| PROCEDURE | NON-MEMBERSHIP PLAN COSTS | ADULT/CHILDREN MEMBERSHIP PLAN COSTS | SHIRLEY SENIOR MEMBERSHIP PLAN COSTS |
|---|---|---|---|
| EXAM, X-RAYS, & CLEANING (2xYEAR) | $250 | FREE | FREE |
| EMERGENCY AND LIMITED EXAM | $50 | $40 | $35 |
| WISDOM TEETH CONSULT | FREE | FREE | FREE |
| BRACES CONSULT | FREE | FREE | FREE |
| PALLIATIVE TREATMENT | $125 | $100 | $87.50 |
| PANO X-RAY | $100 | $80 | $70 |
| CONE BEAM CT SCAN | $200 | $160 | $140 |
| 1 SURFACE COMPOSITE FILLING | $125 | $100 | $87.50 |
| 2 SURFACE COMPOSITE FILLING | $155 | $124 | $108.50 |
| 3 SURFACE COMPOSITE FILLING | $185 | $148 | $129.50 |
| 4+ SURFACE COMPOSITE FILLING | $215 | $172 | $150.50 |
| CERAMIC CROWN | $1,000 | $800 | $700 |
| BRIDGE ABUTMENT CROWN | $1,000 | $800 | $700 |
| BRIDGE PONTIC CROWN | $1,000 | $800 | $700 |
| CORE BUILD UP | $125 | $100 | $87.50 |
| POST BUILD UP | $175 | $140 | $122.50 |
| CAST POST BUILD UP | $275 | $220 | $192.50 |
| CROWN RECEMENTATION | $125 | $100 | $87 |
| DEEP CLEANING PER QUAD (1-3 TEETH) | $80 | $64 | $56 |
| DEEP CLEANING PER QUAD (4-8 TEETH) | $125 | $100 | $87 |
| ANTERIOR ROOT CANAL THERAPY | $450 | $360 | $315 |
| PREMOLAR ROOT CANAL THERAPY | $550 | $440 | $385 |
| MOLAR ROOT CANAL THERAPY | $650 | $520 | $455 |
| SEALANT | $45 | $36 | N/A |
| FIXED SPACE MAINTAINER | $265 | $212 | N/A |
| PRIMARY TEETH EXTRACTION | $50 | $40 | N/A |
| ROUTINE EXTRACTION | $150 | $120 | $105 |
| SURGICAL EXTRACTION | $225 | $180 | $157.50 |
| SOFT TISSUE EXTRACTION | $325 | $260 | $227.50 |
| PARTIAL BONY EXTRACTION | $425 | $340 | $297.50 |
| COMPLETE BONY EXTRACTION | $525 | $420 | $367.50 |
| INVISALIGN | $6,500 | $6,500 | $6,500 |
| IMPLANT | $1,500 | $1,500 | $1,500 |
| IMPLANT CROWN | $1,200 | $1,200 | $1,200 |
| IMPLANT ABUTMENT | $600 | $600 | $600 |
| COMPLETE DENTURE | $1,350 | $1,350 | $1,350 |
| COMPLETE IMMEDIATE DENTURE | $1,450 | $1,450 | $1,450 |
| METAL BASE PARTIAL DENTURE | $1,450 | $1,450 | $1,450 |
