Anne Barclay-Filler, DMD
31 Lowell Road Windham, NH 03087
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $128 | 0% | $128 | Medium |
| Child Dental Cleaning | $103 | 0% | $103 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $359 | 0% | $359 | Medium |
| Sealant placed on the tooth surface to prevent decay | $77 | 0% | $77 | 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 | $123 | 0% | $123 | Medium |
| Periodic dental exam - established patient | $77 | 0% | $77 | Medium |
| X-Ray Dental - Complete intraoral series | $180 | 0% | $180 | Medium |
| X-Ray Dental - Four images - bitewings | $89 | 0% | $89 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $46 | 0% | $46 | Medium |
| X-Ray Dental - Two images - bitewings | $62 | 0% | $62 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $36 | 0% | $36 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $154 | 0% | $154 | 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 | $271 | 0% | $271 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $323 | 0% | $323 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $396 | 0% | $396 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $271 | 0% | $271 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $323 | 0% | $323 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $298 | 0% | $298 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $396 | 0% | $396 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $288 | 0% | $288 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $192 | 0% | $192 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $277 | 0% | $277 | Medium |