the subsamples of general practitioners and specialists and their
populations.
Data collection
The 2013 Survey of Dental Fees was initially mailed to 13,052 dentists in private practice in April 2013, and two
follow-up mailings to non-respondents were sent in May and June. Data collection was concluded in August 2013
after responses had been received from 2,198 dentists. The final adjusted response rate of 18.2% excludes those
individuals who were retired, not in private practice, deceased, or had unknown or foreign addresses.
Weighting
The proportion of oversampled dentists in the sample and among the respondents was higher than in the actual
population. To be able to make statements about all private practitioners, all general practitioners, or all
specialists, the proportion of general practitioners and specialists among the respondents had to match those of
the sample frame and the dental population as a whole. If left unbalanced, the statistics presented for all dentists,
all general practitioners, or all specialists would have been skewed by the disproportionate number of oversampled
dentists among the respondents and would not have been an accurate representation of the dental population
being analyzed.
In the sampling frame, 4.3% of dentists were New England general practitioners, 3.8% were East South Central
general practitioners, 73.4% were general practitioners from other divisions, 1.5% were prosthodontists, and 17.0%
were specialists other than prosthodontists. Among the respondents to the survey, 3.6% of dentists were New
England general practitioners, 4.3% were East South Central general practitioners, 51.3% were general
practitioners from other divisions, 3.0% were prosthodontists, and 37.8% were specialists other than
prosthodontists. Weights were calculated for these five sets of dentists to bring the proportions found among the
respondents into line with those found in the dental population.
In this report, the weights were used in the calculation of statistics in which all general practitioners were combined.
Weights were not used when a single division of general practitioners or a single specialty were analyzed
separately. Statistics computed with weights are indicated as such in the report.
Each weight was calculated by dividing the percentage of each in the sampling frame by the percentage in the
respondent population.
For example, when reporting all general practitioners combined, weighting had the effect of turning every
responding general practitioner from the New England division into 0.86847 general practitioners.
Glossary
AVERAGE The arithmetic average of all fees reported by the respondents, obtained by taking
the sum of all fees and dividing by the number of responses. It is possible that no
dentist reported charging a fee that is exactly equal to the average value. If the
distribution of fees is not symmetrical (that is, one half is not the mirror image of the
other), the median is a better indicator of the typical fee charged than the average.
CHI-SQUARE STATISTICS Chi-square statistics indicate, in the context of this report, whether the demographic
characteristics of a random sample occur with a distribution similar to that of the
population from which the sample is drawn.
DIVISIONS Nine U.S. Census Divisions:
New England: Connecticut, Maine, Massachusetts, New Hampshire, Rhode

Island, and Vermont.
Middle Atlantic: New Jersey, New York, and Pennsylvania.
East North Central: Illinois, Indiana, Michigan, Ohio, and Wisconsin.
West North Central: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota,
and South Dakota.
South Atlantic: Delaware, Florida, Georgia, Maryland, North Carolina, South

Carolina, Virginia, Washington D.C., and West Virginia.
East South Central: Alabama, Kentucky, Mississippi, and Tennessee.
West South Central: Arkansas, Louisiana, Oklahoma, and Texas.
Mountain: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico,

Utah, and Wyoming.
Pacific: Alaska, California, Hawaii, Oregon, and Washington.
MEDIAN A statistical measure that divides ranked numeric responses into halves. The
median is the response that falls at the fifty percent mark. The responses in one half
are all smaller than the median and those in the other half are all larger than the
median.
PERCENTILE A percentile represents a fee at which a certain percentage of dentists charge up to

the value of that fee. Example: the 75th percentile describes the fee equal to or
greater than 75% of the fees for a given procedure.
SIMPLE RANDOM PROBABILITY A simple random probability sample denotes a sample in which names are drawn at
SAMPLE random without replacement.
STANDARD DEVIATION (S.D.) The typical deviation of sample values from the mean. The size of the standard
deviation reflects the accuracy of the sample mean in representing the population.
In a normal population, 68.0% of the observations fall within one standard deviation
of the mean, 95.5% within two standard deviations, and 99.7% within three standard
deviations.
T-TESTS T-tests indicate, in the context of this report, whether the mean values of numeric
demographic characteristics (age, year of graduation) of a random sample are
statistically similar to those of the population from which the sample is drawn.
211 East Chicago Avenue Health Policy Resources Center
Chicago, Illinois 60611
312-440-2568
Please circle the number corresponding to the most 5. Please indicate the current number of full- or part-time
appropriate response or fill in the blank. Please do not dentist positions in the entire primary practice.
report ranges. Please include yourself. (If none, enter zero.)
a. Number of owner dentists

