Belknap Dental Associates

40 Chestnut Street, Suite 2 Dover, NH 03820
http://www.belknapdental.com/
(603) 742-4735

All cost information is based on claims data collected in the New Hampshire Comprehensive Healthcare Information System which is updated quarterly. All quality information is based on claims and administrative data collected by the Centers for Medicare and Medicaid Services which is updated annually. For more information click the links above and review our methodology section.

Methodology
Procedure Estimate of Procedure Cost Estimate of Procedure Cost
This is an estimate of the total charge for the health care service before any discounts provided to the uninsured.
Number of Visits Number of Visits
When the number of visits varies, it is difficult to estimate the total cost of care. This indicates the number of visits you can expect, calculated using the median. To determine the total you might pay, multiply the Estimate of Procedure Cost and the Statewide Average for Number of Visits.
- Above Average: Expect to visit the provider more than the average number of visits.
- Near Average: Expect the visit the provider close to the average number of visits.
- Below Average: Expect to visit the provider less than the average number of visits.
What You Will Pay What You Will Pay
The estimated charge amount minus the uninsured discount (when available).
Additional X-Ray Image of Tooth from Crown to Root from Inside Mouth $48 N/A $48
Adult Dental Cleaning $110 N/A $110
Child Dental Cleaning $129 N/A $129
Complete Intraoral X-Ray Series $260 N/A $260
Comprehensive Dental Exam $101 N/A $101
Dental Crown, Porcelain/Ceramic $1,360 N/A $1,360
Four Bitewing X-Ray Images $122 N/A $122
Intraoral X-Ray, Periapical Radiographic Image $63 N/A $63
Maintenance Therapy $167 N/A $167
Oral Hygiene Instructions $44 N/A $44
Periodic Dental Exam for an Established Patient $86 N/A $86
Placing Sealant on Tooth Surface to Prevent Decay $65 N/A $65
Plaque and Tartar Removal Around Teeth and Gums, Per Quadrant $456 N/A $456
Problem Focused Evaluation, Limited to a Specific Oral Health Problem or Complaint $134 N/A $134
Silver (Amalgam) Dental Filling: One Surface, Primary or Permanent $288 N/A $288
Silver (Amalgam) Dental Filling: Three Surfaces, Primary or Permanent $360 N/A $360
Silver (Amalgam) Dental Filling: Two Surfaces, Primary or Permanent $353 N/A $353
Tooth Extraction, Elevation and/or Forceps Removal $231 N/A $231
Topical Fluoride Application $43 N/A $43
Topical Varnish Fluoride Application $43 N/A $43
Two Bitewing X-Ray Images $95 N/A $95
White (Resin) Dental Filling: One Surface, Anterior $288 N/A $288
White (Resin) Dental Filling: One Surface, Posterior $353 N/A $353
White (Resin) Dental Filling: Three Surfaces, Posterior $360 N/A $360
White (Resin) Dental Filling: Two Surfaces, Anterior $353 N/A $353
White (Resin) Dental Filling: Two Surfaces, Posterior $282 N/A $282
Whole Mouth X-Ray from Outside Mouth $146 N/A $146