Leslie Ann Elston
Dental Procedures
| Procedure | Estimate of Total Cost | Number of Visits | What You Will Pay Uninsured Discount: 0% |
|---|---|---|---|
| Dental Cleaning - Adult | $95 | N/A | $95 |
| Dental Exam - Periodic, Established Patient | $43 | N/A | $43 |
| Dental Filling - White (Resin): One Surface, Posterior | $181 | N/A | $181 |
| Dental Filling - White (Resin): Three Surfaces, Posterior | $273 | N/A | $273 |
| Dental Filling - White (Resin): Two Surfaces, Anterior | $170 | N/A | $170 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $217 | N/A | $217 |
| Flouride - Topical Varnish Application | $34 | N/A | $34 |
| Oral Hygiene Instructions | $38 | N/A | $38 |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $81 | N/A | $81 |
| X-Ray - Complete Intraoral Series | $197 | N/A | $197 |
| X-Ray - Intraoral, Periapical Radiographic Image | $34 | N/A | $34 |