Lois Lombardo, DMD
68 Park Street Andover, MA 01810
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $132 | 0% | $132 | Medium |
| Child Dental Cleaning | $110 | 0% | $110 | Medium |
| Fluoride - Topical Application | $54 | 0% | $54 | Medium |
| Sealant placed on the tooth surface to prevent decay | $70 | 0% | $70 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $100 | 0% | $100 | Medium |
| Periodic dental exam - established patient | $68 | 0% | $68 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $84 | 0% | $84 | Medium |
| X-Ray Dental - Complete intraoral series | $158 | 0% | $158 | Medium |
| X-Ray Dental - Four images - bitewings | $74 | 0% | $74 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $32 | 0% | $32 | Medium |
| X-Ray Dental - Two images - bitewings | $53 | 0% | $53 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $53 | 0% | $53 | 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 | $226 | 0% | $226 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $298 | 0% | $298 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $508 | 0% | $508 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $624 | 0% | $624 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $163 | 0% | $163 | Medium |