Sai Dental
11 Main Street Pepperell, MA 01463
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $109 | 0% | $109 | Medium |
| Child Dental Cleaning | $113 | 0% | $113 | Medium |
| Sealant placed on the tooth surface to prevent decay | $85 | 0% | $85 | Medium |
| Topical fluoride varnish application | $53 | 0% | $53 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $99 | 0% | $99 | Medium |
| Periodic dental exam - established patient | $53 | 0% | $53 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $89 | 0% | $89 | Medium |
| X-Ray Dental - Complete intraoral series | $185 | 0% | $185 | Medium |
| X-Ray Dental - Four images - bitewings | $82 | 0% | $82 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $39 | 0% | $39 | Medium |
| X-Ray Dental - Two images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $35 | 0% | $35 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $170 | 0% | $170 | 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 | $218 | 0% | $218 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $163 | 0% | $163 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $247 | 0% | $247 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $326 | 0% | $326 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $415 | 0% | $415 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $326 | 0% | $326 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $468 | 0% | $468 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $189 | 0% | $189 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $294 | 0% | $294 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $191 | 0% | $191 | Medium |