Your Personalized Treatment Plan

Dear Jordan,

Thank you for visiting Bright Smile Dental. Following your recent examination, Dr. Patel has prepared a personalized treatment plan to address the findings from your visit. Please review the recommended treatments below, along with your estimated out-of-pocket costs after insurance.

We recommend completing all treatments within the next 90 days to prevent further progression and ensure the best possible outcome.

Recommended Treatments

All costs shown are estimated patient responsibility after insurance.

Composite Fillings

Upper right molars — 2 teeth requiring restoration

Small to moderate cavities detected in your upper right molars. Early treatment prevents further decay and avoids more complex restorations.

Estimated Cost

$280 after insurance

Schedule Fillings

Periodontal Deep Cleaning (SRP)

Scaling and root planing — 2 quadrants

Moderate buildup of calculus detected below the gumline. A deep cleaning will remove deposits and help restore gum health to prevent periodontal disease.

Estimated Cost

$190 after insurance

Schedule Cleaning

Porcelain Crown

Tooth #19 — lower left first molar

Tooth #19 has significant structural compromise due to an existing large filling and minor fracture. A full porcelain crown will restore function, protect the tooth, and prevent potential fracture or loss.

Estimated Cost

$850 after insurance

Schedule Crown

Total Estimated Out-of-Pocket

$1,320.00

After insurance — subject to final verification

Fillings: $280

Deep Cleaning: $190

Crown: $850

CareCredit Financing Available

We accept CareCredit, allowing you to spread your treatment costs over 12 months with no interest with approved credit. Apply in minutes before your appointment.

Apply for CareCredit

Dr. Anita Patel, DDS

Lead Dentist, Bright Smile Dental

Have questions about your treatment plan or cost estimates? Dr. Patel is happy to speak with you directly.

(415) 555-0192

Mon – Fri, 8:00 AM – 5:00 PM

dr.patel@brightsmilental.com

Response within 1 business day

Treatment Window Reminder

Dr. Patel recommends completing all recommended treatments within 90 days of this notice to avoid further dental complications and potential increases in treatment complexity.

Schedule All Appointments

Or call us at (415) 555-0192 to book over the phone.

Bright Smile Dental

480 Market Street, Suite 200, San Francisco, CA 94105

(415) 555-0192 | brightsmilental.com

This email was sent to Jordan Lee regarding your dental treatment plan on file at Bright Smile Dental. Cost estimates are based on your current insurance benefits and are subject to change upon final claim processing. This communication is intended solely for the named patient and may contain protected health information.

Dental Treatment Plan Follow-Up