Andover Family Dental
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Dental Cleaning - Adult | $133 | 0% | $133 | Medium |
| Dental Exam - Comprehensive | $146 | 0% | $146 | Medium |
| Dental Exam - Periodic, Established Patient | $76 | 0% | $76 | Medium |
| Dental Filling - White (Resin): One Surface, Anterior | $289 | 0% | $289 | Medium |
| Dental Filling - White (Resin): One Surface, Posterior | $236 | 0% | $236 | Medium |
| Dental Filling - White (Resin): Two Surfaces, Anterior | $289 | 0% | $289 | Medium |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $289 | 0% | $289 | Medium |
| Fluoride - Topical Application | $71 | 0% | $71 | Medium |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $126 | 0% | $126 | Medium |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $29 | 0% | $29 | Medium |
| X-Ray - Complete Intraoral Series | $184 | 0% | $184 | Medium |
| X-Ray - Four Images, Bitewings | $97 | 0% | $97 | Medium |
| X-Ray - Intraoral, Periapical Radiographic Image | $37 | 0% | $37 | Medium |
