Brand & Sawicki, DDS
13 Town West Road Plymouth, NH 03264
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $105 | 0% | $105 | Medium |
| Child Dental Cleaning | $74 | 0% | $74 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $200 | 0% | $200 | Medium |
| Sealant placed on the tooth surface to prevent decay | $47 | 0% | $47 | Medium |
| Topical fluoride varnish application | $38 | 0% | $38 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $168 | 0% | $168 | Medium |
| Periodic dental exam - established patient | $44 | 0% | $44 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $89 | 0% | $89 | Medium |
| X-Ray Dental - Complete intraoral series | $175 | 0% | $175 | Medium |
| X-Ray Dental - Four images - bitewings | $109 | 0% | $109 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $26 | 0% | $26 | Medium |
| X-Ray Dental - Two images - bitewings | $40 | 0% | $40 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $22 | 0% | $22 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $121 | 0% | $121 | 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 | $197 | 0% | $197 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $284 | 0% | $284 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $415 | 0% | $415 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $197 | 0% | $197 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $284 | 0% | $284 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $197 | 0% | $197 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $415 | 0% | $415 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $252 | 0% | $252 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $143 | 0% | $143 | Medium |