Springfield Medical Care System

25 Ridgewood Road Springfield, VT 05156
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$930%$93 Medium
Dental Cleaning - Child$740%$74 Medium
Dental Exam - Comprehensive$790%$79 Medium
Dental Exam - Periodic, Established Patient$420%$42 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1790%$179 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$2680%$268 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2150%$215 Medium
Dental Filling - White (Resin): One Surface, Posterior$1790%$179 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$2680%$268 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$1890%$189 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2150%$215 Medium
Fluoride - Topical Application$370%$37 Medium
Orthodontic Treatment - Periodic Visit, Part of a Contract$1150%$115 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$740%$74 Medium
Root Canal - Anterior Tooth$6830%$683 Medium
Root Canal - Bicuspid Tooth$8400%$840 Medium
Root Canal - Molar$1,0500%$1,050 Medium
Tooth Extraction - Elevation and/or Forceps Removal$1890%$189 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$210%$21 Medium
X-Ray - Four Images, Bitewings$630%$63 Medium
X-Ray - Intraoral, Periapical Radiographic Image$260%$26 Medium
X-Ray - Two Images, Bitewings$420%$42 Medium
X-Ray - Whole Mouth from Outside Mouth$1100%$110 Medium