Wayne Lariviere, DMD
813b Main Street Waterboro, ME 04087
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $98 | 0% | $98 | Medium |
| Child Dental Cleaning | $71 | 0% | $71 | Medium |
| Sealant placed on the tooth surface to prevent decay | $50 | 0% | $50 | Medium |
| Topical fluoride varnish application | $32 | 0% | $32 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $84 | 0% | $84 | Medium |
| Periodic dental exam - established patient | $46 | 0% | $46 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $81 | 0% | $81 | Medium |
| X-Ray Dental - Complete intraoral series | $137 | 0% | $137 | Medium |
| X-Ray Dental - Four images - bitewings | $59 | 0% | $59 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $27 | 0% | $27 | Medium |
| X-Ray Dental - Two images - bitewings | $46 | 0% | $46 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $22 | 0% | $22 | 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 | $191 | 0% | $191 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $252 | 0% | $252 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $347 | 0% | $347 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $184 | 0% | $184 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $250 | 0% | $250 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $347 | 0% | $347 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $158 | 0% | $158 | Medium |