Pleasant Valley Dental Health
380 Merrimack Street Methuen, MA 01844
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 | $118 | 0% | $118 | Medium |
| Fluoride - Topical Application | $63 | 0% | $63 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $395 | 0% | $395 | Medium |
| Sealant placed on the tooth surface to prevent decay | $72 | 0% | $72 | Medium |
| Topical fluoride varnish application | $63 | 0% | $63 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $108 | 0% | $108 | Medium |
| Periodic dental exam - established patient | $61 | 0% | $61 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $97 | 0% | $97 | Medium |
| X-Ray Dental - Complete intraoral series | $165 | 0% | $165 | Medium |
| X-Ray Dental - Four images - bitewings | $95 | 0% | $95 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $38 | 0% | $38 | Medium |
| X-Ray Dental - Two images - bitewings | $70 | 0% | $70 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $29 | 0% | $29 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $163 | 0% | $163 | 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 | $208 | 0% | $208 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $265 | 0% | $265 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $326 | 0% | $326 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $214 | 0% | $214 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $300 | 0% | $300 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $200 | 0% | $200 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $352 | 0% | $352 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $271 | 0% | $271 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $212 | 0% | $212 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $260 | 0% | $260 | Medium |