Tewksbury Dental Associates
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay |
|---|---|---|---|
| Dental Cleaning - Adult | $116 | 0% | $116 |
| Dental Cleaning - Child | $181 | 0% | $181 |
| Dental Exam - Comprehensive | $158 | 0% | $158 |
| Dental Exam - Periodic, Established Patient | $59 | 0% | $59 |
| Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $313 | 0% | $313 |
| Dental Filling - White (Resin): One Surface, Posterior | $249 | 0% | $249 |
| Dental Filling - White (Resin): Three Surfaces, Posterior | $365 | 0% | $365 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $313 | 0% | $313 |
| Flouride - Topical Varnish Application | $76 | 0% | $76 |
| Maintenance Therapy - Periodontal | $166 | 0% | $166 |
| Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $355 | 0% | $355 |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $65 | 0% | $65 |
| X-Ray - Four Images, Bitewings | $85 | 0% | $85 |
| X-Ray - Intraoral, Periapical Radiographic Image | $35 | 0% | $35 |
| X-Ray - Two Images, Bitewings | $64 | 0% | $64 |
| X-Ray - Whole Mouth from Outside Mouth | $230 | 0% | $230 |