Dartmouth-Hitchcock (Keene)
Dental Procedures
| Procedure | Estimate of Total Cost | Number of Visits | What You Will Pay Uninsured Discount: 0% |
|---|---|---|---|
| Dental Exam - Periodic, Established Patient | $49 | N/A | $49 |
| Maintenance Therapy - Periodontal | $201 | N/A | $201 |
| Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $350 | N/A | $350 |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $81 | N/A | $81 |
| Tooth Extraction - Elevation and/or Forceps Removal | $395 | N/A | $395 |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $35 | N/A | $35 |
| X-Ray - Complete Intraoral Series | $183 | N/A | $183 |
| X-Ray - Intraoral, Periapical Radiographic Image | $41 | N/A | $41 |