Aesthetic Dental Center
177 Pleasant Street Concord, NH 03301
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $107 | 0% | $107 | Medium |
| Child Dental Cleaning | $85 | 0% | $85 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $307 | 0% | $307 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
| Topical fluoride varnish application | $41 | 0% | $41 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $91 | 0% | $91 | Medium |
| Periodic dental exam - established patient | $50 | 0% | $50 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $97 | 0% | $97 | Medium |
| X-Ray Dental - Complete intraoral series | $149 | 0% | $149 | Medium |
| X-Ray Dental - Four images - bitewings | $72 | 0% | $72 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Two images - bitewings | $72 | 0% | $72 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $28 | 0% | $28 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $131 | 0% | $131 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $306 | 0% | $306 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $365 | 0% | $365 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $306 | 0% | $306 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $202 | 0% | $202 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $365 | 0% | $365 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $286 | 0% | $286 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $84 | 0% | $84 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $150 | 0% | $150 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $452 | 0% | $452 | Medium |