Beacon Family Medicine
130 Country Road, Suite G Ipswich, MA 01938
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $126 | 0% | $126 | Medium |
| Child Dental Cleaning | $92 | 0% | $92 | Medium |
| Fluoride - Topical Application | $44 | 0% | $44 | Medium |
| Sealant placed on the tooth surface to prevent decay | $75 | 0% | $75 | Medium |
| Topical fluoride varnish application | $28 | 0% | $28 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $126 | 0% | $126 | Medium |
| Periodic dental exam - established patient | $70 | 0% | $70 | Medium |
| X-Ray Dental - Complete intraoral series | $175 | 0% | $175 | Medium |
| X-Ray Dental - Four images - bitewings | $90 | 0% | $90 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $39 | 0% | $39 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $34 | 0% | $34 | 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 | $330 | 0% | $330 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $256 | 0% | $256 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $330 | 0% | $330 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $410 | 0% | $410 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $182 | 0% | $182 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $266 | 0% | $266 | Medium |