Darren Boles, DDS
36 Endicott Street, East Laconia, NH 03246
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $97 | 0% | $97 | Medium |
| Child Dental Cleaning | $78 | 0% | $78 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $260 | 0% | $260 | Medium |
| Sealant placed on the tooth surface to prevent decay | $56 | 0% | $56 | Medium |
| Topical fluoride varnish application | $45 | 0% | $45 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $83 | 0% | $83 | Medium |
| Periodic dental exam - established patient | $46 | 0% | $46 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $86 | 0% | $86 | Medium |
| X-Ray Dental - Complete intraoral series | $140 | 0% | $140 | Medium |
| X-Ray Dental - Four images - bitewings | $65 | 0% | $65 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $30 | 0% | $30 | Medium |
| X-Ray Dental - Two images - bitewings | $47 | 0% | $47 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $24 | 0% | $24 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $126 | 0% | $126 | 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 | $153 | 0% | $153 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $215 | 0% | $215 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $280 | 0% | $280 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $184 | 0% | $184 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $164 | 0% | $164 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $334 | 0% | $334 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $169 | 0% | $169 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $143 | 0% | $143 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $151 | 0% | $151 | Medium |