Shaun Janvier, DMD
3571 856 Main Street Sanford, ME 04073
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $126 | 0% | $126 | Medium |
| Child Dental Cleaning | $116 | 0% | $116 | Medium |
| Sealant placed on the tooth surface to prevent decay | $61 | 0% | $61 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $126 | 0% | $126 | Medium |
| Periodic dental exam - established patient | $53 | 0% | $53 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $102 | 0% | $102 | Medium |
| X-Ray Dental - Complete intraoral series | $173 | 0% | $173 | Medium |
| X-Ray Dental - Four images - bitewings | $87 | 0% | $87 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Two images - bitewings | $68 | 0% | $68 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $37 | 0% | $37 | 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 | $247 | 0% | $247 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $315 | 0% | $315 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $383 | 0% | $383 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $247 | 0% | $247 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $331 | 0% | $331 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $278 | 0% | $278 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $368 | 0% | $368 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $331 | 0% | $331 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $173 | 0% | $173 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $263 | 0% | $263 | Medium |