Brentwood Village Dental Clinic

Insurance Coverage?

There are several components involved in a regular check-up and cleaning.  We strongly suggest that you contact your insurance company prior to your appointment, to verify if the services you choose will be covered.   

How Much Is A Cleaning?

Are you wondering how much a cleaning is? Are you concerned about whether or not your insurance will cover the costs of your cleaning?

There are several components involved in a regular check-up and cleaning.  We strongly suggest that you contact your insurance company prior to your appointment, to verify if the services you choose will be covered.  For your convenience this form provides you with a brief explanation of the different services available as well as the procedure codes for each of the listed services.  When you contact your dental insurance provider to verify coverage you will have to provide them with these procedure codes. 

Cleaning Services
  • Scaling
Scaling (which is the most essential component of cleaning) is when the Dentist or Hygienist removes calculus (tarter) build-up from around your teeth and gums.  Scaling is billed according to the time it requires, 15 minutes equals one unit of time and each unit of time is approximately $72.22.  Most people, on average, require 2-4 units of scaling, some people require considerably more.  If you request, the Hygienist will inform you of your specific scaling needs and the cost associated before they get started. When calling your insurance company you may not have to provide an exact procedure code for scaling.  Instead we suggest that you ask them the total number of scaling units you are allowed per year.  If they require a specific procedure code the codes up to four units are listed here; one unit (11111), two units (11112), three units (11113), four units (11114).  (11117 is the code for half a unit.)

  • Polishing (11101)
Polishing is when the Registered Dental Assistant or Registered Dental Hygienist uses the rubber tipped hand piece and a polishing paste to remove surface stains from your teeth.  As with scaling, polishing is billed according to time units, and one unit of polish is approximately $68.36.  For most people, one unit of polishing is sufficient.

  • Fluoride (12101)
Another optional component in dental cleaning is fluoride.  Fluoride treatment once a year is an excellent way to help prevent tooth decay and maintain your oral health.  The fluoride is delivered to your teeth through topical treatments; either a mouth rinse or a foam or gel in dental trays.  It takes about 5 minutes, after which you cannot eat or drink for 30 minutes.  The cost is $30.00.

  • Oral Hygiene Instruction (13211)
Good oral hygiene at home is essential to prevent dental decay and gum disease. The primary purpose of Oral Hygiene Instruction (OHI) is to educate and train the patient with a hands-on approach, in order to develop excellent oral hygiene skills, resulting in better control of bacterial plaque (the primary cause of periodontal disease). A regular dental cleaning is done simultaneously to remove deposits of plaque, calculus, and stain from the surfaces of the teeth to facilitate the development of better home care techniques. During OHI your Registered Dental Hygienist will instruct you on the proper methods of brushing and flossing, as well as other relevant healthy lifestyle tips related to your individual oral hygiene. The result of better oral hygiene will be fewer dental caries (cavities), healthier gums, and a reduction in halitosis (bad breath).  Brentwood Village Dental Clinic charges $61.43 for this service.

Exams and X-rays
  • Dental Examinations
We strongly advise everyone to have a complete oral exam at least once a year.  Exams are essential to detect cavities and conditions that may require treatment.  Waiting until something hurts is not the best way to manage your oral health.  Being pro-active with regular exams to detect minor problems before they become major problems can save you a lot of pain and money in the future.  On your first visit to our office for a complete exam, the procedure code used is (01103) and the cost is $99.00.  IT IS VERY IMPORTANT that you verify with your insurance that this particular exam will be covered, as most insurance companies limit this exam to once per 2 – 5 years.  On subsequent appointments for check ups the exam code used is (01202) and the cost is approximately $78.75.

  • X-rays
X-rays enable the Dentist to see between your teeth, and other areas not visible to the naked eye.  The two types of x-rays we regularly use are bitewings and panoramic.

    > Four bitewing x-rays (02144), usually taken once per year, show the way the molar teeth fit together, and whether or not there are any cavities between the teeth.  The cost for four bitewing x-rays is $84.67.

    > The panoramic x-ray (02601) is a large film of your entire mouth and is very important, especially if the patient has wisdom teeth.  Once taken, a panoramic x-ray is good for up to 5 years.  The cost is $93.71. THIS X-RAY IS ALSO OFTEN LIMITED TO ONCE PER 2 – 5 YEARS.  Therefore, we strongly suggest that you verify coverage with your insurance company before having this x-ray taken.


Having dental work done and then trying to coordinate coverage with your insurance company can often be a confusing and frustrating experience.  That is why we strive to educate and inform our patients of the treatment options available so they are able to make informed decisions regarding their dental care.  If you require any additional information about the above topics, or any other dental treatment, one of our representatives will be more than happy to assist you.