Tewksbury Dental Associates
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Dental Cleaning - Adult | $113 | 0% | $113 | Medium |
| Dental Cleaning - Child | $176 | 0% | $176 | Medium |
| Dental Exam - Comprehensive | $120 | 0% | $120 | Medium |
| Dental Exam - Periodic, Established Patient | $57 | 0% | $57 | Medium |
| Dental Filling - White (Resin): Three Surfaces, Posterior | $355 | 0% | $355 | Medium |
| Flouride - Topical Varnish Application | $97 | 0% | $97 | Medium |
| Maintenance Therapy - Periodontal | $160 | 0% | $160 | Medium |
| Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $334 | 0% | $334 | Medium |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $30 | 0% | $30 | Medium |
| X-Ray - Complete Intraoral Series | $149 | 0% | $149 | Medium |
| X-Ray - Four Images, Bitewings | $82 | 0% | $82 | Medium |
| X-Ray - Intraoral, Periapical Radiographic Image | $34 | 0% | $34 | Medium |
| X-Ray - Two Images, Bitewings | $61 | 0% | $61 | Medium |
| X-Ray - Whole Mouth from Outside Mouth | $155 | 0% | $155 | Medium |
