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