Procedure
|
National Average Fee
|
Avia Members Pay
|
|
|
|
|
| DIAGNOSTIC |
|
|
| Periodic Oral Exam- Established Patient |
$70.00 |
$18.00 |
| Limited Oral Exam-Problem focused |
$101.00 |
$23.00 |
| Comprehensive Oral Exam- New or established patient |
$115.00 |
$24.00 |
| Full Mouth X-rays Intraoral-complete series, including bitewing |
$180.00 |
$50.00 |
| Intraoral-periapical-first film |
$40.00 |
$13.00 |
| Intraoral-periapical-each additional film |
$33.00 |
$8.00 |
| Bitewing X-rays-two films |
$60.00 |
$17.00 |
| Bitewing X-rays-three films |
$70.00 |
$22.00 |
| Bitewing X-rays-four films |
$85.00 |
$27.00 |
| Panoramic X-ray |
$155.00 |
$48.00 |
| PREVENTIVE |
|
|
| Prophylaxis-Adult Cleaning (includes scaling and polishing) |
$122.00 |
$36.00 |
| Prophylaxis Child Cleaning (includes scaling & polishing) |
$90.00 |
$28.00 |
| Sealant- per tooth |
$72.00 |
$25.00 |
| Space maintainer-fixed, unilateral-per quad |
$398.00 |
$120.00 |
| Space maintainer-fixed-bilateral, maxillary |
$525.00 |
$185.00 |
| RESTORATIVE |
|
|
| Amalgam-one surface, primary or permanent |
$194.00 |
$50.00 |
| Amalgam-two surfaces, primary or permanent |
$239.00 |
$63.00 |
| Amalgam-three surfaces, primary or permanent |
$290.00 |
$73.00 |
| Amalgam-four or more surfaces, primary or permanent |
$345.00 |
$85.00 |
| Resin-based composite-one surface. anterior |
$220.00 |
$63.00 |
| Resin-based composite-two surfaces, anterior |
$265.00 |
$73.00 |
| Resin -based composite-three surfaces, anterior |
$320.00 |
$87.00 |
| Resin-based composite- four or more surfaces-anterior |
$390.00 |
$112.00 |
| Resin-based composite-one surface-posterior |
$240.00 |
$77.00 |
| Resin- based composite-two surfaces-posterior |
$305.00 |
$108.00 |
| Resin- based composite-three surfaces-posterior |
$372.00 |
$125.00 |
| Resin- based composite-four or more surfaces-posterior |
$435.00 |
$155.00 |
| Crown-resin/Ceramic |
$1,495.00 |
$575.00 |
| Crown-porcelain fused to high noble meta |
$1,500.00 |
$575.00 |
| Crown-porcelain fused to noble metal |
$1,410.00 |
$550.00 |
| Recement or re-bond Crown |
$152.00 |
$45.00 |
| Crown-prefabricated stainless steel, primary |
$350.00 |
$110.00 |
| Crown-prefabricated stainless steel, permanent |
$414.00 |
$125.00 |
| Protective restoration |
$163.00 |
$45.00 |
| Core buildup, including pins |
$357.00 |
$110.00 |
| Post and core, in addition to crown, indirectly fabricated |
$506.00 |
$170.00 |
| Prefabricated post and core in addition to crown |
$432.00 |
$135.00 |
| ENDODONTICS |
|
|
| Pulp cap-direct (excluding final restoration) |
$112.00 |
$28.00 |
| Pulp cap-indirect(excluding final restoration) |
$112.00 |
$28.00 |
| Therapeutic pulpotomy (excluding final restoration) |
$267.00 |
$63.00 |
| Endodontic Therapy – Anterior Root Canal (excluding final restoration) |
$1,007.00 |
$340.00 |
| Endodontic Therapy – Premolar Root Canal (excluding final restoration) |
$1,154.00 |
$410.00 |
| Endodontic Therapy – Molar Root Canal (excluding final restoration) |
$1,415.00 |
$510.00 |
| PERIODONTICS |
|
|
| Gingivectomy or gingivoplasty-per quad |
$839.00 |
$335.00 |
| Periodontal scaling & Root planing-per quad |
$340.00 |
$115.00 |
| Periodontal maintenance |
$188.00 |
$75.00 |
| PROSTHODONTICS |
|
|
| Complete denture-Maxillary |
$2,297.00 |
$735.00 |
| Complete denture Mandibular |
$2,297.00 |
$735.00 |
| Partial denture-Maxillary-resin base |
$1,800.00 |
$670.00 |
| Partial denture -Mandibular- resin base |
$1,808.00 |
$670.00 |
| Replace missing or broken teeth (each tooth) |
$255.00 |
$60.00 |
| Add tooth to existing partial denture |
$297.00 |
$66.00 |
| Add clasp to existing partial denture |
$350.00 |
$80.00 |
| Reline complete Maxillary denture (chairside) |
$497.00 |
$145.00 |
| Reline complete Mandibular denture (chairside) |
$496.00 |
$145.00 |
| Reline complete Maxillary denture (lab) |
$610.00 |
$190.00 |
| Reline complete Mandibular denture (lab) |
$603.00 |
$190.00 |
| Pontic-cast high noble metal |
$1,450.00 |
$525.00 |
| Pontic-porcelain fused to high noble metal |
$1,458.00 |
$525.00 |
| Retainer Crown-porcelain fused to high noble metal |
$1,487.00 |
$555.00 |
| ORAL AND MAXILLOFACIAL SURGERY |
|
|
| Simple Extraction- erupted tooth or exposed root |
$250.00 |
$63.00 |
| Extraction, erupted tooth, requiring removal of bone |
$375.00 |
$135.00 |
| Removal of impacted tooth, soft tissue |
$413.00 |
$140.00 |
| Removal of impacted tooth, partially bony |
$534.00 |
$175.00 |
| Removal of impacted tooth, completely bony |
$645.00 |
$245.00 |
| Surgical Removal of residual tooth roots (cutting procedure) |
$396.00 |
$135.00 |
| Alveolplasty- in conjunction with extractions (per quad) |
$420.00 |
$115.00 |
| Alveolplasty- not in conjunction with extractions (per quad) |
$599.00 |
$160.00 |
|
|
|
| ORTHODONTICS |
|
|
| Comprehensive Orthodontic treatment of the transitional dentition |
$6,410.00 |
25% off normal fees |
| Comprehensive Orthodontic treatment of the adolescent dentition |
$6,125.00 |
25% off normal fees |
| Comprehensive Orthodontic treatment of the adult dentition |
$6,380.00 |
25% off normal fees |
| GENERAL |
|
|
| Pallative (emergency) treatment |
$170.00 |
$42.00 |
| Local Anesthesia |
$75.00 |
$15.00 |
| Analgesia-Nitrous oxide |
$100.00 |
$27.00 |
|
|
|
|
|
|
| *These National Average Fees are based on the 80th percentile of the survey of dental fees for 2022. 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 25% 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 25% discount off their normal fees. |
|
|
|
| THIS IS NOT AN INSURANCE PLAN |
|
|
|
|
