816-523-3665
Red Bridge Family & Asha Dental
Fee Schedule
Effective January, 2023
Procedure
Member Cost
Typical Fee
Office Visit....................................................................................................................
Oral Exam ....................................................................................................................
Oral Cancer Screening ................................................................................................
Prophylaxis (cleaning) .................................................................................................
Periapical X-Rays .........................................................................................................
Bitewing X-Rays ...........................................................................................................
Instruction .....................................................................................................................
Flouride Treatment .......................................................................................................
Post-Op Treatment .......................................................................................................
Emergency Visit ...........................................................................................................
X-Ray, Full Mouth .........................................................................................................
Panoramic Film .............................................................................................................
Local Anesthetic ...........................................................................................................
Nitrous Oxide (per unit) ................................................................................................
Scaling/Root Planning Per Quadrant ...........................................................................
Scaling/Root Planning 1-3 Teeth ..................................................................................
Full Mouth Debridement ...............................................................................................
Periodontal Maintenance After Therapy .......................................................................
Extractions, Single Tooth Non-Surgical ........................................................................
Extractions, Each Additional Non-Surgical ..................................................................
Extractions, Surgical where available ..........................................................................
Fillings, Amalgam Silver Fillings 1 Surface Permanent ................................................
Fillings, Amalgam Silver Fillings 2 Surface Permanent ................................................
Fillings, Amalgam Silver Fillings 3 Surface Permanent ................................................
Fillings, Amalgam Silver Fillings 4 Surface Permanent ................................................
Fillings, Composite White or Tooth Colored Fillings 1 Surface Anterior .......................
Fillings, Composite White or Tooth Colored Fillings 2 Surface Anterior .......................
Fillings, Composite White or Tooth Colored Fillings 3 Surface Anterior .......................
Fillings, Composite White or Tooth Colored Fillings 4 Surface Anterior Incisal Angle..
Fillings, Composite White or Tooth Colored Fillings 1 Surface Posterior .....................
Fillings, Composite White or Tooth Colored Fillings 2 Surface Posterior .....................
Fillings, Composite White or Tooth Colored Fillings 3 Surface Posterior .....................
Crowns, Porcelain/Ceramic ..........................................................................................
Crowns, Temp (with Crown) .........................................................................................
Crowns, Recement Crown/Inlay ...................................................................................
Crowns, Porcelain/Metal ..............................................................................................
Crowns, Full Metal ........................................................................................................
Crowns, Full Gold, Plus the cost of gold ......................................................................
Crowns, Core Buildup ..................................................................................................
Crowns, Cast Post & Core ...........................................................................................
Crowns, Prefabricated Post & Core .............................................................................
Bridges, Porcelain fused to High Noble Metal, Pontic or Retainer ..............................
Bridges, fused to Gold Pontic or Retainer (plus cost of gold) .....................................
Dentures, Complete Upper ..........................................................................................
Dentures, Complete Lower ..........................................................................................
Dentures, Immediate Upper .........................................................................................
Dentures, Immediate Lower .........................................................................................
Dentures, Upper Cast Partial .......................................................................................
Dentures, Lower Cast Partial ........................................................................................
Dentures, Denture Relines ...........................................................................................
Dentures, First Denture Adjustment .............................................................................
Dentures, Additional Adjustments ................................................................................
$0
$30
$0
$75
$20
$35
$0
$21
$0
$52
$80
$80
$0
$45
$140
$100
$95
$85
$90
$90
$160
$80
$95
$120
$128
$105
$115
$145
$170
$110
$155
$180
$850
$0
$45
$850
$850
$850
$140
$200
$200
$850
$850
$1,200
$1,200
$1,200
$1,200
$1,200
$1,200
$320
$0
$35
$69
$71
$85
$95
$30
$77
$55
$43
$55
$99
$140
$105
$22
$55
$245
$184
$175
$150
$133
$105
$175
$130
$165
$191
$235
$160
$198
$244
$255
$184
$225
$282
$1,108
$0
$99
$1,108
$1,080
$1,080
$270
$395
$305
$1,010
N/A
$1,663
$1,663
$1,540
$1,540
$1,663
$1,663
$397
$70
$70
Any procedure not listed will be performed at a 20% discount from the usual and customary fee.
Prices are subject to change from time to time, they were last updated in 2012 and before that in 2002.
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