Richard Kozlowski, DDS
1229 Main Street St. Johnsbury, VT 05819
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $95 | 0% | $95 | Medium |
| Child Dental Cleaning | $76 | 0% | $76 | Medium |
| Fluoride - Topical Application | $34 | 0% | $34 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $82 | 0% | $82 | Medium |
| Periodic dental exam - established patient | $39 | 0% | $39 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $71 | 0% | $71 | Medium |
| X-Ray Dental - Complete intraoral series | $126 | 0% | $126 | Medium |
| X-Ray Dental - Four images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $30 | 0% | $30 | Medium |
| X-Ray Dental - Two images - bitewings | $47 | 0% | $47 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $111 | 0% | $111 | 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 | $116 | 0% | $116 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $161 | 0% | $161 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $234 | 0% | $234 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $161 | 0% | $161 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $263 | 0% | $263 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $163 | 0% | $163 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $142 | 0% | $142 | Medium |