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Advanced Practice Management
7101 York Avenue South, Suite 300 Edina, Minnesota 55435-4407
Contact Us Today (952) 921-3360
Metro Area And Rochester Outstate Area
CODE Procedure Mean 95%tile 75%tile 5%tile Range of Certainty* Mean 95%tile 75%tile 5%tile Range of Certainty*
0120 Periodic Exam $52 $60 $54 $45 1% $44 $52 $48 $37 2%
0140 Emergency Exam $73 $92 $78 $50 3% $62 $78 $69 $41 3%
0150 Comprehensive Exam $80 $97 $86 $60 2% $68 $93 $73 $50 3%
1110 Adult Prophy $95 $106 $98 $82 1% $82 $93 $88 $69 1%
1120 Child Prophy $67 $75 $70 $56 1% $57 $67 $60 $48 2%
0220 PA 1st Film $30 $35 $32 $24 2% $27 $34 $29 $21 2%
0272 2 Bitewings $48 $55 $51 $40 1% $42 $49 $45 $33 2%
0274 4 Bitewings $63 $70 $65 $52 1% $56 $67 $59 $47 2%
0210 FMX $136 $161 $141 $115 2% $123 $153 $130 $99 2%
0330 Panoramic Film $124 $143 $129 $105 2% $108 $127 $115 $92 2%
0367 Cone CT Capture & Interpretation $342 $522 $450 $191 20% $253 $440 $276 $103 26%
1206 Fluoride Varnish $41 $51 $45 $25 3% $36 $46 $40 $26 3%
1208 Fluoride $41 $50 $45 $29 3% $35 $42 $39 $25 3%
1351 Sealant (EACH) $54 $60 $56 $46 1% $47 $55 $50 $38 2%
Amalgams (Permanent):
2140 1 Surface $139 $180 $145 $111 2% $118 $149 $128 $95 2%
2150 2 Surfaces $179 $249 $185 $145 3% $151 $199 $160 $122 2%
2160 3 Surfaces $218 $301 $223 $176 3% $182 $244 $196 $145 3%
2161 4 Surfaces $268 $357 $279 $214 3% $224 $293 $243 $176 3%
Anterior Composites:
2330 1 Surface $164 $189 $170 $140 1% $139 $161 $147 $115 2%
2331 2 Surfaces $218 $253 $227 $181 2% $177 $218 $187 $141 7%
2332 3 Surfaces $268 $322 $279 $217 2% $215 $267 $234 $169 2%
2335 Resin involvingincisal Angle Class IV $316 $375 $330 $250 2% $257 $319 $279 $195 2%
Posterior Composites:
2391 1 Surface $179 $207 $186 $150 1% $152 $180 $162 $124 2%
2392 2 Surfaces $255 $293 $268 $210 2% $207 $250 $224 $160 2%
2393 3 Surfaces $316 $364 $333 $255 2% $256 $310 $278 $188 2%
2394 4 Surfaces $369 $437 $386 $297 2% $301 $372 $328 $213 2%
2630 Porcelain inlay $1,066 $1,286 $1,165 $821 3% $923 $1,110 $997 $679 3%
2643 Porcelain or
Ceramic Onlay
$1,117 $1,329 $1,200 $889 2% $960 $1,187 $1,045 $728 3%
2652 Composite inlay $979 $1,238 $1,108 $645 4% $816 $1,108 $931 $520 5%
Crowns:
2740 Ceramic Crown $1,199 $1,350 $1,262 $993 1% $995 $1,175 $1,051 $835 2%
2750 Porcelain fused to high noble $1,166 $1,341 $1,222 $995 1% $990 $1,155 $1,050 $834 2%
2751 Porcelain to
predom base metal
$1,099 $1,297 $1,169 $915 2% $946 $1,100 $999 $800 2%
2752 Porcelain to noble $1,139 $1,336 $1,200 $965 2% $969 $1,143 $1,025 $825 2%
2931 Stainless Steel $374 $499 $410 $276 5% $303 $407 $336 $209 4%
2950 Crown Build-up $286 $360 $303 $194 3% $228 $293 $251 $144 3%
2960 Labial Veneer (LAMINATE) $677 $1,068 $744 $343 5% $551 $979 $632 $274 6%
2962 Labial Veneer (PORCELAIN) $1,209 $1,484 $1,279 $953 2% $982 $1,236 $1,059 $759 2%
Endodontics:
3221 Open and Drain $215 $320 $241 $140 5% $169 $243 $195 $104 4%
3310 1 Canal $767 $880 $800 $630 2% $640 $763 $680 $506 2%
3320 2 Canals $892 $1,004 $943 $756 2% $750 $896 $796 $602 2%
3330 3 Canals $1,077 $1,234 $1,132 $934 2% $920 $1,078 $979 $744 2%
4341 Four or more Root Planing $286 $330 $300 $225 2% $239 $300 $260 $180 5%
4342 Root Planing (1-3) $198 $250 $221 $132 3% $162 $226 $178 $100 3%
4355 Debridement $223 $284 $245 $149 3% $175 $240 $194 $110 3%
4381 Arestin per Site $62 $140 $75 $30 9% $61 $140 $70 $31 9%
4381 Atridox Per Application $73 $158 $83 $32 12% $67 $150 $78 $32 12%
4910 Perio Maintenance $150 $173 $159 $120 2% $124 $152 $136 $89 2%
5120 LOWER Full Denture $1,950 $2,500 $2,019 $1,550 3% $1,568 $1,951 $1,700 $1,173 2%
5213 UPPER Partial $2,048 $2,825 $2,180 $1,610 3% $1,653 $1,997 $1,800 $1,241 2%
6010 Surgical Placement of Implant $2,041 $2,495 $2,213 $1,373 6% $1,734 $2,320 $1,948 $920 6%
6013 Surgical Placement of  Mini Implant $1,109 $1,927 $1,200 $683 23% $856 $1,786 $876 $391 19%
6056 Prefabricated Abutment $705 $1,055 $807 $376 5% $651 $1,009 $772 $350 6%
6059 Abutment Sup Crown Implant $1,336 $1,638 $1,470 $996 3% $1,168 $1,500 $1,300 $867 3%
6066 Implant – Supp Crown-Porc to Metal $1,437 $2,176 $1,554 $1,000 4% $1,220 $1,692 $1,380 $882 4%
7140 Simple Extraction $178 $225 $188 $140 2% $151 $188 $165 $116 11%
8090 Invisalign $5,102 $6,371 $5,585 $3,859 6% $5,065 $6,679 $5,342 $3,565 5%
9110 Palliative Treatment $143 $240 $161 $76 5% $116 $182 $135 $69 10%
9972 Take Home Bleaching (Both Arches) $284 $439 $351 $150 5% $262 $463 $313 $110 7%
9999 In Office Bleaching (Both Arches) $475 $726 $581 $259 7% $465 $693 $542 $249 10%
*95% chance that the population mean is within plus or minus this percentage of the mean.
METRO AREA IS DEFINED AS THE SEVEN COUNTY METRO AREA