1. What is your current occupation? (Please circle only one
(i.e., sole proprietors, partners
response.)
or shareholders) ................................... ____________
b. Number of non-owner dentists
a. Private practice (full- or part-time) ........................... 1
(i.e., employed dentists,
b. Other dental occupation .......................................... 2
associates and
c. Other non-dental occupation ................................... 3
non-shareholders) ................................ ____________
Please complete this questionnaire if you are currently in 6. Approximately what percentage of the patients who
private practice. Otherwise, stop here and return the currently visit the entire primary practice are:
questionnaire. Thank you.
a. covered by a private insurance
program that pays or partially
Individual Dentist Questions pays for their dental care?................... ___________%
b. covered by a public assistance
2. In your primary practice in 2013, in which of the following program that pays or partially
ADA-recognized specialty areas were you announcing pays for their dental care?................... ___________%
E
yourself and practicing as a licensed specialist? (Circle
one response.) c. covered by a direct
reimbursement plan? .......................... %
a. No specialty, I am a general practitioner .................
PL 0 d. not covered by an
b. Oral and maxillofacial surgery................................. 1 insurance program? ............................ %
c. Endodontics ............................................................ 2 Total 100%
d. Orthodontics and dentofacial orthopedics ............... 3
e. Pediatric dentistry ................................................... 4 7a. Does your primary practice accept payment from third
f. Periodontics ............................................................ 5 party payers for dental claims?
M
g. Prosthodontics ........................................................ 6
h. Oral and maxillofacial pathology ............................. 7 Yes ................................................................................. 1
i. Public health ........................................................... 8 No (Skip to Question 8.) ................................................. 2
j. Oral and maxillofacial radiology .............................. 9
SA
7b. In your primary practice, how many days does it take, on

3. Please describe your primary practice. average, to receive reimbursement for clean claims
(when you have submitted all the information required in
a. The practice is: accordance with applicable laws or contract provisions
for the company to review the claim) from the following
1. incorporated ...................................................... 1 types of payers?
2. unincorporated .................................................. 2
1. Commercial insurance carriers
b. You are: (Aetna, MetLife, etc.) ................................. ________
2. Delta Dental Plans..................................... ________
1. a sole proprietor (i.e., the only owner) ............... 1 3. Blue Cross/Blue Shield Plans .................... ________
2. a partner (i.e., one of two or more owners)........ 2 4. Government programs .............................. ________
3. an employee (on a salary, commission, days
percentage or associate basis).......................... 3

4. an independent contractor ................................. 4 8. Do you submit dental claims electronically?
Yes ................................................................................. 1
No ................................................................................... 2
Primary Practice Questions
9. How frequently do you update your fees? (Select the
4. What is the zip code closest time interval.)
of your primary practice? ........................ ____________
zip code a. Less than 6 months between updates ..................... 1
b. Every 6 months ....................................................... 2
c. Every year ............................................................... 3
d. Every two years ....................................................... 4
e. More than two years between updates.................... 5
Legal Disclaimer: This survey is taken in accordance with Statement 6 of the Federal Trade Commission’s Statements of Antitrust Enforcement Policy in HealthCare. Dentists are reminded to
avoid sharing fee or cost information with their competitors.
For the following procedures, record the actual fee amount that you most often charge, not the portion of
your charge which you expect to receive or for which you might be reimbursed.
 Do not report a fee range.

