Indiana University Northwest
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Preventive Dental Clinic

College of Health and Human Services

Preventive Dental Clinic

Services

  • Oral Examination
  • Prophylaxis (Cleaning)
  • Fluoride Treatment
  • Dental Radiographs (X-Rays)
  • Dental Sealants
  • Oral Hygiene Instruction
  • Referrral (Upon Request)
Preventive Fees  
D1110 Adult Prophylaxis (12 teeth or less, $10.00 discount) $ 30.00
D1120 Child Prophylaxis (up to 12 years) $ 20.00
D1208 Fluoride Treatment $ 6.00
D1206 Fluoride Varnish $ 6.00
D1351 Pit and Fissure Sealant (per tooth) $ 6.00
Diagnostic Fees  
D0150 Comprehensive Oral Exam $ 15.00
D0120 Periodic Oral Exam $ 10.00
D0210 Complete Radiograph Survey (Child or Adult) $ 30.00
D0330 Panoramic Radiograph (Child or Adult) $ 30.00
D0220 Periapical- Single, first film $ 6.00
D0230 Periapical- Each additional film $ 6.00
D0272 Bite-wings- 2 films $ 12.00
D0274 Bite-wings- 4 films $ 17.00
D0277 Vertical Bite-wing Survey (7 films) $ 20.00
Film Duplicating- Each survey $ 15.00