Belknap Dental Associates

40 Chestnut Street, Suite 2 Dover, NH 03820
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1040%$104 Medium
Dental Cleaning - Child$800%$80 Medium
Dental Exam - Comprehensive$900%$90 Medium
Dental Exam - Periodic, Established Patient$500%$50 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1890%$189 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3420%$342 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2630%$263 Medium
Dental Filling - White (Resin): One Surface, Anterior$1650%$165 Medium
Dental Filling - White (Resin): One Surface, Posterior$1890%$189 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3420%$342 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2020%$202 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2630%$263 Medium
Flouride - Topical Varnish Application$400%$40 Medium
Fluoride - Topical Application$400%$40 Medium
Maintenance Therapy - Periodontal$1510%$151 Medium
Orthodontic Treatment - Periodic Visit, Part of a Contract$1410%$141 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2640%$264 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$880%$88 Medium
Root Canal - Bicuspid Tooth$1,0460%$1,046 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$580%$58 Medium
Tooth Extraction - Elevation and/or Forceps Removal$1980%$198 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$280%$28 Medium
X-Ray - Complete Intraoral Series$1510%$151 Medium
X-Ray - Four Images, Bitewings$750%$75 Medium
X-Ray - Intraoral, Periapical Radiographic Image$350%$35 Medium
X-Ray - Two Images, Bitewings$540%$54 Medium
X-Ray - Whole Mouth from Outside Mouth$1300%$130 Medium