Atrius Health
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay |
|---|---|---|---|
| Dental Cleaning - Adult | $151 | 0% | $151 |
| Dental Exam - Comprehensive | $144 | 0% | $144 |
| Dental Exam - Periodic, Established Patient | $89 | 0% | $89 |
| Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $414 | 0% | $414 |
| Dental Filling - White (Resin): One Surface, Anterior | $265 | 0% | $265 |
| Dental Filling - White (Resin): One Surface, Posterior | $276 | 0% | $276 |
| Dental Filling - White (Resin): Three Surfaces, Posterior | $418 | 0% | $418 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $355 | 0% | $355 |
| Maintenance Therapy - Periodontal | $224 | 0% | $224 |
| Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $398 | 0% | $398 |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $132 | 0% | $132 |
| X-Ray - Complete Intraoral Series | $205 | 0% | $205 |
| X-Ray - Four Images, Bitewings | $104 | 0% | $104 |
| X-Ray - Intraoral, Periapical Radiographic Image | $49 | 0% | $49 |
| X-Ray - Whole Mouth from Outside Mouth | $193 | 0% | $193 |