Charles D. White, DMD
29 Island Pond Road Atkinson, NH 03811
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $113 | 0% | $113 | Medium |
| Child Dental Cleaning | $120 | 0% | $120 | Medium |
| Fluoride - Topical Application | $48 | 0% | $48 | Medium |
| Sealant placed on the tooth surface to prevent decay | $80 | 0% | $80 | Medium |
| Topical fluoride varnish application | $59 | 0% | $59 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $120 | 0% | $120 | Medium |
| Periodic dental exam - established patient | $40 | 0% | $40 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $68 | 0% | $68 | Medium |
| X-Ray Dental - Complete intraoral series | $218 | 0% | $218 | Medium |
| X-Ray Dental - Four images - bitewings | $92 | 0% | $92 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $39 | 0% | $39 | Medium |
| X-Ray Dental - Two images - bitewings | $59 | 0% | $59 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $39 | 0% | $39 | 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 | $208 | 0% | $208 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $265 | 0% | $265 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $326 | 0% | $326 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $233 | 0% | $233 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $245 | 0% | $245 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $177 | 0% | $177 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $336 | 0% | $336 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $216 | 0% | $216 | 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 |