[ { "Procedure Code": "D1999", "Description": "", "Price": "50" }, { "Procedure Code": "D0120", "Description": "perio exam", "Price": "105" }, { "Procedure Code": "D0140", "Description": "limited exam", "Price": "90" }, { "Procedure Code": "D0150", "Description": "comprehensive exam", "Price": "120" }, { "Procedure Code": "D0210", "Description": "Fmx.", "Price": "120" }, { "Procedure Code": "D0220", "Description": "first PA.", "Price": "60" }, { "Procedure Code": "D0230", "Description": "2nd PA.", "Price": "50" }, { "Procedure Code": "D0330", "Description": "pano", "Price": "150" }, { "Procedure Code": "D0272", "Description": "2 BW", "Price": "80" }, { "Procedure Code": "D0274", "Description": "4BW", "Price": "160" }, { "Procedure Code": "D1110", "Description": "adult prophy", "Price": "150" }, { "Procedure Code": "D1120", "Description": "child prophy", "Price": "120" }, { "Procedure Code": "D1351", "Description": "sealant", "Price": "80" }, { "Procedure Code": "D4341", "Description": "srp", "Price": "250" }, { "Procedure Code": "D4910", "Description": "perio maintains", "Price": "250" }, { "Procedure Code": "D1208", "Description": "FL", "Price": "90" }, { "Procedure Code": "D2330", "Description": "front composite. 1 s.", "Price": "180" }, { "Procedure Code": "D2331", "Description": "2s", "Price": "220" }, { "Procedure Code": "D2332", "Description": "3s", "Price": "280" }, { "Procedure Code": "D2335", "Description": "4s or more", "Price": "350" }, { "Procedure Code": "D2391", "Description": "back. 1s", "Price": "200" }, { "Procedure Code": "D2392", "Description": "2s", "Price": "250" }, { "Procedure Code": "D2393", "Description": "3s", "Price": "280" }, { "Procedure Code": "D2394", "Description": "4s", "Price": "320" }, { "Procedure Code": "D2140", "Description": "amalgam, one surface", "Price": "150" }, { "Procedure Code": "D2150", "Description": "amalgam, two surface", "Price": "200" }, { "Procedure Code": "D2750", "Description": "high noble", "Price": "1300" }, { "Procedure Code": "D2751", "Description": "base metal", "Price": "1200" }, { "Procedure Code": "D2740", "Description": "crown porcelain", "Price": "1300" }, { "Procedure Code": "D2954", "Description": "p/c", "Price": "450" }, { "Procedure Code": "D7910", "Description": "suture, small wound up to 5 mm", "Price": "400" }, { "Procedure Code": "D5110", "Description": "FU", "Price": "1200", "Full Price": "1700" }, { "Procedure Code": "D5120", "Description": "FL", "Price": "1700", "Full Price": "1700" }, { "Procedure Code": "D5211", "Description": "pu", "Price": "1300" }, { "Procedure Code": "D5212", "Description": "pl", "Price": "1300" }, { "Procedure Code": "D5213", "Description": "cast pu.", "Price": "1700" }, { "Procedure Code": "D5214", "Description": "cast pl", "Price": "1700" }, { "Procedure Code": "D5510", "Description": "Repair broken complete denture base (QUAD)", "Price": "400" }, { "Procedure Code": "D5520", "Description": "Replace missing or broken teeth - complete denture (each tooth) (TOOTH)", "Price": "200" }, { "Procedure Code": "D5750", "Description": "lab reline", "Price": "600" }, { "Procedure Code": "D5730", "Description": "chairside reline", "Price": "500" }, { "Procedure Code": "D2920", "Description": "re cement crown", "Price": "120" }, { "Procedure Code": "D2950", "Description": "core buildup", "Price": "350" }, { "Procedure Code": "D2955", "Description": "post renoval", "Price": "350" }, { "Procedure Code": "D6100", "Description": "", "Price": "320" }, { "Procedure Code": "D6110", "Description": "implant", "Price": "1600" }, { "Procedure Code": "D6056", "Description": "pre fab abut", "Price": "750" }, { "Procedure Code": "D6057", "Description": "custom abut", "Price": "800" }, { "Procedure Code": "D6058", "Description": "porcelain, implant crown, ceramic crown", "Price": "1400" }, { "Procedure Code": "D6059", "Description": "", "Price": "1400" }, { "Procedure Code": "D6242", "Description": "noble metal. For united", "Price": "1400" }, { "Procedure Code": "D6245", "Description": "porcelain, not for united", "Price": "1400" }, { "Procedure Code": "D0367", "Description": "", "Price": "400" }, { "Procedure Code": "D0364", "Description": "Less than one jaw", "Price": "350" }, { "Procedure Code": "D0365", "Description": "Mand", "Price": "350" }, { "Procedure Code": "D0366", "Description": "Max", "Price": "350" }, { "Procedure Code": "D0368", "Description": "include TMJ", "Price": "375" }, { "Procedure Code": "D0383", "Description": "", "Price": "350" }, { "Procedure Code": "D0380", "Description": "Less than one jaw", "Price": "300" }, { "Procedure Code": "D0381", "Description": "Mand", "Price": "300" }, { "Procedure Code": "D0382", "Description": "Max", "Price": "300" }, { "Procedure Code": "D7950", "Description": "max", "Price": "800" }, { "Procedure Code": "D7140", "Description": "simple ext", "Price": "150" }, { "Procedure Code": "D7210", "Description": "surgical ext", "Price": "280" }, { "Procedure Code": "D7220", "Description": "soft impacted", "Price": "380" }, { "Procedure Code": "D7230", "Description": "partial bony", "Price": "450" }, { "Procedure Code": "D7240", "Description": "fully bony", "Price": "550" }, { "Procedure Code": "D3320", "Description": "pre M RCT", "Price": "1050" } ]