• (970) 688-8838
  • 4870 Peachtree Industrial BlvdBerkeley Lake, GA 30071
Book Online

Office Fee Schedule

Office Fee Schedule

CDT codeOffice feeGold 20% savingsPlatinum 30% savings
D01208400periodic oral evaluation - established patient
D014010600limited oral evaluation - problem focused
D014510900oral evaluation for a patient under three years of age and counseling with primary caregiver
D015012200comprehensive oral evaluation - new or established patient
D021017700intraoral - complete series of radiographic images
D02204000intraoral - periapical first radiographic image
D02303500intraoral - periapical each additional radiographic image
D02704000bitewing - single radiographic image
D02726100bitewings - two radiographic images
D02737400bitewings - three radiographic images
D02748800bitewings - four radiographic images
D027713200vertical bitewings - 7 to 8 radiographic images
D033015300panoramic radiographic image
D0364368294258cone beam CT capture and interpretation with limited field of view – less than one whole jaw
D0367473378331cone beam CT capture and interpretation with field of view of both jaws; with or without cranium
D11101681340prophylaxis - adult
D1120105840prophylaxis - child
D12066000topical application of fluoride varnish
D13511058474sealant - per tooth
D1352145116102preventive resin restoration in a moderate to high caries risk patient – permanent tooth
D135312610188sealant repair – per tooth
D2330252202176resin-based composite - one surface, anterior
D2331284227199resin-based composite - two surfaces, anterior
D2332368294258resin-based composite - three surfaces, anterior
D2335452362316resin-based composite - four or more surfaces or involving incisal angle (anterior)
D2391284227199resin-based composite - one surface, posterior
D2392336269235resin-based composite - two surfaces, posterior
D2393420336294resin-based composite - three surfaces, posterior
D2394494395346resin-based composite - four or more surfaces, posterior
D2940167134117protective restoration
D2950368294258core buildup, including any pins when required
D2954483386338prefabricated post and core in addition to crown
D31101199583pulp cap - direct (excluding final restoration)
D31201149180pulp cap - indirect (excluding final restoration)
D3220278222195therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament
D33101103882772endodontic therapy, anterior tooth (excluding final restoration)
D332012601008882endodontic therapy, premolar tooth (excluding final restoration)
D3330152312181066endodontic therapy, molar tooth (excluding final restoration)
D3331847678593treatment of root canal obstruction; non-surgical access
D3332665532465incomplete endodontic therapy; inoperable, unrestorable or fractured tooth
D334612601008882retreatment of previous root canal therapy - anterior
D334714181134993retreatment of previous root canal therapy - premolar
D3348162813021140retreatment of previous root canal therapy - molar
D34701052842736intentional re-implantation (including necessary splinting)
D4212394315276gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth
D42401156925809gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant
D4241870696609gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant
D4266995796697guided tissue regeneration - resorbable barrier, per site
D42671205964844guided tissue regeneration - nonresorbable barrier, per site (includes membrane removal)
D4322693554485splint - intra-coronal; natural teeth or prosthetic crowns
D4323637510446splint - extra-coronal; natural teeth or prosthetic crowns
D4341399319279periodontal scaling and root planing - four or more teeth per quadrant
D4342315252221periodontal scaling and root planing - one to three teeth per quadrant
D4346263210184scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation
D4355263210184full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit
D4910263210184periodontal maintenance
D5110294023522058complete denture - maxillary
D5120294023522058complete denture - mandibular
D5130399031922793immediate denture - maxillary
D5140399031922793immediate denture - mandibular
D5211262521001837maxillary partial denture – resin base (including, retentive/clasping materials, rests, and teeth)
D5212262521001837mandibular partial denture – resin base (including, retentive/clasping materials, rests, and teeth)
D5213262521001837maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)
D5214262521001837mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)
D5221367529402573immediate maxillary partial denture - resin base (including retentive/clasping materials, rests and teeth)
D5222367529402573immediate mandibular partial denture - resin base (including retentive/clasping materials, rests and teeth)
D5223367529402573immediate maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)
D5224367529402573immediate mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)
D5225262521001837maxillary partial denture - flexible base (including retentive/clasping materials, rests, and teeth)
