How much could you save?
This is an estimate price list for the Aetna Dental Access Network. Each dentist has a different price list, but we took averages from Los Angeles, New York, Chicago and Orlando to give you an idea of what you’ll save.
D0120 | Periodic Oral Exam ADA Code: D0120 | $73 | $35 | $38 |
D0150 | Comprehensive Oral Exam ADA Code: D0150 | $113 | $49 | $64 |
D0210 | X-Ray Intraoral - complete series including bitewings, ADA Code: D0210 Intraoral - complete series including bitewings | $168 | $87 | $81 |
D0274 | X-Ray Bitewings - Four Films Bitewings - Four Films ADA Code: D0274 | $82 | $41 | $41 |
D0330 | X-Ray Panoramic Film Panoramic Film ADA Code: D0330 | $145 | $73 | $72 |
D1110 | Cleaning (Prophylaxis) - Adult (Prophylaxis) - Adult ADA Code: D1110 | $127 | $68 | $59 |
D1120 | Cleaning (Prophylaxis) - Child (Prophylaxis) - Child ADA Code: D1120 | $93 | $51 | $42 |
D1351 | Sealant Per Tooth Per Tooth ADA Code: D1351 | $74 | $36 | $38 |
D2330 | Filling 1-surface resin (white) filling, front (anterior) tooth, ADA Code: D2330 1-surface resin (white) filling, front (anterior) tooth | $204 | $102 | $102 |
D2750 | Crown Porcelain fused to high noble metal (i.e. gold), ADA Code: D2750 Porcelain fused to high noble metal (i.e. gold) | $1,312 | $829 | $483 |
D2752 | Restorative Crown Porcelain fused to noble metal, ADA Code: D2752 Porcelain fused to noble metal | $1,306 | $787 | $519 |
D3310 | Root Canal Front Tooth (Anterior) Excluding Final Restoration Front Tooth (Anterior) Excluding Final Restoration ADA Code: D3310 | $880 | $536 | $344 |
D3320 | Root Canal Premolar tooth (bicuspid) excluding final restoration Premolar tooth (bicuspid) excluding final restoration ADA Code: D3320 | $987 | $638 | $349 |
D3330 | Root Canal Molar, excluding final restoration, ADA Code: D3330 Molar, excluding final restoration | $1,226 | $859 | $367 |
D4260 | Osseous Surgery Four or more contiguous teeth - modifies bony support of teeth, ADA Code: D4260 Four or more contiguous teeth - modifies bony support of teeth | $1,175 | $853 | $322 |
D4341 | Scaling/Root Planing Four or more contiguous teeth, ADA Code: D4341 Four or more contiguous teeth | $274 | $160 | $114 |
D4910 | Periodontal Maintenance For patients who have been previously treated for periodontal disease For patients who have been previously treated for periodontal disease ADA Code: D4910 | $171 | $91 | $80 |
D5110 | Complete Upper Denture (Maxillary), ADA Code: D5110 (Maxillary) | $1,441 | $1,003 | $438 |
D7140 | Extraction Erupted tooth or exposed root-includes local anaesthesia and suturing if needed Erupted tooth or exposed root-includes local anaesthesia and suturing if needed, ADA Code: D7140 | $229 | $101 | $128 |
D8080 | Comprehensive Orthodontic Treatment (Child), ADA Code: D8080 (Child) | $5,952 | $3,484 | $2,468 |
In addition to the above procedures, your plan will also save on dental work like implants, veneers, bone grafts, ceramic crowns, adult braces and more!
The select regional average cost represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the cost of care tool as of June 2020.
Actual costs and savings may vary by provider, service and geographic location. We use the average of negotiated fees from participating providers to determine the average costs, as shown on the chart.
Common Questions
Your plan will save on all officially recognized dental
treatments at an in-network provider. We recommend
checking with your dentist for exact treatment pricing at their location.
Each dentist contracts with the Aetna Dental Access
network individually, so prices will vary between providers.
While we can give estimates for certain procedures and a
general savings range of 15-50% per visit across all
procedures, we recommend checking with your dentist for
exact treatment pricing at their location.