3 Stone Dental
1525 South Willow Street Manchester, NH 03103
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $89 | 0% | $89 | Medium |
| Child Dental Cleaning | $68 | 0% | $68 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $230 | 0% | $230 | Medium |
| Sealant placed on the tooth surface to prevent decay | $53 | 0% | $53 | Medium |
| Topical fluoride varnish application | $38 | 0% | $38 | 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 | $48 | 0% | $48 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $74 | 0% | $74 | Medium |
| X-Ray Dental - Complete intraoral series | $125 | 0% | $125 | Medium |
| X-Ray Dental - Four images - bitewings | $63 | 0% | $63 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $28 | 0% | $28 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $26 | 0% | $26 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $110 | 0% | $110 | 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 | $336 | 0% | $336 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $347 | 0% | $347 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $218 | 0% | $218 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $336 | 0% | $336 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $445 | 0% | $445 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $167 | 0% | $167 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $289 | 0% | $289 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $216 | 0% | $216 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $212 | 0% | $212 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $160 | 0% | $160 | Medium |