Dental Education
Dental Clinic
Dunes Medical / Professional Building
3400 Broadway
Gary, Indiana 46408
219-980-6772
care provided include:
Oral Examination
Prophylaxis (Cleaning)
Fluoride Treatment
Dental Radiographs (X-Rays)
Dental Sealants
Oral Hygiene Instruction
Referrral (Upon Request)
Clinic Fee Schedule
|
Diagnostic |
||
| Code | Dental Procedure | Fee |
| 0110 | Initial Oral Exam | $15.00 |
| 0120 | Periodic Oral Exam | $10.00 |
| 0210 | Adult Complete Mouth Radiographic Survey | $30.00 |
| 0217 | Child Complete Mouth Radiographic Survey | $25.00 |
| 0330 | Panoramic Radiograhic (Adult or Child) | $30.00 |
| 0220 | Periapical - Single First Film | $ 6.00 |
| 0230 | Periapical - Each Additional Film | $ 6.00 |
| 0272 | Bitewings - 2 Films | $12.00 |
| 0274 | Bitewings - 4 Films | $17.00 |
|
Preventive |
||
| 1110 | Adult Prophylaxis (12 teeth or less $10.00 Discount) | $20.00 |
| 1120 | Child Prophylaxis (up to 12 years) | $20.00 |
| 0120 | Fluoride Treatment | $ 6.00 |
| 1351 | Pit and Fissure Sealants (per tooth) | $ 6.00 |
| 1350 | Pit and Fissure Sealants (per quadrants) | $18.00 |
