Kinga Royer DMD
Family and Cosmetic Dentistry
6116 S Tamiami Trl, Sarasota FL
941-922-6777
Office Fees
Here is a list of the most commonly used ADA/CDT codes and the standard fees of the office. In-network insurance fees will differ based on each insurance company and policy.
Exams
ADA Code Description Fee
D0120 Periodic Oral Evaluation - established patient $70
D0140 Limited oral evaluation - problem focused $105
D0150 Comprehensive oral evaluation - new or established patient $125
X-rays
ADA Code Description Fee
D0210 Intraoral - complete series of radiographic images $195
D0220 Intraoral - periapical first radiographic image $35
D0274 Bitewings - four radiographic images $85
Cleanings
ADA Code Description Fee
D1111 Prophylaxis - adult $120
D1120 Prophylaxis - child $90
D4341 Periodontal scaling and root planing - four or more teeth per quadrant $340
D4342 Periodontal scaling and root planing - one to three teeth per quadrant $255
D4910 Periodontal maintenance $180
Fillings
ADA Code Description Fee
D2330 Resin-based composite - one surface, front $225
D2331 Resin-based composite - two surfaces, front $270
D2332 Resin-based composite - three surfaces, front $330
D2335 Resin-based composite - four or more surfaces, front $415
D2391 Resin-based composite - one surface, back $245
D2392 Resin-based composite - two surfaces, back $310
D2393 Resin-based composite - three surfaces, back $380
D2394 Resin-based composite - four or more surfaces, back $445
Crowns/Bridges
ADA Code Description Fee
D2740 Crown - porcelain/ceramic $1450
D2950 Core build-up, including any pins when required $350
D2954 Prefabricated post and core in addition to crown $430
D6065 Implant supported crown - porcelain/ceramic $1980
D6245 Pontic - porcelain/ceramic $1450
D6740 Retainer crown - porcelain/ceramic $1450
Extractions
ADA Code Description Fee
D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) $275
D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, $375
and including elevation of mucoperiosteal flap if indicated
Root Canals
ADA Code Description Fee
D3310 Endodontic therapy, anterior tooth (excluding final restoration) $990
D3320 Endodontic therapy, premolar tooth (excluding final restoration) $1145
D3330 Endodontic therapy, molar tooth (excluding final restoration) $1360
Dentures/Partial Dentures
ADA Code Description Fee
D5213 Maxillary partial denture - cast metal frame $2400
D5214 Mandibular partial denture - cast metal frame $2400
D5510 Complete denture - maxillary $2335
D5520 Complete denture - mandibular $2335
(Prices valid 01/01/2024 - 12/31/2024)