| 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 | $50 | $57 | $52 | $43 | 1% | $43 | $51 | $47 | $33 | 2% | |
| 0140 | Emergency Exam | $72 | $94 | $76 | $49 | 3% | $59 | $76 | $67 | $40 | 3% | |
| 0150 | Comprehensive Exam | $78 | $96 | $83 | $59 | 2% | $65 | $88 | $71 | $47 | 3% | |
| 1110 | Adult Prophy | $92 | $103 | $96 | $80 | 1% | $80 | $94 | $86 | $63 | 2% | |
| 1120 | Child Prophy | $65 | $74 | $68 | $55 | 1% | $55 | $65 | $60 | $43 | 2% | |
| 0220 | PA 1st Film | $29 | $34 | $31 | $24 | 2% | $26 | $31 | $29 | $20 | 2% | |
| 0272 | 2 Bitewings | $47 | $52 | $49 | $39 | 2% | $41 | $49 | $44 | $31 | 2% | |
| 0274 | 4 Bitewings | $60 | $68 | $64 | $50 | 1% | $55 | $65 | $58 | $43 | 2% | |
| 0210 | FMX | $131 | $152 | $138 | $112 | 2% | $120 | $150 | $130 | $95 | 2% | |
| 0330 | Panoramic Film | $120 | $137 | $125 | $102 | 1% | $104 | $121 | $111 | $85 | 2% | |
| 1206 | Fluoride Varnish | $41 | $52 | $45 | $28 | 3% | $35 | $47 | $39 | $25 | 3% | |
| 1208 | Fluoride | $41 | $49 | $44 | $29 | 3% | $34 | $42 | $38 | $24 | 3% | |
| 1351 | Sealant (EACH) | $52 | $60 | $55 | $44 | 2% | $45 | $53 | $48 | $35 | 2% | |
| Amalgams (Permanent): | ||||||||||||
| 2140 | 1 Surface | $134 | $178 | $142 | $112 | 3% | $113 | $1345 | $121 | $87 | 2% | |
| 2150 | 2 Surfaces | $173 | $244 | $180 | $144 | 3% | $144 | $184 | $155 | $110 | 2% | |
| 2160 | 3 Surfaces | $212 | $297 | $216 | $177 | 3% | $176 | $222 | $188 | $132 | 3% | |
| 2161 | 4 Surfaces | $262 | $356 | $275 | $213 | 3% | $215 | $280 | $233 | $158 | 3% | |
| Anterior Composites: | ||||||||||||
| 2330 | 1 Surface | $159 | $180 | $166 | $140 | 1% | $134 | $162 | $143 | $106 | 2% | |
| 2331 | 2 Surfaces | $211 | $246 | $224 | $180 | 2% | $171 | $215 | $184 | $130 | 2% | |
| 2332 | 3 Surfaces | $262 | $308 | $275 | $214 | 2% | $207 | $262 | $225 | $153 | 2% | |
| 2335 | Resin involvingincisal Angle Class IV | $307 | $364 | $324 | $250 | 2% | $249 | $319 | $273 | $183 | 3% | |
| Posterior Composites: | ||||||||||||
| 2391 | 1 Surface | $174 | $199 | $182 | $149 | 1% | $148 | $177 | $157 | $115 | 2% | |
| 2392 | 2 Surfaces | $248 | $285 | $263 | $205 | 2% | $201 | $245 | $217 | $152 | 2% | |
| 2393 | 3 Surfaces | $308 | $350 | $325 | $255 | 2% | $249 | $310 | $270 | $181 | 2% | |
| 2394 | 4 Surfaces | $357 | $417 | $380 | $286 | 2% | $292 | $370 | $319 | $209 | 3% | |
| 2630 | Porcelain inlay | $1,039 | $1,224 | $1,144 | $799 | 3% | $881 | $1,095 | $940 | $677 | 3% | |
| 2643 | Porcelain or Ceramic Onlay |
$1,073 | $1,260 | $1,174 | $802 | 2% | $924 | $1,157 | $988 | $718 | 3% | |
| 2652 | Composite inlay | $940 | $1,214 | $1,061 | $555 | 5% | $768 | $992 | $917 | $394 | 5% | |
| Crowns: | ||||||||||||
| 2740 | Ceramic Crown | $1,164 | $1,339 | $1,235 | $957 | 2% | $975 | $1,150 | $1,038 | $831 | 2% | |
| 2750 | Porcelain fused to high noble | $1,125 | $1,290 | $1,195 | $948 | 1% | $967 | $1,150 | $1,026 | $800 | 2% | |
| 2751 | Porcelain to predom base metal |
$1,069 | $1,210 | $1,140 | $895 | 2% | $915 | $1,095 | $972 | $766 | 2% | |