 Record a single fee for each service.
 If you provide certain services without charge, write in zero.
 If you do not perform a certain procedure, leave the corresponding space blank. Procedure codes from the
most recent revision of the ADA's Code on Dental Procedures and Nomenclature are provided for your
assistance in specifying services. All codes and nomenclature are published in the ADA's CDT 2013: Dental
Procedure Codes.
DIAGNOSTIC (D0100 - D0999) DIAGNOSTIC (D0100 - D0999) Continued
Periodic oral evaluation — Cone beam CT capture and

D0120 established patient $___________.00 interpretation with field of view of
Limited oral evaluation - problem D0365 one full dental arch — mandible $___________.00
D0140 focused $___________.00 Cone beam CT capture and
Oral evaluation for a patient under interpretation with field of view of
three years of age and counseling one full dental arch — maxilla, with
D0145 with primary caregiver $___________.00 D0366 or without cranium $___________.00
Comprehensive oral evaluation — Cone beam CT capture and
E
D0150 new or established patient $___________.00 interpretation with field of view of
D0367 both jaws, with or without cranium $___________.00
Detailed and extensive oral
evaluation — problem focused, by Collection and preparation of saliva
D0160 report
PL
$___________.00
D0417
sample for laboratory diagnostic
testing $___________.00
Re-evaluation - limited, problem
focused (established patient; not
D0170 post-operative visit) $___________.00 D0418 Analysis of saliva sample $___________.00
Comprehensive periodontal Adjunctive pre-diagnostic test that
evaluation — new or established aids in detection of mucosal
M
D0180 patient $___________.00 D0431 abnormalities $___________.00
D0190 Screening of a patient $___________.00 D0470 Diagnostic casts $___________.00

SA
D0191 Assessment of a patient $___________.00

PREVENTIVE (D1000 — D1999)
Intraoral - complete series of
D0210 radiographic images $___________.00
Intraoral - periapical first
D0220 radiographic image $___________.00
D1110 Prophylaxis - adult $___________.00
D0230 radiographic image $___________.00
D1120 Prophylaxis - child $___________.00
Bitewings - two radiographic
D0272 images $___________.00 Topical application of fluoride
D1206 varnish $___________.00
Bitewings - three radiographic
D0273 images $___________.00
D1208 Topical application of fluoride $___________.00
Bitewings - four radiographic
D0274 images $___________.00 Tobacco counseling for the control
D1320 and prevention of oral disease $___________.00
Vertical bitewings - 7 to 8
D0277 radiographic images $___________.00
D1330 Oral hygiene instructions $___________.00
D0330 Panoramic radiographic image $___________.00

D1351 Sealant - per tooth $___________.00
D0350 Oral/facial photographic images $___________.00 Preventive resin restoration in a

moderate to high caries risk patient
Cone beam — 3D image D1352 — permanent tooth $___________.00
reconstruction using existing data,
D0363 includes multiple images $___________.00
D1510 Space maintainer — fixed unilateral $___________.00
Cone beam CT capture and
interpretation with limited field of
D0364 view — less than one whole jaw $___________.00 D1515 Space maintainer — fixed bilateral $___________.00
RESTORATIVE (D2000 — D2999) RESTORATIVE (D2000 — D2999) Continued
Amalgam - one surface, primary or Crown - porcelain fused to noble

