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 $53 $61 $56 $46 2% $46 $55 $49 $37 2%
0140 Emergency Exam $75 $93 $79 $56 2% $64 $82 $70 $40 3%
0150 Comprehensive Exam $82 $98 $86 $66 2% $70 $92 $75 $50 3%
1110 Adult Prophy $96 $108 $100 $85 1% $84 $97 $90 $71 1%
1120 Child Prophy $68 $77 $71 $58 1% $59 $70 $63 $46 2%
0220 PA 1st Film $31 $36 $34 $25 2% $28 $34 $30 $22 2%
0272 2 Bitewings $49 $56 $52 $42 2% $43 $50 $46 $35 2%
0274 4 Bitewings $64 $71 $66 $55 2% $58 $67 $61 $46 2%
0210 FMX $139 $159 $145 $120 2% $127 $160 $135 $101 2%
0330 Panoramic Film $128 $146 $135 $112 2% $112 $131 $118 $91 2%
0367 Cone CT Capture & Interpretation $304 $450 $415 $87 26% $332 $620 $366 $131 32%
1206 Fluoride Varnish $42 $50 $45 $30 2% $37 $47 $40 $24 3%
1351 Sealant (EACH) $55 $62 $58 $46 1% $48 $56 $51 $39 2%
Amalgams (Permanent):
2140 1 Surface $141 $179 $147 $115 2% $124 $157 $133 $95 2%
2150 2 Surfaces $181 $250 $186 $147 3% $157 $206 $166 $120 3%
2160 3 Surfaces $222 $302 $228 $178 3% $190 $246 $201 $145 3%
2161 4 Surfaces $274 $361 $284 $222 3% $232 $300 $250 $175 3%
Anterior Composites:
2330 1 Surface $167 $189 $174 $145 1% $144 $173 $154 $117 7%
2331 2 Surfaces $223 $260 $232 $190 2% $182 $217 $193 $141 2%
2332 3 Surfaces $275 $325 $287 $229 2% $222 $267 $240 $169 2%
2335 Resin involvingincisal Angle Class IV $324 $384 $340 $262 3% $266 $331 $287 $200 2%
Posterior Composites:
2391 1 Surface $183 $207 $192 $159 2% $158 $186 $169 $125 2%
2392 2 Surfaces $261 $295 $273 $203 2% $213 $256 $230 $168 2%
2393 3 Surfaces $324 $376 $338 $271 2% $264 $319 $287 $198 2%
2394 4 Surfaces $377 $445 $394 $311 2% $310 $381 $339 $230 2%
2630 Porcelain inlay $1,088 $1,317 $1,198 $800 3% $951 $1,140 $1,011 $777 2%
2643 Porcelain/Ceramic Onlay $1,128 $1,331 $1,200 $881 3% $991 $1,183 $1,071 $786 3%
2652 Composite inlay $1,007 $1,257 $1,109 $624 5% $825 $1,090 $935 $520 5%
Crowns:
2740 Ceramic Crown $1,213 $1,377 $1,275 $1,017 1% $1,024 $1,200 $1,094 $865 2%
2750 Porcelain fused to high noble $1,193 $1,357 $1,250 $1,021 1% $1,022 $1,211 $1,091 $863 2%
2751 Porcelain to predom base metal $1,128 $1,272 $1,196 $988 2% $977 $1,147 $1,021 $850 2%
2752 Porcelain to noble $1,164 $1,323 $1,221 $995 2% $996 $1,199 $1,050 $855 2%
2931 Stainless Steel $384 $525 $411 $286 4% $313 $411 $347 $223 3%
2950 Crown Build-up $293 $360 $310 $222 2% $239 $298 $267 $164 4%
2960 Labial Veneer (LAMINATE) $722 $1,207 $785 $375 5% $564 $975 $659 $282 6%
2962 Labial Veneer (PORCELAIN) $1,234 $1,500 $1,294 $974 2% $1,016 $1,262 $1,088 $775 2%
Endodontics:
3221 Pulpal Debridement $219 $327 $241 $135 5% $174 $248 $199 $97 4%
3310 1 Canal $783 $887 $830 $626 2% $662 $805 $706 $510 2%
3320 2 Canals $911 $1,027 $960 $768 2% $776 $923 $829 $617 2%
3330 3 Canals $1,095 $1,242 $1,150 $940 1% $948 $1,111 $1,015 $755 2%
4341 Four or more Root Planing $291 $342 $305 $226 2% $246 $296 $269 $186 2%
4342 Root Planing (1-3 Teeth) per tooth $203 $263 $225 $126 3% $166 $224 $188 $101 3%
4355 Debridement $229 $288 $250 $163 3% $182 $243 $204 $115 3%
4381 Arestin per Site $63 $139 $75 $32 9% $63 $103 $75 $38 7%
4910 Perio Maintenance $153 $178 $162 $120 2% $128 $156 $141 $97 2%
5120 LOWER Full Denture $1,976 $2,420 $2,077 $1,600 2% $1,623 $2,000 $1,760 $1,270 2%
5213 UPPER Partial $2,073 $2,515 $2,200 $1,650 2% $1,711 $2,049 $1,866 $1,350 2%
6010 Surgical Placement of Implant $2,065 $2,639 $2,203 $1,414 8% $1,793 $2,233 $2,000 $1,187 5%
6013 Surgical Placement of  Mini Implant $1,142 $1,815 $1,375 $700 16% $901 $1,587 $1,059 $390 14%
6056 Prefabricated Abutment $707 $1,004 $810 $401 5% $682 $1,048 $797 $339 9%
6057 Custom Abutment $865 $1,323 $950 $571 5% $779 $1,201 $900 $458 5%
6060 Supp Porc to Metal Crown Predom $1,353 $1,764 $1,489 $1,034 4% $1,204 $1,642 $1,317 $896 4%
6061 Abutment Supported PFM $1,387 $1,822 $1,501 $1,055 3% $1,190 $1,605 $1,324 $858 3%
6065 Implant Supported Ceramic Crown $1,501 $2,325 $1,648 $1,140 4% $1,295 $1,846 $1,462 $903 4%
7140 Simple Extraction $186 $236 $195 $145 5% $158 $196 $173 $120 2%
8090 Invisalign/Clear Correct/Other $5,014 $6,246 $5,600 $3,565 6% $4,768 $6,118 $5,329 $2,208 6%
9110 Palliative Treatment $143 $222 $160 $79 5% $120 $185 $140 $63 4%
9972 Take Home Bleaching (Both Arches) $296 $500 $358 $150 6% $261 $491 $321 $105 7%
9999 In Office Bleaching (Both Arches) $494 $750 $600 $295 8% $426 $749 $530 $127 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