Procedure

National Average Fee

Avia Members Pay

DIAGNOSTIC
Periodic Oral Exam$57$15
Limited Oral Exam-problem focused$85$18
Comprehensive Oral Exam$100$18
Full Mouth X-rays Intraoral-complete series, including bitewing$148$45
Intraoral-periapical-first film$33$12
Intraoral-periapical-each additional film$28$8
Bitewing X-ray (single film)$32$12
Bitewing X-rays-two films$50$15
Bitewing X-rays-three films$61$20
Bitewing X-rays-four films$73$24
Panoramic X-ray$126$45
Diagnostic casts$132$35
PREVENTIVE
Prophy-Adult Cleaning (includes scaling and polishing)$103$35
Prophy- Child Cleaning (includes scaling & polishing)$75$28
Fluoride Treatment$43$18
Oral hygiene instructions$61$8
Sealant- per tooth$63$25
SPACE MAINTENANCE
Space maintainer-fixed-unilateral$350$120
Space maintainer-fixed-bilateral$473$150
Space maintainer-removeable-unilateral$424$130
Space maintainer-removeable-bilateral$527$165
RESTORATIVE
Amalgam-one surface, primary or permanent$165$48
Amalgam-two surface, primary or permanent$210$61
Amalgam-three surface, primary or permanent$256$72
Amalgam-four or more surfaces, primary or permanent$300$85
Resin-one surface-anterior$190$58
Resin-two surface-anterior$232$72
Resin -three surface-anterior$285$92
Resin-four or more surface-anterior$351$115
Resin/composite-one surface-posterior$204$78
Resin/composite-two surface-posterior$261$100
Resin/composite-three surface-posterior$324$120
Resin/composite-four or more surface-posterior$394$150
Crown-resin with high noble metal$1,221$470
Crown-porcelain fused to high noble metal$1,270$550
Crown-porcelain fused to predominantly base metal$1,182$515
Crown-porcelain fused to noble metal$1,208$545
Crown-full cast high noble metal$1,298$560
Recement Crown$127$40
Crown-prefabricated stainless steel, primary$300$105
Crown-prefabricated stainless steel, permanent$360$128
Sedative filling$136$40
Core buildup, including pins$305$110
Cast post and core, in addition to crown$475$165
Prefabricated post and core in addition to crown$380$135
ENDODONTICS
Pulp cap-direct (excluding final restoration)$95$25
Pulp cap-indirect(excluding final restoration)$94$25
Therapeutic pulpotomy (excluding final restoration)$227$63
Anterior Root Canal (excluding final restoration)$850$320
Bicuspid Root Canal (excluding final restoration)$964$380
Molar Root Canal (excluding final restoration)$1,169$490
PERIODONTICS
Gingivectomy or gingivoplasty-per quad$725$315
Gingivectomy or gingivoplasty-per tooth$355$100
Osseous surgery (including flap entry & closure) per quad$1,237$510
Periodontal scaling & Root planing-per quad$285$110
Full mouth debridement$202$75
Periodontal maintenance procedures$156$65
PROSTHODONTICS
Complete denture-Maxillary$1,969$690
Complete denture Mandibular$1,984$690
Immediate Denture-Maxillary$2,077$715
Immediate denture- Mandibular$2,100$715
Partial denture-Maxillary-resin base$1,536$615
Partial denture -Mandibular- resin base$1,534$615
Partial denture-Maxillary-cast metal framework with resin denture base$2,018$775
Partial denture-Mandibular-cast metal framework with resin denture base$2,024$775
(all of the above includes conventional clasps, rests and teeth)
Adjust complete denture-Maxillary$100$35
Adjust complete denture-Mandibular$99$35
Repair broken complete denture base$246$63
Replace missing or broken teeth (each tooth)$217$58
Add tooth to existing partial denture$259$68
Add clasp to existing partial denture$303$80
Reline complete Maxillary denture (chairside)$420$145
Reline complete Mandibular denture (chairside)$417$145
Reline partial Maxillary denture (chairside)$405$145
Reline partial Mandibular denture (chairside)$411$145
Reline complete Maxillary denture (lab)$525$190
Reline complete Mandibular denture (lab)$525$190
Reline partial Maxillary denture (lab)$520$185
Reline partial Mandibular denture (lab)$524$185
Pontic-cast high noble metal$1,251$495
Pontic-porcelain fused to high noble metal$1,250$495
Pontic-porcelain fused to predominantly base metal$1,185$455
Crown-porcelain fused to high noble metal$1,271$510
Crown-porcelain fused to predominantly base metal$1,163$465
Crown-full cast high noble metal$1,275$510
ORAL AND MAXILLOFACIAL SURGERY
Extraction- single tooth-erupted tooth or exposed root$200$60
Surgical Removal of erupted tooth$310$115
Removal of impacted tooth, soft tissue$350$125
Removal of impacted tooth, partially bony$439$165
Removal of impacted tooth, completely bony$531$225
Surgical Removal of residual tooth roots (cutting procedure)$349$125
Alveolplasty- in conjunction with extractions (per quad)$336$105
Alveolplasty- not in conjunction with extractions (per quad)$500$155
Incision and drainage of abscess-Intraoral soft tissue$271$75
ORTHODONTICS
Comprehensive Orthodontic treatment of the transitional dentition$5,62220% off normal fees
Comprehensive Orthodontic treatment of the adolescent dentition$5,80020% off normal fees
Comprehensive Orthodontic treatment of the adult dentition$5,84120% off normal fees
GENERAL
Pallative (emergency) treatment$145$40
Local Anesthesia$85$15
Analgesia$90$27
Broken appointment (without notice)$50$25
These are typical fees based on the 80th percentile of the National Dental Advisory Service Fee Report for 2014. Member is responsible for all charges at the time of service. This entire fee schedule is for participating Avia Dental General Dentists only. Cosmetic and any other procedures not listed are 20% off the provider’s normal fee. Some fees may vary where unusual services and/ or materials are required. Please discuss all fees with dentist prior to treatment. Lab fees are additional. Fees schedules are subject to change without prior notice to members. Be sure to verify that a dentist is a participating Avia provider before seeking treatment. Avia cannot guarantee the continued participation of any dentist. If dentist leaves plan, you will need to select another participating provider. Any dental procedures performed by a non participating dentist are charged dentist’s normal fees. Not all types of dentists may be available in your area. Avia does not guarantee the quality of service of the providers.
Participating Specialists do not charge according to this fee schedule. Avia Members receiving treatment from any participating specialists including Oral surgeons, Orthodontists, Periodontists, Pediatrics, Pedodontists, Prosthodontists and Endodontists will receive a 20% discount off their normal fees.

THIS IS NOT AN INSURANCE PLAN