Osofsky DDS & Sabatelle DMD
1 Court Street, Suite 270 Lebanon, NH 03766
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $128 | 0% | $128 | Medium |
| Child Dental Cleaning | $99 | 0% | $99 | Medium |
| Fluoride - Topical Application | $49 | 0% | $49 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $336 | 0% | $336 | Medium |
| Sealant placed on the tooth surface to prevent decay | $71 | 0% | $71 | Medium |
| Topical fluoride varnish application | $49 | 0% | $49 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $114 | 0% | $114 | Medium |
| Periodic dental exam - established patient | $66 | 0% | $66 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $107 | 0% | $107 | Medium |
| X-Ray Dental - Complete intraoral series | $176 | 0% | $176 | Medium |
| X-Ray Dental - Four images - bitewings | $93 | 0% | $93 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $39 | 0% | $39 | Medium |
| X-Ray Dental - Two images - bitewings | $63 | 0% | $63 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $39 | 0% | $39 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $155 | 0% | $155 | 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 | $223 | 0% | $223 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $279 | 0% | $279 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $378 | 0% | $378 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $223 | 0% | $223 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $279 | 0% | $279 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $223 | 0% | $223 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $382 | 0% | $382 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $280 | 0% | $280 | 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) | $143 | 0% | $143 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $189 | 0% | $189 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $236 | 0% | $236 | Medium |