St. Johnsbury Dental Associates
1 Place Notre Dame, #1 St. Johnsbury, VT 05819
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $91 | 0% | $91 | Medium |
| Child Dental Cleaning | $67 | 0% | $67 | Medium |
| Sealant placed on the tooth surface to prevent decay | $48 | 0% | $48 | Medium |
| Topical fluoride varnish application | $45 | 0% | $45 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $78 | 0% | $78 | Medium |
| Periodic dental exam - established patient | $40 | 0% | $40 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $80 | 0% | $80 | Medium |
| X-Ray Dental - Complete intraoral series | $159 | 0% | $159 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $30 | 0% | $30 | Medium |
| X-Ray Dental - Two images - bitewings | $43 | 0% | $43 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $21 | 0% | $21 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $126 | 0% | $126 | 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 | $142 | 0% | $142 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $175 | 0% | $175 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $229 | 0% | $229 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $142 | 0% | $142 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $221 | 0% | $221 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $145 | 0% | $145 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $230 | 0% | $230 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $181 | 0% | $181 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $132 | 0% | $132 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $172 | 0% | $172 | Medium |