Alan M. Gonick, DDS
122 Kenoza Avenue Haverhill, MA 01830
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $107 | 0% | $107 | Medium |
| Child Dental Cleaning | $86 | 0% | $86 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $315 | 0% | $315 | Medium |
| Sealant placed on the tooth surface to prevent decay | $68 | 0% | $68 | Medium |
| Topical fluoride varnish application | $58 | 0% | $58 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Periodic dental exam - established patient | $58 | 0% | $58 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $113 | 0% | $113 | Medium |
| X-Ray Dental - Complete intraoral series | $200 | 0% | $200 | Medium |
| X-Ray Dental - Four images - bitewings | $107 | 0% | $107 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $38 | 0% | $38 | Medium |
| X-Ray Dental - Two images - bitewings | $68 | 0% | $68 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $32 | 0% | $32 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $185 | 0% | $185 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - One surface, primary or permanent | $185 | 0% | $185 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $235 | 0% | $235 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $318 | 0% | $318 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $191 | 0% | $191 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $300 | 0% | $300 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $208 | 0% | $208 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $370 | 0% | $370 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $215 | 0% | $215 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $193 | 0% | $193 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $191 | 0% | $191 | Medium |