D5226262521001837mandibular partial denture - flexible base (including retentive/clasping materials, rests, and teeth)
D5227367529402573immediate maxillary partial denture - flexible base (including any clasps, rests and teeth)
D5228367529402573immediate mandibular partial denture - flexible base (including any clasps, rests and teeth)
D528214181134993removable unilateral partial denture – one piece cast metal (including retentive/clasping materials, rests, and teeth), maxillary
D528314181134993removable unilateral partial denture – one piece cast metal (including rententive/clasping materias, rests, and teeth), mandibular
D528414181134993removable unilateral partial denture – one piece flexible base (including retentive/clasping materials, rests, and teeth) – per quadrant
D528614181134993removable unilateral partial denture – one piece resin (including retentive/clasping materials, rests, and teeth) – per quadrant
D541012610188adjust complete denture - maxillary
D541112610188adjust complete denture - mandibular
D542112610188adjust partial denture - maxillary
D542212610188adjust partial denture - mandibular
D5511286229200repair broken complete denture base, mandibular
D5512292234204repair broken complete denture base, maxillary
D5520257206180replace missing or broken teeth - complete denture (each tooth)
D5611268214188repair resin partial denture base, mandibular
D5612272218190repair resin partial denture base, maxillary
D5621351281246repair cast partial framework, mandibular
D5622335268234repair cast partial framework, maxillary
D5630358286251repair or replace broken retentive clasping materials – per tooth
D5640268214188replace broken teeth - per tooth
D5650309247216add tooth to existing partial denture
D5660359287251add clasp to existing partial denture - per tooth
D5730509407356reline complete maxillary denture (direct)
D5731505404354reline complete mandibular denture (direct)
D5740496397347reline maxillary partial denture (direct)
D5741499399349reline mandibular partial denture (direct)
D5862945756662precision attachment, by report
D5863346527722426overdenture – complete maxillary
D5864346527722426overdenture – partial maxillary
D5865325526042279overdenture – complete mandibular
D5866325526042279overdenture – partial mandibular
D5867531425372replacement of replaceable part of semi-precision or precision attachment (male or female component)
D620513161053921pontic - indirect resin based composite
D621114081126986pontic - cast predominantly base metal
D621214161133991pontic - cast noble metal
D6214148311861038pontic - titanium and titanium alloys
D6242143411471004pontic - porcelain fused to noble metal
D6250145611651019pontic - resin with high noble metal
D625114221138995pontic - resin with predominantly base metal
D625213981118979pontic - resin with noble metal
D6253993794695provisional pontic - further treatment or completion of diagnosis necessary prior to final impression
D654813031042912retainer - porcelain/ceramic for resin bonded fixed prosthesis
D660013231058926retainer inlay - porcelain/ceramic, two surfaces
D660113551084948retainer inlay - porcelain/ceramic, three or more surfaces
D660213231058926retainer inlay - cast high noble metal, two surfaces
D660313601088952retainer inlay - cast high noble metal, three or more surfaces
D660413251060927retainer inlay - cast predominantly base metal, two surfaces
D660513281062930retainer inlay - cast predominantly base metal, three or more surfaces
D660613271062929retainer inlay - cast noble metal, two surfaces
D660713661093956retainer inlay - cast noble metal, three or more surfaces
D660813811105967retainer onlay - porcelain/ceramic, two surfaces
D6609146711741027retainer onlay - porcelain/ceramic, three or more surfaces
D661013971118978retainer onlay - cast high noble metal, two surfaces
D6611151712141062retainer onlay - cast high noble metal, three or more surfaces
D661213791103965retainer onlay - cast predominantly base metal, two surfaces
D661313841107969retainer onlay - cast predominantly base metal, three or more surfaces
D661413661093956retainer onlay - cast noble metal, two surfaces
D6615142811421000retainer onlay - cast noble metal, three or more surfaces
D662414001120980retainer inlay - titanium
D663414141131990retainer onlay - titanium
D6740157512601103retainer crown - porcelain/ceramic
D6752143611491005retainer crown - porcelain fused to noble metal
D6793748598524provisional retainer crown - further treatment or completion of diagnosis necessary prior to final impression
D6930229183160re-cement or re-bond fixed partial denture
D2610156012481092inlay - porcelain/ceramic - one surface
D2620151712141062inlay - porcelain/ceramic - two surfaces
D2630159412751116inlay - porcelain/ceramic - three or more surfaces
D2962168013441176labial veneer (porcelain laminate) - indirect
D9971210168147odontoplasty - per tooth
D9972462370323external bleaching - per arch - performed in office
