Coastal Dental Associates
2837 Lafayette Road Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $108 | 0% | $108 | Medium |
| Child Dental Cleaning | $87 | 0% | $87 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $286 | 0% | $286 | Medium |
| Sealant placed on the tooth surface to prevent decay | $61 | 0% | $61 | Medium |
| Topical fluoride varnish application | $46 | 0% | $46 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $90 | 0% | $90 | Medium |
| Periodic dental exam - established patient | $53 | 0% | $53 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $159 | 0% | $159 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $34 | 0% | $34 | Medium |
| X-Ray Dental - Two images - bitewings | $53 | 0% | $53 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $27 | 0% | $27 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $147 | 0% | $147 | 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 | $218 | 0% | $218 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $276 | 0% | $276 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $340 | 0% | $340 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $218 | 0% | $218 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $261 | 0% | $261 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $164 | 0% | $164 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $342 | 0% | $342 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $218 | 0% | $218 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $150 | 0% | $150 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $209 | 0% | $209 | Medium |