| 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 | ||||||||||||
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