Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Dental Implants
Surgical placement of implant body.1800760-58%D6010
Bone graft 1cc. (only if necessary).824280-66%D6104
Membrane (only if necessary).420205-51%
Temporary healing denture maxilla or mandibula.1799370-79%D5130/D5120
Single tooth implant Crown with prefabricated abutment.1557760-51%D6060/D6066
Single tooth implant Crown with custom abutment.1703810-52%D6063/D6065
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Crowns, Veneers and Single Restorations
Temporary Crown.49570-86%D2799
100% Porcelain Crown CAD CAM technology.NCSD1200460-62%D2740
100% Porcelain Crown E-Max.1200420-65%D2740
Zirconia Crown CAD CAM technology. NCSD1500500-67%D2740
Metal-Porcelain Crown (high noble-metal).1266520-59%D2750
Metal-Porcelain Crown (base metal).1000380-62%D2751
Complete gold cast Crown 1320290-78%D2790
Metal-Porcelain crown with milling guide plane. (base metal).1000410-59%D2751
Porcelain veneer.1200470-61%D2962
Temporary veneer.77985-89%D2960
Fiber glass post and core build up381175-65%D2954
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Crown and Bridges
Temporary Crown. (Retainer or pontic).85370-92%D2799/D6253
100% Porcelain Crown CAD CAM technology (Retainer or pontic). NCSD1450460-68%D2740/D6245
100% Porcelain Crown E-Max. (Retainer or pontic).1260420-67%D2740/D6245
Zirconia Crown CAD CAM technology. (Retainer or pontic) NCSD1500500-67%D2740/D6245
Metal-Porcelain Crown. High noble-metal. (Retainer or pontic).1273520-59%D2750/D6240
Metal-Porcelain Crown. Non-noble metal (Retainer or pontic).1187380-68%D2751/D6241
Complete gold cast Crown . (Retainer or pontic).1320290-78%D2790/D6210
Metal-Porcelain Crown with milling guide plane. Non-noble metal. (Retainer or pontic).1187410-65%D2751/D6241
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
In –lays / On-lays
In-lay E-Max. (100% porcelain).1141265-77%D2630
On-lay E-Max. (100% porcelain).1236280-77%D2644
Gold cast in-lay + weight in gold1092240-78%D2530
Gold cast on-lay + weight in gold1192255-79%D2544
In-lay SR Nexco (lab composite).1079210-81%D2652
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Composite resin fillings.
Composite resin filling anterior or posterior tooth one surface16895-43%D2330
Composite resin filling anterior or posterior tooth two surfaces210110-48%D2331
Composite resin filling anterior or posterior tooth three surfaces281120-57%D2332
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Endodontic.
Root canal treatment anterior tooth.833200-76%D3310
Root canal treatment bicuspid tooth.949230-76%D3320
Root canal treatment molar tooth.1168260-78%D3330
Root canal re treatment anterior tooth.948290-69%D3346
Root canal re treatment bicuspid tooth.1073320-70%D3347
Root canal re treatment molar tooth.1274350-73%D3348
Fiber glass post and core build up.381175-54%D2954
Core build up.302105-65%D2950
Apicoetomy-Anterior779410-47%D3410
Apicoetomy-Bicuspid (First Root) 874440-50%D3421
Apicoetomy-Molar (First root)969470-51%D3425
Apicoetomy-Additional Root487220-55%D3426
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Extractions
Simple extractions.18555-70%D7140
Complicated extraction.300100-67%D7210
Surgical extraction.500235-53%D7240
Third molar extraction.500235-53%D7240
Removal of residual tooth roots.344100-71%D7250
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Dental cleaning and Whitennig.
General dental cleaning adult270130-52%D1110
Boost Whitenning both arch732220-70%D9972
Dental Procedure US PricesSalud Oral PreferredSAVINGSADA Code
Periodontics
Consultation / Per visit$120.0060-50%D0120
Prophylaxis / Per mouth$270.00130-52%D110
Deep cleaning / Per cuadrant$290.00175-40%D4341
Deep cleaning / Per sexant$240.00145-40%D4341
Deep cleaning / 1,2,3 teeth$210.00110-48%D4342
Open curettage / Per cuadrant$621.00250-60%D4240
Open curettage / per sexant$570.00210-63%D4240
Open curettage / 1,2,3 teeth$517.00190-63%D4241
Bone replacement graft / Per site$770.00285-63%D4263
Crown lengthening with osteotomy / Per tooth$250.00170-32%D4249
Crown lengthening without osteotomy / Per tooth$210.00115-45%D4249
Crown lengthening for an esthetic smile / Per arch$1000.00570-43%D4249
Gingivectomy / Per arch$1000.00410-62%D4210
Frenulectomy / Per site$502.00250-52%D7960
Excisional biopsy reduced injury / Per site$380.00180-55%D7410
Excisional biopsy wide injury/ Per site$469.00240-49%D7410
Lip repositioning / Per site$6500.001100-88%
Vestibuloplasty / Per site$1413.00600-61%D7340
Vestibuloplasty with free gingival graft / Per site$2723.00800-80%D7350
Pedicle soft tissue graft / Per cuadrant$928.00450-53%D4270
Pedicle soft tissue graft / Per tooth$385.00150-64%D4270
Pedicle soft tissue graft / 2 Teeth$530.00250-53%D4270
Pedicle soft tissue graft / 3-4 Teeth$720.00350-51%D4270
Root coverage with conective tissue graft / Per gingival recession$1209.00500-59%D4273
Prophylactic free gingival graft / Per site$876.00320-63%D4278
Terapeutic free gingival graft / Per gingival recession$1055.00320-70%D4277
Distal wedge / Per site$744.00195-74%D4274
Alveoloplasty without extractions / Per site$570.00290-49%D7320
Abscess drainage / Per tooth$271.0095-65%D7510
Corticotomy for orthodontic treatment / Per arch$1350.00780-42%D7297
Autogenus conective tissue graft procedure in endetuLus zone / Per arch$550.00260-55%D4283
Surgical Access of unerupted tooth / Per tooth$400.00200-48%D7280
Exploratory surgery / Per area$517.00155-73%D4241
Third molar extraction / Per tooth$500.00235-53%D7240
Simple extraction / Per tooth$185.0055-70%D7140
Root amputation / Per root$418.00210-50%D3450

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