Groton Dental Wellness Center
493-495 Main Street Groton, MA 01450
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $154 | 0% | $154 | Medium |
| Child Dental Cleaning | $112 | 0% | $112 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $321 | 0% | $321 | Medium |
| Sealant placed on the tooth surface to prevent decay | $91 | 0% | $91 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $86 | 0% | $86 | Medium |
| Periodic dental exam - established patient | $64 | 0% | $64 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $114 | 0% | $114 | Medium |
| X-Ray Dental - Complete intraoral series | $306 | 0% | $306 | Medium |
| X-Ray Dental - Four images - bitewings | $99 | 0% | $99 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $49 | 0% | $49 | Medium |
| X-Ray Dental - Two images - bitewings | $81 | 0% | $81 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $39 | 0% | $39 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $207 | 0% | $207 | 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 | $282 | 0% | $282 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $355 | 0% | $355 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $415 | 0% | $415 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $282 | 0% | $282 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $355 | 0% | $355 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $243 | 0% | $243 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $408 | 0% | $408 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $277 | 0% | $277 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $173 | 0% | $173 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $367 | 0% | $367 | Medium |