Linda M Blaschke, DMD
75 Main Street Pepperell, MA 01463
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $126 | 0% | $126 | Medium |
| Child Dental Cleaning | $95 | 0% | $95 | Medium |
| Sealant placed on the tooth surface to prevent decay | $79 | 0% | $79 | 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 | $105 | 0% | $105 | Medium |
| Periodic dental exam - established patient | $63 | 0% | $63 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $158 | 0% | $158 | Medium |
| X-Ray Dental - Complete intraoral series | $191 | 0% | $191 | Medium |
| X-Ray Dental - Four images - bitewings | $95 | 0% | $95 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $42 | 0% | $42 | Medium |
| X-Ray Dental - Two images - bitewings | $68 | 0% | $68 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $37 | 0% | $37 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $210 | 0% | $210 | 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 | $210 | 0% | $210 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $273 | 0% | $273 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $216 | 0% | $216 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $273 | 0% | $273 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $357 | 0% | $357 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $51 | 0% | $51 | 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) | $210 | 0% | $210 | Medium |