Andover Family Dental
16 Haverhill Street Andover, MA 01810
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $121 | 0% | $121 | Medium |
| Child Dental Cleaning | $90 | 0% | $90 | Medium |
| Fluoride - Topical Application | $42 | 0% | $42 | Medium |
| Topical fluoride varnish application | $56 | 0% | $56 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $112 | 0% | $112 | Medium |
| Periodic dental exam - established patient | $70 | 0% | $70 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $97 | 0% | $97 | Medium |
| X-Ray Dental - Complete intraoral series | $166 | 0% | $166 | Medium |
| X-Ray Dental - Four images - bitewings | $81 | 0% | $81 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $32 | 0% | $32 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $284 | 0% | $284 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $223 | 0% | $223 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $284 | 0% | $284 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $229 | 0% | $229 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $358 | 0% | $358 | Medium |