Merrimack Valley Dentistry
144 Arlington Street Dracut, MA 01826
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $109 | 0% | $109 | Medium |
| Child Dental Cleaning | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $54 | 0% | $54 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $255 | 0% | $255 | Medium |
| Sealant placed on the tooth surface to prevent decay | $67 | 0% | $67 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $99 | 0% | $99 | Medium |
| Periodic dental exam - established patient | $56 | 0% | $56 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $87 | 0% | $87 | Medium |
| X-Ray Dental - Complete intraoral series | $197 | 0% | $197 | Medium |
| X-Ray Dental - Four images - bitewings | $84 | 0% | $84 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $28 | 0% | $28 | Medium |
| X-Ray Dental - Two images - bitewings | $56 | 0% | $56 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $22 | 0% | $22 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $127 | 0% | $127 | 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 | $185 | 0% | $185 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $227 | 0% | $227 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $290 | 0% | $290 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $166 | 0% | $166 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $240 | 0% | $240 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $154 | 0% | $154 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $297 | 0% | $297 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $248 | 0% | $248 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $160 | 0% | $160 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $204 | 0% | $204 | Medium |