Children's Dentistry of Cocheco Valley
750 Central Ave Dover, NH 03820
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $103 | 0% | $103 | Medium |
| Child Dental Cleaning | $87 | 0% | $87 | Medium |
| Fluoride - Topical Application | $39 | 0% | $39 | Medium |
| Sealant placed on the tooth surface to prevent decay | $63 | 0% | $63 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $105 | 0% | $105 | Medium |
| Periodic dental exam - established patient | $53 | 0% | $53 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $74 | 0% | $74 | Medium |
| X-Ray Dental - Complete intraoral series | $191 | 0% | $191 | Medium |
| X-Ray Dental - Four images - bitewings | $68 | 0% | $68 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $32 | 0% | $32 | Medium |
| X-Ray Dental - Two images - bitewings | $49 | 0% | $49 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $26 | 0% | $26 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $142 | 0% | $142 | 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 | $179 | 0% | $179 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $247 | 0% | $247 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $331 | 0% | $331 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $179 | 0% | $179 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $247 | 0% | $247 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $244 | 0% | $244 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $331 | 0% | $331 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $51 | 0% | $51 | 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) | $158 | 0% | $158 | Medium |