Kindred Smiles Pediatric Dentistry
300 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 | $103 | 0% | $103 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Sealant placed on the tooth surface to prevent decay | $72 | 0% | $72 | Medium |
| Topical fluoride varnish application | $57 | 0% | $57 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $108 | 0% | $108 | Medium |
| Periodic dental exam - established patient | $70 | 0% | $70 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $100 | 0% | $100 | Medium |
| X-Ray Dental - Four images - bitewings | $88 | 0% | $88 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $46 | 0% | $46 | Medium |
| X-Ray Dental - Two images - bitewings | $67 | 0% | $67 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $34 | 0% | $34 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $142 | 0% | $142 | 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 | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $205 | 0% | $205 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $231 | 0% | $231 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Tooth Extraction (Elevation and/or forceps removal) | $206 | 0% | $206 | Medium |