D9975462370323external bleaching for home application, per arch; includes materials and fabrication of custom trays
N4223534237Whitening refill
D6010278322261948surgical placement of implant body: endosteal implant
D6057945756662custom fabricated abutment – includes placement
D6058157512601103abutment supported porcelain/ceramic crown
D6059187515001313abutment supported porcelain fused to metal crown (high noble metal)
D6060174013921218abutment supported porcelain fused to metal crown (predominantly base metal)
D6061177014161239abutment supported porcelain fused to metal crown (noble metal)
D6062185414831298abutment supported cast metal crown (high noble metal)
D6063177114171240abutment supported cast metal crown (predominantly base metal)
D6064177114171240abutment supported cast metal crown (noble metal)
D6065198315861388implant supported porcelain/ceramic crown
D6066194115531359implant supported crown - porcelain fused to high noble alloys
D6067199315941395implant supported crown - high noble alloys
D6068187615011313abutment supported retainer for porcelain/ceramic FPD
D6069188115051317abutment supported retainer for porcelain fused to metal FPD (high noble metal)
D6070181514521271abutment supported retainer for porcelain fused to metal FPD (predominantly base metal)
D6071177114171240abutment supported retainer for porcelain fused to metal FPD (noble metal)
D6072188915111322abutment supported retainer for cast metal FPD (high noble metal)
D6073178914311252abutment supported retainer for cast metal FPD (predominantly base metal)
D6074175414031228abutment supported retainer for cast metal FPD (noble metal)
D6075194615571362implant supported retainer for ceramic FPD
D6076196915751378implant supported retainer for FPD - porcelain fused to high noble alloys
D6077203716301426implant supported retainer for metal FPD - high noble alloys
D6080403322282implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments
D6085649519454provisional implant crown
D6092211169148re-cement or re-bond implant/abutment supported crown
D6093250200175re-cement or re-bond implant/abutment supported fixed partial denture
D6100906725634implant removal, by report
D6104901600500bone graft at time of implant placement
D6110435634853049implant /abutment supported removable denture for edentulous arch – maxillary
D6111387230982710implant /abutment supported removable denture for edentulous arch – mandibular
D6112365629252559implant /abutment supported removable denture for partially edentulous arch – maxillary
D6113366529322566implant /abutment supported removable denture for partially edentulous arch – mandibular
D611413385107089370implant /abutment supported fixed denture for edentulous arch – maxillary
D611513188105509232implant /abutment supported fixed denture for edentulous arch – mandibular
D6116824865985774implant /abutment supported fixed denture for partially edentulous arch – maxillary
D6117926574126486implant /abutment supported fixed denture for partially edentulous arch – mandibular
D6191630504441semi-precision abutment – placement
D6192630504441semi-precision attachment – placement
D6243149911991049pontic - porcelain fused to titanium and titanium alloys
D251013561085949inlay - metallic - one surface
D252014021122981inlay - metallic - two surfaces
D2530148711901041inlay - metallic - three or more surfaces
D254214151132990onlay - metallic - two surfaces
D2543154212341079onlay - metallic - three surfaces
D2544165313221157onlay - metallic - four or more surfaces
D2642152312181066onlay - porcelain/ceramic - two surfaces
D2643154812381084onlay - porcelain/ceramic - three surfaces
D2644161612931131onlay - porcelain/ceramic - four or more surfaces
D26501200960840inlay - resin-based composite - one surface
D26511215972851inlay - resin-based composite - two surfaces
D265212581006881inlay - resin-based composite - three or more surfaces
D266212691015888onlay - resin-based composite - two surfaces
D266313111049918onlay - resin-based composite - three surfaces
D266413631090954onlay - resin-based composite - four or more surfaces
D2710157512601103crown - resin-based composite (indirect)
D2712157512601103crown - ¾ resin-based composite (indirect)
D2720189015121323crown - resin with high noble metal
D2721157512601103crown - resin with predominantly base metal
D2722189015121323crown - resin with noble metal
D2740157512601103crown - porcelain/ceramic
D2740.c14900HITECH crown - CEREC same day
D2740.e14900HITECH crown - emax (cosmetic)
D2740.z14900HITECH crown - zirconia (long-lasting)
D2750189015121323crown - porcelain fused to high noble metal
D2751157512601103crown - porcelain fused to predominantly base metal
D2752189015121323crown - porcelain fused to noble metal
D2753157512601103crown - porcelain fused to titanium and titanium alloys
D2780189015121323crown - 3/4 cast high noble metal
D2781157512601103crown - 3/4 cast predominantly base metal
D2782189015121323crown - 3/4 cast noble metal
D2783157512601103crown - 3/4 porcelain/ceramic
