Richard Kozlowski, DDS
1229 Main Street St. Johnsbury, VT 05819
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay |
|---|---|---|---|
| Dental Cleaning - Adult | $98 | 0% | $98 |
| Dental Cleaning - Child | $78 | 0% | $78 |
| Dental Exam - Periodic, Established Patient | $43 | 0% | $43 |
| Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $179 | 0% | $179 |
| Fluoride - Topical Application | $39 | 0% | $39 |
| Maintenance Therapy - Periodontal | $144 | 0% | $144 |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $76 | 0% | $76 |
| Sealant - Placed on Tooth Surface to Prevent Decay | $47 | 0% | $47 |
| X-Ray - Complete Intraoral Series | $126 | 0% | $126 |
| X-Ray - Four Images, Bitewings | $65 | 0% | $65 |
| X-Ray - Intraoral, Periapical Radiographic Image | $34 | 0% | $34 |
| X-Ray - Two Images, Bitewings | $47 | 0% | $47 |
| X-Ray - Whole Mouth from Outside Mouth | $126 | 0% | $126 |