Brian J. Wicenski, DMD, Mary E. Wicenski, DMD
27 Newport Road New London, NH 03257
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $109 | 0% | $109 | Medium |
| Child Dental Cleaning | $81 | 0% | $81 | Medium |
| Sealant placed on the tooth surface to prevent decay | $61 | 0% | $61 | Medium |
| Topical fluoride varnish application | $45 | 0% | $45 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $92 | 0% | $92 | Medium |
| Periodic dental exam - established patient | $54 | 0% | $54 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $85 | 0% | $85 | Medium |
| X-Ray Dental - Complete intraoral series | $144 | 0% | $144 | Medium |
| X-Ray Dental - Four images - bitewings | $76 | 0% | $76 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $36 | 0% | $36 | Medium |
| X-Ray Dental - Two images - bitewings | $55 | 0% | $55 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $22 | 0% | $22 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $143 | 0% | $143 | 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 | $215 | 0% | $215 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $229 | 0% | $229 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $306 | 0% | $306 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $274 | 0% | $274 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $206 | 0% | $206 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $354 | 0% | $354 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $264 | 0% | $264 | 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) | $252 | 0% | $252 | Medium |