David A Bloom, DMD
1 Manor Pkwy Salem, NH 03079
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $128 | 0% | $128 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $411 | 0% | $411 | Medium |
| Topical fluoride varnish application | $42 | 0% | $42 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Periodic dental exam - established patient | $59 | 0% | $59 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $130 | 0% | $130 | Medium |
| X-Ray Dental - Complete intraoral series | $158 | 0% | $158 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $33 | 0% | $33 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $23 | 0% | $23 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $378 | 0% | $378 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $405 | 0% | $405 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $326 | 0% | $326 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $378 | 0% | $378 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $405 | 0% | $405 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $271 | 0% | $271 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $374 | 0% | $374 | Medium |