Common Procedure Codes

The following chart displays our offices 15 most common procedure codes. We will update this monthly to ensure that patients can refer to this chart for any questions. Please feel free to call our office if you would like more information about our fees.

Updated: 11/02/22

Service Code
Description
Standard Fee
D1110
Adult Prophylaxis
$93
D0120
Recall Examination
$56
D0210
Full Mouth X-Rays
$138
D0220
Periapical X-Ray, First Film
$29
D0274
Bitewing X-Rays, 4 Films
$63
D1206
Fluoride Varnish
$44
D0150
Comprehensive Exam
$119
D5411
Denture Adjustment, Lower
$109
D5410
Denture Adjustment, Upper
$109
D4910
Periodontal Maintenance
$145
D4342
Scaling and Root Planning 1-3 Teeth
$196
D2391
Composite - 1 SUR, Posterior
$195
D0350
2D Oral/Facial Photography Image
$53
D2392
Composite - 2 SUR, Posterior
$263
D4341
Scaling and Root Planning 4+ Teeth
$298

Joseph A. Lucero DDS Inc.

2575 Park Lane, Suite 101

Lafayette, CO 80026