D2140 permanent $___________.00 D2752 metal $___________.00
D2150 permanent $___________.00 D2780 Crown - ¾ cast high noble metal $___________.00
Amalgam - three surfaces, primary
D2160 or permanent $___________.00 D2783 Crown - ¾ porcelain/ceramic $___________.00
Amalgam - four or more surfaces,
D2161 primary or permanent $___________.00 D2790 Crown - full cast high noble metal $___________.00
Resin-based composite — one Provisional crown – further
D2330 surface, anterior $___________.00 treatment or completion of
Resin-based composite - two diagnosis necessary prior to final
D2331 surfaces, anterior $___________.00 D2799 impression $___________.00
Resin-based composite — three
D2332 surfaces, anterior $___________.00 D2920 Recement crown $___________.00
Resin-based composite - four or Prefabricated porcelain/ceramic
more surfaces or involving incisal D2929 crown – primary tooth $___________.00
D2335 angle (anterior) $___________.00 Prefabricated stainless steel crown
Resin-based composite crown, D2930 - primary tooth $___________.00
D2390 anterior $___________.00 Prefabricated stainless steel crown
Resin-based composite - one D2931 - permanent tooth $___________.00
D2391 surface, posterior $___________.00
Resin-based composite - two D2940 Protective restoration $___________.00
E
D2392 surfaces, posterior $___________.00
Resin-based composite - three D2950 Core buildup, including any pins $___________.00
D2393 surfaces, posterior $___________.00 Post and core in addition to crown,
Resin-based composite — four or
PL D2952 indirectly fabricated $___________.00
D2394 more surfaces, posterior $___________.00 Prefabricated post and core in
D2954 addition to crown $___________.00
D2520 Inlay — metallic - two surfaces $___________.00 Labial veneer (resin laminate) -
D2961 laboratory $___________.00
M
D2543 Onlay — metallic - three surfaces $___________.00 Labial veneer (porcelain laminate) -
Inlay - porcelain/ceramic -two D2962 laboratory $___________.00
D2620 surfaces $___________.00
Onlay - porcelain/ceramic -two D2970 Temporary crown (fractured tooth) $___________.00
SA
D2642 surfaces $___________.00 Inlay repair necessitated by

Onlay - porcelain/ceramic -three D2981 restorative material failure $___________.00
D2643 surfaces $___________.00 Onlay repair necessitated by
Onlay - porcelain/ceramic — four or D2982 restorative material failure $___________.00
D2644 more surfaces $___________.00 Veneer repair necessitated by
Inlay - resin-based composite -two D2983 restorative material failure $___________.00
D2651 surfaces $___________.00 Resin infiltration of incipient smooth
Onlay - resin-based composite -two D2990 surface lesions $___________.00
D2662 surfaces $___________.00
Onlay - resin-based composite -
D2663 three surfaces $___________.00 ENDODONTICS (D3000 — D3999)
Onlay - resin-based composite -
D2664 four or more surfaces $___________.00
Crown - resin-based composite
D3110 restoration) $___________.00
D2710 (indirect) $___________.00
Crown - porcelain/ceramic
D3120 restoration) $___________.00
D2740 substrate $___________.00
Therapeutic pulpotomy (excluding
Crown - porcelain fused to high
D3220 final restoration) $___________.00
D2750 noble metal $___________.00
Crown - porcelain fused to
D3221 permanent teeth $___________.00
D2751 predominantly base metal $___________.00
D3222 Partial pulpotomy for apexogenesis $___________.00
ENDODONTICS (D3000 — D3999) Continued PERIODONTICS (D4000 — D4999) Continued
Pulpal therapy (resorbable filling) - Gingival flap procedure, including

anterior, primary tooth (excluding root planing — one to three
D3230 final restoration) $___________.00 contiguous teeth or tooth bounded
Pulpal therapy (resorbable filling) - D4241 spaces per quadrant $___________.00
posterior, primary tooth (excluding Clinical crown lengthening — hard
D3240 final restoration) $___________.00 D4249 tissue $___________.00
Endodontic therapy, anterior tooth Osseous surgery (including flap
D3310 (excluding final restoration) $___________.00 entry and closure) - four or more
Endodontic therapy, bicuspid tooth contiguous teeth or tooth bounded
D3320 (excluding final restoration) $___________.00 D4260 spaces per quadrant $___________.00
Endodontic therapy, molar Osseous surgery (including flap
D3330 (excluding final restoration) $___________.00 entry and closure) - one to three
contiguous teeth or tooth bounded
Treatment of root canal obstruction; D4261 spaces per quadrant $___________.00
D3331 non-surgical access $___________.00
Incomplete endodontic therapy; D4263 quadrant $___________.00
inoperable, unrestorable or
D3332 fractured tooth $___________.00 Bone replacement graft — each
D4264 additional site in quadrant $___________.00
D3346 therapy — anterior $___________.00 Guided tissue regeneration —
D4266 resorbable barrier, per site $___________.00
D3347 therapy — bicuspid $___________.00 Guided tissue regeneration — non-
resorbable barrier, per site
Retreatment of previous root canal D4267 (includes membrane removal) $___________.00
E
D3348 therapy — molar $___________.00
Subepithelial connective tissue
Apexification/recalcification/pulpal D4273 graft procedures, per tooth $___________.00
D3351 regeneration - initial visit $___________.00
PL D4275 Soft tissue allograft $___________.00
D3352 replacement $___________.00 Free soft tissue graft procedure
(including donor site surgery), first
Apexification/recalcification — final tooth or edentulous tooth position
D3353 visit $___________.00 D4277 in graft $___________.00
M
D3354 Pulpal regeneration $___________.00 D4321 Provisional splinting - extracoronal $___________.00
Apicoectomy/periradicular surgery - Periodontal scaling and root
D3410 anterior $___________.00 planing - four or more teeth per
SA
Apicoectomy/periradicular surgery D4341 quadrant $___________.00

