Sai Dental

11 Main Street Pepperell, MA 01463
(978) 433-6344

All cost information is based on claims data collected in the New Hampshire Comprehensive Healthcare Information System which is updated quarterly. All quality information is based on claims and administrative data collected by the Centers for Medicare and Medicaid Services which is updated annually. For more information click the links above and review our methodology section.

Procedure Estimate of Procedure Cost Estimate of Procedure Cost
This is an estimate of the total charge for the health care service before any discounts provided to the uninsured.
Number of Visits Number of Visits
When the number of visits varies, it is difficult to estimate the total cost of care. This indicates the number of visits you can expect, calculated using the median. To determine the total you might pay, multiply the Estimate of Procedure Cost and the Statewide Average for Number of Visits.
- Above Average: Expect to visit the provider more than the average number of visits.
- Near Average: Expect the visit the provider close to the average number of visits.
- Below Average: Expect to visit the provider less than the average number of visits.
What You Will Pay What You Will Pay
The estimated charge amount minus the uninsured discount (when available).
Additional X-Ray Image of Tooth from Crown to Root from Inside Mouth $35 N/A $35
Adult Dental Cleaning $119 N/A $119
Child Dental Cleaning $118 N/A $118
Complete Intraoral X-Ray Series $157 N/A $157
Comprehensive Dental Exam $117 N/A $117
Dental Crown, Porcelain/Ceramic $1,466 N/A $1,466
Four Bitewing X-Ray Images $84 N/A $84
Intraoral X-Ray, Periapical Radiographic Image $39 N/A $39
Maintenance Therapy $187 N/A $187
Periodic Dental Exam for an Established Patient $61 N/A $61
Placing Sealant on Tooth Surface to Prevent Decay $74 N/A $74
Plaque and Tartar Removal Around Teeth and Gums, Per Quadrant $319 N/A $319
Problem Focused Evaluation, Limited to a Specific Oral Health Problem or Complaint $99 N/A $99
Silver (Amalgam) Dental Filling: One Surface, Primary or Permanent $306 N/A $306
Silver (Amalgam) Dental Filling: Two Surfaces, Primary or Permanent $552 N/A $552
Tooth Extraction, Elevation and/or Forceps Removal $195 N/A $195
Topical Fluoride Application $71 N/A $71
Topical Varnish Fluoride Application $53 N/A $53
Two Bitewing X-Ray Images $63 N/A $63
White (Resin) Dental Filling: One Surface, Posterior $211 N/A $211
White (Resin) Dental Filling: Three Surfaces, Posterior $343 N/A $343
White (Resin) Dental Filling: Two Surfaces, Anterior $237 N/A $237
White (Resin) Dental Filling: Two Surfaces, Posterior $276 N/A $276
Whole Mouth X-Ray from Outside Mouth $148 N/A $148