Gentle Dental
22 Alpine Lane Chelmsford, MA 01824
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 | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $49 | 0% | $49 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $506 | 0% | $506 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
| Topical fluoride varnish application | $41 | 0% | $41 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $90 | 0% | $90 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $237 | 0% | $237 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $34 | 0% | $34 | Medium |
| X-Ray Dental - Two images - bitewings | $50 | 0% | $50 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $27 | 0% | $27 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $128 | 0% | $128 | 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 | $145 | 0% | $145 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $182 | 0% | $182 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $221 | 0% | $221 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $321 | 0% | $321 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $439 | 0% | $439 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $165 | 0% | $165 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $563 | 0% | $563 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $202 | 0% | $202 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $216 | 0% | $216 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $183 | 0% | $183 | Medium |