E Charles Beliveau, DDS
987 Osgood Street North Andover, MA 01845
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $116 | 0% | $116 | Medium |
| Child Dental Cleaning | $87 | 0% | $87 | Medium |
| Fluoride - Topical Application | $47 | 0% | $47 | Medium |
| Topical fluoride varnish application | $58 | 0% | $58 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $202 | 0% | $202 | Medium |
| Periodic dental exam - established patient | $60 | 0% | $60 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $155 | 0% | $155 | Medium |
| X-Ray Dental - Complete intraoral series | $206 | 0% | $206 | Medium |
| X-Ray Dental - Four images - bitewings | $79 | 0% | $79 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $47 | 0% | $47 | Medium |
| X-Ray Dental - Two images - bitewings | $75 | 0% | $75 | 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 | $278 | 0% | $278 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $211 | 0% | $211 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $282 | 0% | $282 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $256 | 0% | $256 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $386 | 0% | $386 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $256 | 0% | $256 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $191 | 0% | $191 | Medium |