Chestnut Family Dental
745 Chestnut Street Manchester, NH 03104
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $124 | 0% | $124 | Medium |
| Child Dental Cleaning | $93 | 0% | $93 | Medium |
| Fluoride - Topical Application | $60 | 0% | $60 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $351 | 0% | $351 | Medium |
| Sealant placed on the tooth surface to prevent decay | $76 | 0% | $76 | Medium |
| Topical fluoride varnish application | $60 | 0% | $60 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $128 | 0% | $128 | Medium |
| Periodic dental exam - established patient | $70 | 0% | $70 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $104 | 0% | $104 | Medium |
| X-Ray Dental - Complete intraoral series | $176 | 0% | $176 | Medium |
| X-Ray Dental - Four images - bitewings | $85 | 0% | $85 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | Medium |
| X-Ray Dental - Two images - bitewings | $67 | 0% | $67 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $34 | 0% | $34 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $150 | 0% | $150 | 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 | $251 | 0% | $251 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $317 | 0% | $317 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $382 | 0% | $382 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $251 | 0% | $251 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $317 | 0% | $317 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $237 | 0% | $237 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $382 | 0% | $382 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $279 | 0% | $279 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $188 | 0% | $188 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $251 | 0% | $251 | Medium |