New Jersey General Dentist Fee Schedule

** Any treatment provided by a participating specialist, if available, in Oral Surgery, Orthodontics, Periodontics, Pedodontics, Prosthodontics or Endodontics, will be charged at a 25% reduction of participating specialist’s fees for that particular case.

CodeDiagnostic and PreventiveAmount
D0120Periodic Oral Examination35
D0140Limited Oral Evaluation - Problem Focused41
D0150Comprehensive Oral Evaluation48
D0210x-ray Intraoral - Complete - Including Bitewings62
D0220x-ray Intraoral -Periapical - First Film14
D0230x-ray Intraoral - Perciapical - Each Add. Film10
D0270x-ray Bitewings - Single Film13
D0272x-ray Bitewings - Two Films26
D0273x-ray Bitewings - Three Films30
D0274x-ray Bitewings - Four Films36
D0330x-ray Panoramic Film69
D1110Dental Prophylaxis Adult68
D1120Dental Prophylaxis Children43
D1208Topical Fluoride Application26
D1351Topical Sealants - Per Tooth28
D1510Space Maintainer - Fixed - Unilateral195
D1515Space Maintainer - Fixed - Bilateral235
CodeRestorative (Fillings)Amount
D2140Amalgam - One surface, Permanent71
D2150Amalgam - Two surfaces, Permanent89
D2160Amalgam - Three Surfaces Permanent128
D2161Amalgam - 4 Or More Surfaces Permanent142
D2330Resin - One Surface Anterior93
D2331Resin - Two Surface Anterior129
D2332Resin - Three Surface Anterior148
D2335Resin - 4+Surf Or Inv. Incisal Angle159
D2391Resin - One Surface Posterior, Permanent95
D2392Resin - Two Surface Posterior, Permanent129
D2393Resin - Three Surface Posterior, Permanent153
D2394Resin - Four or more surfaces posterior159
CodeCrowns (lab fees included)Amount
D2710Crown - Resins Based Composite, Indirect245
D2720Crown - Resin With High Noble Metal589
D2740Crown - Porcelain/Ceramic substrate858
D2750Crown - Porcelain/High Noble Metal811
D2751Crown - Porcelain/Predominate Base Metal757
D2752Crown - Porcelain/Noble Matal797
D2790Crown - Full Cast High Noble Metal825
D2791Crown - Full Cast Predom. Base Metal695
D2920Recement Crown49
D2931Prefab Stainless Steel Crown - Perm Tooth166
D2932Prefab Resin Crown123
D2950Core Buildup Including Any Pins159
D2951Pin Retention - Per Tooth (W/O Restoration)28
D2952Cast Post/Core (Addition To Crown)210
D2954Prefabricated post and core, in addition to crown195
D2970Temporary Crown (fractured tooth)78
CodeEndodontics (General Dentist) exc. Final restor.Amount
D3110Pulp Cap - Direct35
D3120Pulp Cap - Indirect31
D3220Therapeutic Pulpotomy96
D3310Root Canal Anterior456
D3320Root Canal Bicuspid567
D3330Root Canal Molar775
CodePeriodontics (General Dentist)Amount
D4210Gingivectomy/Gingivoplasty - 4 + contiguos teeth232
D4341Perio. Scaling & Root Planing per quad147
D4355Full Mouth Debridement96
D4910Periodontal Maintenance87
CodeProsthodontics, Removable (lab fees included)Amount
D5110Complete Upper Denture899
D5120Complete Lower Denture899
D5130Immediate Upper985
D5140Immediate Lower985
D5211Upper Partial - Resin Base589
D5212Lower Partial - Resin Base589
CodeProsthodontics, Fixed (lab fees included)Amount
D5213Partial Upper Cast Metal Base1095
D5214Partial Lower Cast Metal Base1095
D5410Adjust Denture - (Upper)51
D5411Adjust Denture - (Lower)51
D5510Repair Broken Complete Denture Base81
D5520Replace Missing or Broken Teeth/Each Tooth76
D5610Repair Resin Denture Base79
D5630Repair Or Replace Broken Clasp98
D5640Replace Broken Teeth - Per Tooth83
D5650Add Tooth To Existing Partial Denture99
D5660Add Clasp To Existing Partial Denture143
D5730Reline Upper Denture - Chairside127
D5731Reline Lower Denture - Chairside127
D5740Reline Complete Maxillary Denture - Chairside125
D5741Reline Complete Mandibular Partial Dent Chairside125
D6000Implant Services D6000- D619425% Discount
CodeProsthodontics, Fixed (lab fees included)Amount
D6240Pontic - Porcelain/High Noble Metal752
D6241Pontic - Porcelain/Predominate Base Metal639
D6242Pontic - Porcelain/Noble Metal739
D6750Crown - Porcelain/High Noble Metal836
D6751Crown - Porcelain/High Noble Metal688
D6752Crown - Porcelain/Noble Metal814
D6930Recement Bridge58
CodeOral Surgery (General Dentist)Amount
D7140Single Tooth Extraction94
D7210Surgical Removal Of Erupted Tooth177
D7220Removal Of Impacted Tooth/Soft Tissue210
D7230Removal Of Impacted Tooth/Partially Bony270
D7240Removal Of Impacted Tooth/Completely Bony340
D7250Surgical Removal Of Residual Tooth Roots142
D7510Incision and Drainage of Abcess/Intraoral80
D8010Orthodontic Treatment D8010-D822025% Discount
CodeAdjunctive ServicesAmount
D9110Palliative Treatment (emergency) pain-minor53
D9215Local AnesthesiaIncluded with procedure
D9610Therapeutic drug Injection37

*Please see a professional dentist for full treatment plan.

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