General Dentistry
Dr Britt Ruby, D.D.S, F.A.G.D
Honors Rate ScheduleAddress:
719 Turtle Creek Dr. Tyler, Tx
Phone: 903-595-3662
Rate Schedule For Dental Services
Rate Schedule For Dental Services
Rates subject to change
* UCR = Usual and customary rates for geographical area.
** Routine only if patient has had regular cleaning. Normal fee charge for first time on plan. Does NOT coincide with ordinary insurance.
Class I Preventative Services | *UCR | MBS |
Exam & Consultation | $56 | $25 |
Palliative Emergency Treatment | 60 | 25 |
Panoramic X-Ray or Full Mouth | 82 | 35 |
Single X-Rays | 23 | 10 |
Bitewing X-Rays | 46 | 20 |
Additional X-Ray | 16 | 5 |
Sealant | 40 | 15 |
Routine Cleaning – Child | 66 | 36 |
Routine Cleaning – Adult ** | 98 | 42 |
Scaling in the Presence of (Inflamation) | 107 | 60 |
Scaling & Root Planning (Per Quad) | 167 | 80 |
Sterilization Charge | 10 | 6 |
Class II Restoration Services | ||
1 Surface (Amalgam) | 91 | 29 |
2 Surface | 118 | 39 |
3 Surface | 134 | 59 |
4 Surface | 150 | 65 |
Add $40 for Composites | ||
Build Ups | 199 | 70 |
Sedative Filling | 78 | 25 |
Class III Surgical Services | ||
Simple Extraction | 100 | 58 |
Each Additional Tooth | 100 | 55 |
Root Removal | 165 | 65 |
Surgical Extraction | 200 | 80 |
Wisdom Extractions | 250 | 100-200 |
Removal of Impacted Tooth – partially boney | 393 | 175 |
Alveoloplasty in Conjunction | 125 | 75 |
Alveoloplasty without Conjuction | 245 | 85 |
Class IV Services – Root Canal Treatment | ||
One Canal | 510 | 275 |
Two Canal | 627 | 350 |
Three Canal | 715 | 455 |
Four Canal | 715 | 455 |
Pulpotomy | 135 | 75 |
Class V Major Services | ||
Stainless Steel Crown | 125 | 80 |
Porcelain Veneers | 950 | 650 |
Porcelain to Metal | 845 | 450 |
Nonprecious Metals (Silver) | 550 | 350 |
Gold Crowns | 875 | 450 |
Gold-Plated Designs | 500 | 310 |
Denture Gold Designs (+ Lab Fee) | 200 | 125 |
Class VI Dentures | ||
Full Upper or Lower Dentures | 1050 | 600 |
Upper or Lower Metal Partials | 1390 | 700 |
Acrylic Partials or Temporary | 895 | 299 |
Relines Permanent | 360 | 125 |
Repairs – Partial or Denture (+ Lab Fee) | 360 | 65 |
Local Anesthesia | 15 | 7 |
Nitrous Oxide Gas (+ Lab Fee) | 25 | 15 |
Any services not listed will have a 25% off discount. |