Westford Dentistry
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay |
|---|---|---|---|
| Dental Cleaning - Adult | $123 | 0% | $123 |
| Dental Cleaning - Child | $92 | 0% | $92 |
| Dental Exam - Comprehensive | $120 | 0% | $120 |
| Dental Exam - Periodic, Established Patient | $69 | 0% | $69 |
| Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $385 | 0% | $385 |
| Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $315 | 0% | $315 |
| Dental Filling - White (Resin): One Surface, Posterior | $249 | 0% | $249 |
| Dental Filling - White (Resin): Three Surfaces, Posterior | $385 | 0% | $385 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $315 | 0% | $315 |
| Flouride - Topical Varnish Application | $58 | 0% | $58 |
| Root Canal - Bicuspid Tooth | $2,510 | 0% | $2,510 |
| Sealant - Placed on Tooth Surface to Prevent Decay | $77 | 0% | $77 |
| X-Ray - Complete Intraoral Series | $177 | 0% | $177 |
| X-Ray - Four Images, Bitewings | $89 | 0% | $89 |
| X-Ray - Intraoral, Periapical Radiographic Image | $40 | 0% | $40 |
| X-Ray - Two Images, Bitewings | $62 | 0% | $62 |