Charles Pipilas, DDS
280 Main Street Nashua, NH 03060
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $162 | 0% | $162 | Medium |
| Child Dental Cleaning | $116 | 0% | $116 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Sealant placed on the tooth surface to prevent decay | $53 | 0% | $53 | Medium |
| Topical fluoride varnish application | $37 | 0% | $37 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $84 | 0% | $84 | Medium |
| Periodic dental exam - established patient | $42 | 0% | $42 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $58 | 0% | $58 | Medium |
| X-Ray Dental - Complete intraoral series | $263 | 0% | $263 | Medium |
| X-Ray Dental - Four images - bitewings | $58 | 0% | $58 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $26 | 0% | $26 | Medium |
| X-Ray Dental - Two images - bitewings | $37 | 0% | $37 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $23 | 0% | $23 | 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 | $200 | 0% | $200 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $257 | 0% | $257 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $315 | 0% | $315 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $200 | 0% | $200 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $168 | 0% | $168 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $315 | 0% | $315 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $210 | 0% | $210 | Medium |