Wow, I have never given the lyme vaccine... you live in a different state though :/
Lets see DA2PP-Booster =Distemper/Parvo/Adenovirus-2/Parainfluenza
Taken from a website:
Heartworm/Lyme/Ehrlichia/Anaplasmosis "4Dx" Testing: We recommend performing this simple blood test on dogs once per year to screen for potentially fatal heartworm disease and for three tick-borne diseases. Thus, not only can we now identify heartworms before they have a chance to clog heart chambers and vessels, we can now routinely test for all three diseases that ticks transfer to dogs here in the Northeastern United States. No medication or vaccine is 100% protective, so if a pathogen should "slip through" it's early identification will maximize the likelihood of a safe treatment.
IMO your vet sounds pushy and hoping you will just believe whatever he says. You can certainly buy the heartworm and flea meds from Drs. Foster and Smith and get the correct item! If nothing else most vets will price match to keep a sale.
So... you may want to go back and ask for a price match- it couldn't hurt. and I personally wouldn't get any more vaccines except for rabies as required by law.
Your vet will really push you to get them because if you look at the difference in the bill- they only make $60 for the exam
At least you know now what to look for next year