Brian David Shuman, DMD
1 Chase Street Kingston, NH 03848
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $100 | 0% | $100 | Medium |
| Child Dental Cleaning | $74 | 0% | $74 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $89 | 0% | $89 | Medium |
| Periodic dental exam - established patient | $42 | 0% | $42 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $95 | 0% | $95 | Medium |
| X-Ray Dental - Complete intraoral series | $145 | 0% | $145 | Medium |
| X-Ray Dental - Four images - bitewings | $69 | 0% | $69 | Medium |
| X-Ray Dental - Two images - bitewings | $50 | 0% | $50 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $7 | 0% | $7 | 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 | $126 | 0% | $126 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $168 | 0% | $168 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $210 | 0% | $210 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $179 | 0% | $179 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $226 | 0% | $226 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $158 | 0% | $158 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $294 | 0% | $294 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $200 | 0% | $200 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Tooth Extraction (Elevation and/or forceps removal) | $183 | 0% | $183 | Medium |