| Procedure | Average Cost* | Average Cost with Aetna Dental Access* | Member Savings |
|---|---|---|---|
| Periodic Oral Exam | $64 | $38 | $26 |
| Comprehensive Oral Exam | $104 | $62 | $42 |
| X-Ray, Intraoral–Complete Series Including Bitewing | $165 | $99 | $66 |
| X-Ray, Bitewings– Four Films | $76 | $46 | $30 |
| X-Ray Panoramic Film | $134 | $80 | $54 |
| Cleaning (Prophylaxis)–Adult | $111 | $67 | $44 |
| Cleaning (Prophylaxis)–Child | $86 | $52 | $34 |
| Fluoride Application |
$45 | $27 | $18 |
| Sealant Per Tooth | $67 | $40 | $27 |
| Filling– 1 Surface Resin (White) Filling, Front (Anterior) Tooth |
$191 | $115 | $76 |
| Crown- Porcelain Fused to High Nobel Metal (i.e. gold) | $1,284 | $770 | $514 |
| Restorative Crown- Porcelain Fused to Nobel Metal | $1,199 | $719 | $480 |
| Root Canal Front Tooth (Anterior) Excluding Final Restoration | $951 | $571 | $380 |
| Root Canal Premolar Tooth (Bicuspid), Excluding Final Restoration | $1,084 | $650 | $434 |
| Root Canal Molar, Excluding Final Restoration | $1,350 | $810 | $540 |
| Osseous Surgery, Four Or More Contiguous Teeth - Modifies Bony Support of Teeth | $1,477 | $886 | $591 |
| Scaling/Root Planing Four or More Contiguous Teeth | $289 | $173 | $116 |
| Periodontal Maintenance For Patients Who Have Been Previously Treated For Periodontal Disease. | $170 | $102 | $68 |
| Complete Upper Denture (Maxillary) | $1,616 | $970 | $646 |
| Extraction of Erupted Tooth or Exposed Root - Includes Local Anesthesia and Suturing If Needed | $200 | $120 | $80 |
| General Anesthesia | $241 | $145 | $96 |
| IV Sedation/Analgesia | $211 | $127 | $84 |
| Occlusal Guard – Hard Appliance, Full Arch | $613 | $368 | $245 |
*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. 1 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 February 2024.