Bruce R. Courtney Jr., DMD
920 Second Street Manchester, NH 03102
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 | $92 | 0% | $92 | Medium |
| Fluoride - Topical Application | $48 | 0% | $48 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $290 | 0% | $290 | 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 | $95 | 0% | $95 | Medium |
| Periodic dental exam - established patient | $58 | 0% | $58 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $91 | 0% | $91 | Medium |
| X-Ray Dental - Complete intraoral series | $147 | 0% | $147 | 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 | $56 | 0% | $56 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $30 | 0% | $30 | 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 | $263 | 0% | $263 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $334 | 0% | $334 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $381 | 0% | $381 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $264 | 0% | $264 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $334 | 0% | $334 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $167 | 0% | $167 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $383 | 0% | $383 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $420 | 0% | $420 | 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) | $196 | 0% | $196 | Medium |