Dental Associates of Gloucester
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Dental Cleaning - Adult | $110 | 0% | $110 | Medium |
| Dental Cleaning - Child | $89 | 0% | $89 | Medium |
| Dental Exam - Comprehensive | $89 | 0% | $89 | Medium |
| Dental Exam - Periodic, Established Patient | $53 | 0% | $53 | Medium |
| Dental Filling - White (Resin): One Surface, Anterior | $208 | 0% | $208 | Medium |
| Dental Filling - White (Resin): One Surface, Posterior | $209 | 0% | $209 | Medium |
| Dental Filling - White (Resin): Three Surfaces, Posterior | $324 | 0% | $324 | Medium |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $269 | 0% | $269 | Medium |
| Flouride - Topical Varnish Application | $58 | 0% | $58 | Medium |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $100 | 0% | $100 | Medium |
| Sealant - Placed on Tooth Surface to Prevent Decay | $63 | 0% | $63 | Medium |
| X-Ray - Complete Intraoral Series | $163 | 0% | $163 | Medium |
| X-Ray - Four Images, Bitewings | $104 | 0% | $104 | Medium |
| X-Ray - Intraoral, Periapical Radiographic Image | $65 | 0% | $65 | Medium |
| X-Ray - Two Images, Bitewings | $93 | 0% | $93 | Medium |