D3421 — bicuspid (first root) $___________.00 Periodontal scaling and root
Apicoectomy/periradicular surgery planing - one to three teeth per
D3425 — molar (first root) $___________.00 D4342 quadrant $___________.00
comprehensive evaluation and
PERIODONTICS (D4000 — D4999) D4355 diagnosis $___________.00
Localized delivery of antimicrobial
agents via a controlled release
Gingivectomy or gingivoplasty - vehicle into diseased crevicular
four or more contiguous teeth or D4381 tissue, per tooth $___________.00
D4210 tooth bounded spaces per quadrant $___________.00
Gingivectomy or gingivoplasty - D4910 Periodontal maintenance $___________.00
one to three contiguous teeth or
D4211 tooth bounded spaces per quadrant $___________.00
Gingivectomy or gingivoplasty to PROSTHODONTICS (D5000 — D5899 )
allow access for restorative
D4212 procedure, per tooth $___________.00
Gingival flap procedure, including
root planing — four or more D5110 Complete denture - maxillary $___________.00
contiguous teeth or tooth bounded
D4240 spaces per quadrant $___________.00 D5120 Complete denture - mandibular $___________.00
D5130 Immediate denture - maxillary $___________.00
PROSTHODONTICS (D5000 — D5899 ) Continued IMPLANT SERVICES (D6000 — D6199) Continued
Connecting bar - implant supported

D5140 Immediate denture - mandibular $___________.00 D6055 or abutment supported $___________.00
Maxillary partial denture — resin Prefabricated abutment — includes
base (including any conventional D6056 modification and placement $___________.00
D5211 clasps, rests and teeth) $___________.00 Custom fabricated abutment -
Mandibular partial denture - resin D6057 includes placement $___________.00
base (including any conventional Abutment supported porcelain
D5212 clasps, rests and teeth $___________.00 fused to metal crown (high noble
Maxillary partial denture — cast D6059 metal) $___________.00
metal framework with resin denture Implant supported porcelain fused
bases (including any conventional to metal crown (titanium, titanium
D5213 clasps, rests, and teeth) $___________.00 D6066 alloy, high noble metal) $___________.00
Mandibular partial denture — cast Abutment supported retainer for
metal framework with resin denture porcelain fused to metal FPD (high
bases (including any conventional D6069 noble metal) $___________.00
D5214 clasps, rests, and teeth) $___________.00
Implant supported retainer for
Maxillary partial denture — flexible porcelain fused to metal FPD
base (including any clasps, rests, (titanium, titanium alloy, or high
D5225 and teeth) $___________.00 D6076 noble metal) $___________.00
Mandibular partial denture — Implant maintenance procedures,
flexible base (including any clasps, including removal of prosthesis,
D5226 rests, and teeth) $___________.00 cleansing of prosthesis and
Repair broken complete denture abutments and reinsertion of
E
D5510 base $___________.00 D6080 prosthesis $___________.00
Replace missing or broken teeth — Bone graft at time of implant
D5520 complete denture (each tooth) $___________.00 D6104 placement $___________.00
PL
D5610 Repair resin denture base $___________.00
PROSTHODONTICS (FIXED) D6200 — D6999
D5640 Replace broken teeth - per tooth $___________.00
M
D5650 Add tooth to existing partial denture $___________.00 Pontic - indirect resin based
D6205 composite $___________.00
Add clasp to existing partial
D5660 denture $___________.00
D6210 Pontic - cast high noble metal $___________.00
SA
D5710 Rebase complete maxillary denture $___________.00 Pontic - porcelain fused to high
D6240 noble metal $___________.00
D5730 (chairside) $___________.00 Pontic - porcelain fused to
D6241 predominantly base metal $___________.00
Reline complete mandibular
D5731 denture (chairside) $___________.00
D6245 Pontic - porcelain/ceramic $___________.00
D5750 (laboratory) $___________.00 Provisional pontic — further
treatment or completion of
Reline complete mandibular
diagnosis necessary prior to final
D5751 denture (laboratory) $___________.00
D6253 impression $___________.00
Retainer - cast metal for resin
D6545 bonded fixed prosthesis $___________.00
IMPLANT SERVICES (D6000 — D6199)
Crown - indirect resin based
D6710 composite $___________.00
Surgical placement of implant Crown - porcelain fused to high
D6010 body: endosteal implant $___________.00 D6750 noble metal $___________.00
Surgical placement of interim Crown - porcelain fused to
implant body for transitional D6751 predominantly base metal $___________.00
D6012 prosthesis: endosteal implant $___________.00
D6790 Crown - full cast high noble metal $___________.00
D6051 Interim abutment $___________.00 Provisional retainer crown - further
Implant/abutment supported treatment or completion of
removable denture for completely diagnosis necessary prior to final
D6053 edentulous arch $___________.00 D6793 impression $___________.00
PROSTHODONTICS (FIXED) D6200 — D6999 Continued ORAL AND MAXILLOFACIAL SURGERY (D7000 — D7999)
Continued
Suture of recent small wounds up

