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 $49 $56 $51 $43 1% $42 $49 $45 $34 2%
0140 Emergency Exam $70 $89 $75 $49 3% $57 $76 $64 $40 3%
0150 Comprehensive Exam $76 $97 $80 $58 3% $63 $81 $68 $47 2%
1110 Adult Prophy $90 $101 $95 $80 1% $78 $89 $82 $68 1%
1120 Child Prophy $63 $72 $66 $55 1% $54 $63 $57 $43 2%
0220 PA 1st Film $28 $33 $30 $23 2% $25 $30 $27 $19 2%
0272 2 Bitewings $45 $51 $48 $39 1% $39 $46 $42 $32 2%
0274 4 Bitewings $59 $66 $62 $51 1% $53 $63 $55 $43 2%
0210 FMX $129 $153 $135 $112 2% $115 $146 $122 $96 2%
0330 Panoramic Film $116 $135 $121 $101 2% $101 $118 $107 $85 2%
1203 Child Fluoride $40 $47 $42 $32 2% $33 $41 $36 $25 11%
1204 Adult Fluoride $39 $48 $42 $25 3% $34 $42 $36 $25 4%
1206 Fluoride Varnish $40 $50 $43 $25 3% $34 $50 $43 $25 3%
1351 Sealant (EACH) $51 $61 $54 $42 2% $44 $51 $47 $35 2%
Amalgams (Permanent):
2140 1 Surface $127 $159 $134 $105 2% $110 $139 $118 $87 2%
2150 2 Surfaces $164 $223 $170 $135 3% $140 $178 $147 $111 2%
2160 3 Surfaces $201 $269 $210 $167 3% $170 $216 $180 $138 2%
2161 4 Surfaces $253 $338 $265 $201 3% $209 $276 $222 $165 3%
Anterior Composites:
2330 1 Surface $155 $177 $161 $134 2% $130 $155 $137 $109 2%
2331 2 Surfaces $206 $238 $217 $175 2% $164 $201 $173 $135 2%
2332 3 Surfaces $255 $302 $270 $207 2% $201 $250 $213 $159 2%
2335 Resin involvingincisal Angle Class IV $303 $372 $319 $242 2% $239 $300 $260 $185 3%
Posterior Composites:
2391 1 Surface $170 $193 $177 $145 1% $143 $171 $152 $114 2%
2392 2 Surfaces $243 $280 $258 $200 2% $196 $232 $210 $154 2%
2393 3 Surfaces $302 $342 $318 $247 2% $242 $294 $262 $184 2%
2394 4 Surfaces $353 $430 $374 $289 2% $284 $350 $310 $214 2%
2630 Porcelain inlay $999 $1,219 $1,097 $800 3% $849 $1,002 $925 $646 3%
2643 Porcelain or
Ceramic Onlay
$1,057 $1,233 $1,149 $874 2% $894 $1,019 $957 $733 2%
2652 Composite inlay $924 $1,176 $1,032 $532 5% $752 $954 $879 $467 5%
Crowns:
2740 Ceramic Crown $1,143 $1,347 $1,211 $980 2% $956 $1,111 $998 $833 1%
2750 Porcelain fused to high noble $1,094 $1,281 $1,150 $940 2% $940 $1,107 $987 $804 1%
2751 Porcelain to
predom base meta
$1,036 $1,200 $1,102 $867 2% $900 $1,026 $952 $776 2%
2752 Porcelain to noble $1,067 $1,239 $1,124 $900 2% $914 $1,021 $967 $793 1%
2790 Full cast high noble $1,115 $1,315 $1,180 $960 2% $958 $1,162 $999 $812 2%
2791 Full cast predom base $1,041 $1,220 $1,101 $852 2% $886 $1,024 $945 $749 4%
2931 Stainless Steel $359 $505 $400 $242 6% $286 $375 $318 $205 4%
2950 Crown Build-up $273 $359 $295 $205 3% $216 $269 $239 $148 3%
2960 Labial Veneer (LAMINATE) $662 $1,084 $720 $356 5% $499 $914 $569 $243 6%
2962 Labial Veneer (PORCELAIN) $1,142 $1,434 $1,218 $862 2% $913 $1,108 $978 $690 3%
Endodontics:
3221 Open and Drain $216 $329 $236 $135 8% $155 $235 $179 $85 7%
3310 1 Canal $723 $846 $768 $576 2% $600 $699 $645 $495 2%
3320 2 Canals $847 $989 $894 $719 2% $704 $821 $743 $569 2%
3330 3 Canals $1,021 $1,175 $1,080 $875 2% $864 $1,001 $915 $701 2%
4341 Four or more Root Planing $275 $323 $295 $220 4% $229 $296 $248 $158 6%
4342 Root Planing (1-3) $192 $255 $215 $125 4% $154 $215 $175 $91 4%
4355 Debridement $218 $293 $237 $149 3% $170 $227 $186 $106 3%
4381 Arestin per Site $59 $144 $68 $30 10% $59 $155 $65 $33 11%
4381 Atridox Per Application $76 $160 $92 $35 14% $72 $158 $92 $34 13%
4910 Perio Maintenance $144 $169 $154 $111 19% $120 $147 $131 $91 3%
5120 LOWER Full Denture $1,832 $2,305 $1,942 $1,432 3% $1,475 $1,878 $1,596 $1,146 2%
5213 UPPER Partial $1,917 $2,422 $2,008 $1,455 3% $1,556 $1,896 $1,698 $1,199 2%
6010 Surgical Placement of Implant $1,941 $2,448 $2,184 $1,215 6% $1,673 $2,180 $1,888 $683 9%
6056 Prefabricated Abutment $650 $949 $783 $350 6% $610 $927 $737 $315 6%
6059 Abutment Sup Crown Implant $1,263 $1,580 $1,413 $916 3% $1,137 $1,567 $1,256 $840 3%
6066 Implant – Supp Crown-Porc to Metal $1,337 $1,783 $1,500 $970 4% $1,202 $1,659 $1,351 $855 4%
7140 Simple Extraction $170 $212 $180 $129 8% $139 $173 $150 $106 3%
8090 Invisalign $4,777 $5,958 $5,500 $1,358 8% $4,835 $6,144 $5,238 $1,900 8%
9110 Palliative Treatment $137 $248 $152 $76 6% $103 $173 $124 $46 20%
9972 TakeÊHome Bleaching (Both Arches) $278 $425 $350 $128 5% $289 $506 $350 $144 10%
9999 In Office Bleaching (Both Arches) $482 $700 $536 $299 8% $418 $676 $493 $250 11%
*95% chance that the population mean is within plus or minus this percentage of the mean. Prepared By: Kern, DeWenter, Viere, Ltd. Certified Public Accountants Dental Practitioners — High and Low Ranges and Averages for years ending by March 31, 2012
Metro Area is defined as the seven county metro area.

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