| CODE |
PROCEDURE |
Los
Angeles
|
San
Diego
|
San
Jose
|
San
Francisco
|
Sacramento |
0120
|
Routine
6
Month
Check-Up
|
21 |
24 |
26 |
27 |
26 |
0150
|
In
Depth
Check-Up
|
32 |
36 |
39 |
41 |
39 |
0210
|
Full
Mouth
X-Rays
|
60 |
70 |
77 |
81 |
77 |
0330
|
Panoramic
Film
|
47 |
55 |
60 |
63 |
60 |
1110
|
Adult
Cleaning
|
46 |
54 |
59 |
62 |
59 |
1120
|
Child
Cleaning
|
32 |
38 |
42 |
44 |
42 |
2140
|
Silver
Filling
|
47 |
54 |
56 |
62 |
59 |
2330
|
White
Filling
|
62 |
71 |
74 |
82 |
78 |
2750
|
Crown
-
Porcelain
|
476 |
535 |
639 |
613 |
584 |
3330
|
Root
Canal
-
Molar
|
497 |
576 |
599 |
660 |
629 |
5110
|
Upper
Denture
(Complete)
|
623 |
701 |
729 |
803 |
765 |
7110 |
Single
Tooth
Extraction
|
56 |
65 |
68 |
75 |
71 |
Note:
Cigna
fees
will
vary
by
region
(and
zip
code)
and
are
subject
to
change
without
notice.
Los
Angeles
fees
based
on
910
zip
codes
San
Diego
fees
based
on
919
zip
codes
San
Jose
fees
based
on
951
zip
codes
San
Francisco
fees
based
on
943
zip
codes
Sacramento
fees
based
on
958
zip
codes
|