D6930 Recement fixed partial denture $___________.00 D7910 to 5 cm $___________.00
Collection and application of
autologous blood concentrate
ORAL AND MAXILLOFACIAL SURGERY (D7000 — D7999) D7921 product $___________.00
D7953 preservation — per site $___________.00
Extraction, coronal remnants - Frenulectomy — also known as
D7111 deciduous tooth $___________.00 frenectomy or frenotomy - separate
Extraction, erupted tooth or D7960 procedure not incidental to another $___________.00
exposed root (elevation and/or Excision of hyperplastic tissue - per
D7140 forceps removal) $___________.00 D7970 arch $___________.00
elevation of mucoperiosteal flap if ORTHODONTICS D8000 — D8999
D7210 indicated $___________.00
Removal of impacted tooth - soft
D7220 tissue $___________.00 Limited orthodontic treatment of the
D8020 transitional dentition $___________.00
Removal of impacted tooth -
D7230 partially bony $___________.00 Limited orthodontic treatment of the
D8030 adolescent dentition $___________.00
Removal of impacted tooth -
E
D7240 completely bony $___________.00
D8040 adult dentition $___________.00
Surgical removal of residual tooth
D7250 roots (cutting procedure) $___________.00 Interceptive orthodontic treatment
D8050 of the primary dentition $___________.00
D7251
Coronectomy - intentional partial
tooth removal
PL
$___________.00 Interceptive orthodontic treatment
D8060 of the transitional dentition $___________.00
D7286 Biopsy of oral tissue — soft $___________.00 Comprehensive orthodontic
treatment of the transitional
Exfoliative cytological sample D8070 dentition $___________.00
D7287 collection $___________.00
M
Comprehensive orthodontic
Brush biopsy — transepithelial
treatment of the adolescent
D7288 sample collection $___________.00
D8080 dentition $___________.00
Harvest of bone for use in
Comprehensive orthodontic
D7295 autogenous grafting procedure $___________.00
SA
D8090 treatment of the adult dentition $___________.00

