Daniel H De Tolla, MD DDS
200 Griffin Road, Suite 8 Portsmouth, NH 03801
Dental Procedures
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $114 | 0% | $114 | Medium |
| Periodic dental exam - established patient | $107 | 0% | $107 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $113 | 0% | $113 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $144 | 0% | $144 | 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) | $218 | 0% | $218 | Medium |