Arthur O Lyford, DMD
9 Ash Street Hollis, NH 03049
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $131 | 0% | $131 | Medium |
| Child Dental Cleaning | $172 | 0% | $172 | Medium |
| Fluoride - Topical Application | $51 | 0% | $51 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $320 | 0% | $320 | Medium |
| Sealant placed on the tooth surface to prevent decay | $69 | 0% | $69 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $158 | 0% | $158 | Medium |
| Periodic dental exam - established patient | $63 | 0% | $63 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $103 | 0% | $103 | Medium |
| X-Ray Dental - Complete intraoral series | $173 | 0% | $173 | Medium |
| X-Ray Dental - Four images - bitewings | $84 | 0% | $84 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $39 | 0% | $39 | Medium |
| X-Ray Dental - Two images - bitewings | $120 | 0% | $120 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $34 | 0% | $34 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $173 | 0% | $173 | 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 | $244 | 0% | $244 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $320 | 0% | $320 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $244 | 0% | $244 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $326 | 0% | $326 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $231 | 0% | $231 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $354 | 0% | $354 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $289 | 0% | $289 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $210 | 0% | $210 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $242 | 0% | $242 | Medium |