Bruce J Trivellini, DDS
25 Dolly Road Contoocook, NH 03229
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $104 | 0% | $104 | Medium |
| Child Dental Cleaning | $93 | 0% | $93 | Medium |
| Fluoride - Topical Application | $60 | 0% | $60 | Medium |
| Sealant placed on the tooth surface to prevent decay | $56 | 0% | $56 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $108 | 0% | $108 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $86 | 0% | $86 | Medium |
| X-Ray Dental - Complete intraoral series | $145 | 0% | $145 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $33 | 0% | $33 | 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 | $27 | 0% | $27 | 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 |
| White (Resin) Dental Filling - One surface, posterior | $184 | 0% | $184 | Medium |