Brian J Mahoney, DMD
20 Webster Street Manchester, NH 03104
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $102 | 0% | $102 | Medium |
| Child Dental Cleaning | $79 | 0% | $79 | Medium |
| Fluoride - Topical Application | $44 | 0% | $44 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $275 | 0% | $275 | Medium |
| Sealant placed on the tooth surface to prevent decay | $59 | 0% | $59 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $88 | 0% | $88 | Medium |
| Periodic dental exam - established patient | $47 | 0% | $47 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $147 | 0% | $147 | Medium |
| X-Ray Dental - Four images - bitewings | $78 | 0% | $78 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $33 | 0% | $33 | Medium |
| X-Ray Dental - Two images - bitewings | $56 | 0% | $56 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $33 | 0% | $33 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $132 | 0% | $132 | 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 | $142 | 0% | $142 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $176 | 0% | $176 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $216 | 0% | $216 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $168 | 0% | $168 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $206 | 0% | $206 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $168 | 0% | $168 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $206 | 0% | $206 | 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) | $188 | 0% | $188 | Medium |