Periodic orthodontic treatment visit
extractions - four or more teeth or
D8670 (as part of contract) $___________.00
D7310 tooth spaces, per quadrant $___________.00
Orthodontic treatment (alternative
Alveoloplasty not in conjunction
D8690 billing to a contract fee) $___________.00
with extractions - four or more teeth
D7320 or tooth spaces, per quadrant $___________.00 Replacement of lost or broken
D8692 retainer $___________.00
Excision of benign lesion up to 1.25
D7410 cm $___________.00
Excision of malignant tumor —
D7440 lesion diameter up to 1.25 cm $___________.00 ADJUNCTIVE GENERAL SERVICES (D9000 — D9999)
Removal of benign odontogenic
cyst or tumor - lesion diameter up
D7450 to 1.25 cm $___________.00 Palliative (emergency) treatment of
D9110 dental pain - minor procedure $___________.00
Mandible - open reduction (teeth
D7630 immobilized, if present) $___________.00
D9120 Fixed partial denture sectioning $___________.00
Mandible - closed reduction (teeth
D7640 immobilized, if present) $___________.00 Local anesthesia in conjunction
with operative or surgical
D9215 procedures $___________.00
D7730 Mandible - open reduction $___________.00
Inhalation of nitrous
D9230 oxide/analgesia, anxiolysis $___________.00
D7740 Mandible - closed reduction $___________.00
Intravenous conscious
sedation/analgesia - first 30
D7880 Occlusal orthotic device, by report $___________.00
D9241 minutes $___________.00
ADJUNCTIVE GENERAL SERVICES (D9000 — D9999) Any comments?
Continued
Intravenous conscious
sedation/analgesia - each
D9242 additional 15 minutes $___________.00
Non-intravenous conscious
D9248 sedation $___________.00
Consultation - diagnostic service
provided by dentist or physician
other than requesting dentist or
D9310 physician $___________.00
D9410 House/extended care facility call $___________.00

Hospital or ambulatory surgical
D9420 center call $___________.00
regularly scheduled hours) - no
D9430 other services performed $___________.00
Office visit - after regularly
D9440 scheduled hours $___________.00
Case presentation, detailed and
D9450 extensive treatment planning $___________.00
D9610 administration $___________.00
E
Other drugs and/or medicaments,
D9630 by report $___________.00
Application of desensitizing
D9910 medicament
PL
$___________.00
Application of desensitizing resin
for cervical and/or root surface, per
D9911 tooth $___________.00
M
D9920 Behavior management, by report $___________.00
surgical) — unusual circumstances,
D9930 by report $___________.00
SA
D9940 Occlusal guard, by report $___________.00
D9941 Fabrication of athletic mouthguard $___________.00
D9951 Occlusal adjustment - limited $___________.00
D9952 Occlusal adjustment - complete $___________.00

External bleaching - per arch -
D9972 performed in office $___________.00
D9974 Internal bleaching - per tooth $___________.00

External bleaching for home
application, per arch; includes
materials and fabrication of custom
D9975 trays $___________.00
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Data Trends in

Oral and Maxillofacial Surgeons ............................................................................................................................................................................... 109

Methodology ............................................................................................................................................................................................................. 134

Copyright © 2014 American Dental Association.

D0140 Limited oral evaluation - problem focused 64.41 18.35 42 52 65 75 78 81 86 95 1,209

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

Intravenous conscious sedation/analgesia

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

D0140 Limited oral evaluation - problem focused 65.93 15.66 44 56 69 76 78 80 83 88 230

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

D0140 Limited oral evaluation - problem focused 58.66 14.76 45 51 59 68 70 72 75 84 116

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

D0140 Limited oral evaluation - problem focused 63.65 17.28 42 54 65 75 76 81 85 89 168

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

D0140 Limited oral evaluation - problem focused 54.28 14.42 39 45 54 65 68 70 71 74 92

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

D0140 Limited oral evaluation - problem focused 59.47 14.55 42 48 60 70 71 75 75 83 93

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

D0140 Limited oral evaluation - problem focused 66.06 16.09 47 52 65 77 79 80 83 97 87

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

Incomplete endodontic therapy;

Osseous surgery (including flap entry and

Osseous surgery (including flap entry and

Mandibular partial denture - flexible base

Abutment supported retainer for porcelain

Intravenous conscious sedation/analgesia

Intravenous conscious sedation/analgesia

Incomplete endodontic therapy;

D0140 Limited oral evaluation - problem focused 37.22 44.15 0 0 0 73 75 85 95 100 37

Osseous surgery (including flap entry and

D0190 Screening of a patient $_.00 D0470 Diagnostic casts $_.00