| 2752 | Porcelain to noble | $1,101 | $1,292 | $1,165 | $930 | 2% | $932 | $1,100 | $993 | $777 | 2% | |
| 2790 | Full cast high noble | $1,159 | $1,344 | $1,239 | $972 | 2% | $990 | $1,200 | $1,050 | $810 | 2% | |
| 2791 | Full cast predom base | $1,046 | $1,261 | $1,130 | $781 | 4% | $905 | $1,097 | $962 | $747 | 2% | |
| 2931 | Stainless Steel | $365 | $500 | $400 | $256 | 4% | $297 | $394 | $335 | $198 | 5% | |
| 2950 | Crown Build-up | $278 | $348 | $300 | $197 | 2% | $225 | $283 | $250 | $151 | 3% | |
| 2960 | Labial Veneer (LAMINATE) | $669 | $1,102 | $740 | $368 | 5% | $533 | $952 | $602 | $250 | 6% | |
| 2962 | Labial Veneer (PORCELAIN) | $1,164 | $1,490 | $1,250 | $881 | 3% | $952 | $1,258 | $1,008 | $731 | 3% | |
| Endodontics: | ||||||||||||
| 3221 | Open and Drain | $216 | $314 | $240 | $145 | 5% | $158 | $237 | $182 | $88 | 5% | |
| 3310 | 1 Canal | $748 | $865 | $794 | $637 | 2% | $620 | $745 | $665 | $480 | 2% | |
| 3320 | 2 Canals | $870 | $994 | $912 | $750 | 2% | $724 | $889 | $773 | $559 | 2% | |
| 3330 | 3 Canals | $1,048 | $1,200 | $1,103 | $890 | 1% | $890 | $1,047 | $944 | $712 | 2% | |
| 4341 | Four or more Root Planing | $281 | $336 | $295 | $229 | 4% | $233 | $292 | $252 | $165 | 2% | |
| 4342 | Root Planing (1-3) | $194 | $256 | $220 | $129 | 4% | $158 | $220 | $176 | $99 | 5% | |
| 4355 | Debridement | $218 | $285 | $240 | $149 | 3% | $171 | $240 | $195 | $102 | 3% | |
| 4381 | Arestin per Site | $60 | $143 | $70 | $30 | 9% | $63 | $157 | $75 | $31 | 10% | |
| 4381 | Atridox Per Application | $78 | $163 | $105 | $30 | 13% | $72 | $159 | $85 | $35 | 13% | |
| 4910 | Perio Maintenance | $145 | $171 | $155 | $109 | 2% | $120 | $149 | $134 | $87 | 2% | |
| 5120 | LOWER Full Denture | $1,886 | $2,392 | $1,994 | $1,500 | 3% | $1,525 | $1,927 | $1,670 | $1,100 | 3% | |
| 5213 | UPPER Partial | $1,959 | $2,404 | $2,092 | $1,549 | 3% | $1,614 | $2,064 | $1,792 | $1,145 | 3% | |
| 6010 | Surgical Placement of Implant | $1,949 | $2,589 | $2,200 | $1,090 | 7% | $1,779 | $2,271 | $1,996 | $842 | 6% | |
| 6056 | Prefabricated Abutment | $675 | $945 | $800 | $360 | 5% | $639 | $999 | $749 | $300 | 6% | |
| 6059 | Abutment Sup Crown Implant | $1,299 | $1,621 | $1,449 | $1,000 | 3% | $1,138 | $1,526 | $1,275 | $843 | 4% | |
| 6066 | Implant – Supp Crown-Porc to Metal | $1,391 | $2,020 | $1,537 | $995 | 4% | $1,206 | $1,693 | $1,342 | $856 | 4% | |
| 7140 | Simple Extraction | $175 | $213 | $184 | $143 | 2% | $145 | $184 | $157 | $110 | 2% | |
| 8090 | Invisalign | $5,177 | $6,262 | $5,590 | $3,500 | 4% | $4,768 | $6,083 | $5,300 | $3,200 | 7% | |
| 9110 | Palliative Treatment | $138 | $204 | $160 | $74 | 5% | $110 | $185 | $127 | $58 | 5% | |
| 9972 | Take Home Bleaching (Both Arches) | $291 | $487 | $357 | $131 | 6% | $275 | $500 | $350 | $90 | 6% | |
| 9999 | In Office Bleaching (Both Arches) | $476 | $705 | $583 | $299 | 6% | $444 | $794 | $518 | $209 | 9% | |
| *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. | ||||||||||||