D2790189015121323crown - full cast high noble metal
D2791157512601103crown - full cast predominantly base metal
D2792189015121323crown - full cast noble metal
D2794157512601103crown - titanium and titanium alloys
D2799594475416provisional crown– further treatment or completion of diagnosis necessary prior to final impression
D2910210168147re-cement or re-bond inlay, onlay, veneer or partial coverage restoration
D2915210168147re-cement or re-bond indirectly fabricated or prefabricated post and core
D2920210168147re-cement or re-bond crown
D6210189015121323pontic - cast high noble metal
D6240189015121323pontic - porcelain fused to high noble metal
D624114221138995pontic - porcelain fused to predominantly base metal
D62451575790780pontic - porcelain/ceramic
D65451162930813retainer - cast metal for resin bonded fixed prosthesis
D65491191953834retainer – for resin bonded fixed prosthesis
D671013801104966retainer crown - indirect resin based composite
D6720189015121323retainer crown - resin with high noble metal
D672113931114975retainer crown - resin with predominantly base metal
D6722189015121323retainer crown - resin with noble metal
D6750189015121323retainer crown - porcelain fused to high noble metal
D675113971118978retainer crown - porcelain fused to predominantly base metal
D6780189015121323retainer crown - 3/4 cast high noble metal
D678113971118978retainer crown - 3/4 cast predominantly base metal
D6782189015121323retainer crown - 3/4 cast noble metal
D6783146811741028retainer crown - 3/4 porcelain/ceramic
D6784146811741028retainer crown ¾ - titanium and titanium alloys
D6790189015121323retainer crown - full cast high noble metal
D679114041123983retainer crown - full cast predominantly base metal
D6792189015121323retainer crown - full cast noble metal
D679414111129988retainer crown - titanium and titanium alloys
D7111336269235extraction, coronal remnants – primary tooth
D7140336269235extraction, erupted tooth or exposed root (elevation and/or forceps removal)
D7210441353309extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D7220504403353removal of impacted tooth - soft tissue
D7230630504441removal of impacted tooth - partially bony
D7240735588515removal of impacted tooth - completely bony
D7250408326286removal of residual tooth roots (cutting procedure)
D7310473378331alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant
D7311473378331alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant
D7510324259227incision and drainage of abscess - intraoral soft tissue
D7922231185162placement of intra-socket biological dressing to aid in hemostasis or clot stabilization, per site
D7953788630550bone replacement graft for ridge preservation - per site
D8090632550604427comprehensive orthodontic treatment of the adult dentition
M8680.3420336294Removable essix retainer (3 sets)
M8680.3315252221Removable essix retainer (1 set)
D8681260208182removable orthodontic retainer adjustment
D8695945756662removal of fixed orthodontic appliances for reasons other than completion of treatment
D8698420336294re-cement or re-bond fixed retainer – maxillary
D8699420336294re-cement or re-bond fixed retainer – mandibular
D8701420336294repair of fixed retainer, includes reattachment – maxillary
D8702420336294repair of fixed retainer, includes reattachment – mandibular
N8040520041603640Clear Aligners (Standard; includes retainer)
N8041680054404760Clear Aligners (Intermediate; includes retainer)
N8042840067205880Clear Aligners (Complex; includes retainer)
N8043415033202905Clear Aligners (Simple; includes retainer)
D9120305244214fixed partial denture sectioning
D92301058474inhalation of nitrous oxide/analgesia, anxiolysis
D99108300application of desensitizing medicament
D9944473378331occlusal guard – hard appliance, full arch
D9951255204179occlusal adjustment - limited
D9952883706618occlusal adjustment - complete
N9901.2024185185185Smile Corners Gold 2024
N9902.2024345345345Smile Corners Platinum 2024
N9903.2024245245245Smile Corners Platinum Jr 2024
N9904.2024645645645Smile Corners Platinum Perio 2024

ADA Code

D110

D120

D140

D150

D160

Procedure Description

Initial Oral

Oral Examination

Emergency Oral 

Comprehensive

intraoral

Office Fee

$40

$45

$41

$46

$55

Gold Member Fee

$35

$42

$40

$40

$50

Platinum Member Fee

$38

$44

$43

$41

$52

Request An Appointment

Choose a date and fill out the form below. We will contact you during our working hours. If you have a dental emergency, please call or text us at (970) 688-8838

Smile Corners services Peachtree Corners, Berkeley Lake, Norcross, Duluth, Pleasant Hill, Chamblee, Dunwoody, Sandy Springs, Johns Creek, Jimmy Carter Blvd, and the greater metropolitan Atlanta area. Thank you for visiting our website!

Menu

Opening Hours

Sun: 11:00 AM – 5:00 PM
Mon: CLOSED
Tue: 8:30 AM – 5:00 PM
Wed: CLOSED
Thurs: 8:30 AM – 5:00 PM
Fri: CLOSED
Sat: 8:30 AM – 5:00 PM

Contact Info

Copyright © 2024 Smile Corners Dental. All Rights Reserved.
Scroll to Top