Pediatric Dentistry of the North Shore
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay |
|---|---|---|---|
| Dental Cleaning - Adult | $127 | 0% | $127 |
| Dental Cleaning - Child | $116 | 0% | $116 |
| Dental Exam - Periodic, Established Patient | $56 | 0% | $56 |
| Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent | $217 | 0% | $217 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $269 | 0% | $269 |
| Flouride - Topical Varnish Application | $49 | 0% | $49 |
| Sealant - Placed on Tooth Surface to Prevent Decay | $84 | 0% | $84 |
| Tooth Extraction - Elevation and/or Forceps Removal | $315 | 0% | $315 |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $37 | 0% | $37 |
| X-Ray - Four Images, Bitewings | $98 | 0% | $98 |
| X-Ray - Intraoral, Periapical Radiographic Image | $37 | 0% | $37 |
| X-Ray - Two Images, Bitewings | $64 | 0% | $64 |
| X-Ray - Whole Mouth from Outside Mouth | $167 | 0% | $167 |