David M. Heydenreich, DMD
192 Rockingham Street Bellows Falls, VT 05101
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $98 | 0% | $98 | Medium |
| Child Dental Cleaning | $80 | 0% | $80 | Medium |
| Fluoride - Topical Application | $39 | 0% | $39 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $263 | 0% | $263 | Medium |
| Sealant placed on the tooth surface to prevent decay | $57 | 0% | $57 | Medium |
| Topical fluoride varnish application | $46 | 0% | $46 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $84 | 0% | $84 | Medium |
| Periodic dental exam - established patient | $47 | 0% | $47 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $80 | 0% | $80 | Medium |
| X-Ray Dental - Complete intraoral series | $140 | 0% | $140 | Medium |
| X-Ray Dental - Four images - bitewings | $69 | 0% | $69 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $30 | 0% | $30 | Medium |
| X-Ray Dental - Two images - bitewings | $48 | 0% | $48 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $25 | 0% | $25 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $116 | 0% | $116 | 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 | $176 | 0% | $176 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $231 | 0% | $231 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $291 | 0% | $291 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $184 | 0% | $184 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $236 | 0% | $236 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $173 | 0% | $173 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $299 | 0% | $299 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $198 | 0% | $198 | Medium |