Aspen Dental Associates of New England
131 Route 101a, Unit 1 Amherst, NH 03031
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $105 | 0% | $105 | Medium |
| Child Dental Cleaning | $85 | 0% | $85 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $331 | 0% | $331 | Medium |
| Sealant placed on the tooth surface to prevent decay | $57 | 0% | $57 | 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 | $95 | 0% | $95 | Medium |
| Periodic dental exam - established patient | $57 | 0% | $57 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $103 | 0% | $103 | Medium |
| X-Ray Dental - Complete intraoral series | $175 | 0% | $175 | Medium |
| X-Ray Dental - Four images - bitewings | $75 | 0% | $75 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $36 | 0% | $36 | Medium |
| X-Ray Dental - Two images - bitewings | $54 | 0% | $54 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $29 | 0% | $29 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $127 | 0% | $127 | 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 | $207 | 0% | $207 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $263 | 0% | $263 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $337 | 0% | $337 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $204 | 0% | $204 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $261 | 0% | $261 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $170 | 0% | $170 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $337 | 0% | $337 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $223 | 0% | $223 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $162 | 0% | $162 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $208 | 0% | $208 | Medium |