David A Ness, DMD
251 NH-108 Somersworth, NH 03878
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $104 | 0% | $104 | Medium |
| Child Dental Cleaning | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $310 | 0% | $310 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
| Topical fluoride varnish application | $43 | 0% | $43 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $121 | 0% | $121 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $145 | 0% | $145 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $38 | 0% | $38 | Medium |
| X-Ray Dental - Two images - bitewings | $50 | 0% | $50 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $27 | 0% | $27 | 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 | $205 | 0% | $205 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $273 | 0% | $273 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $352 | 0% | $352 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $205 | 0% | $205 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $273 | 0% | $273 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $191 | 0% | $191 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $352 | 0% | $352 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $231 | 0% | $231 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $155 | 0% | $155 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $420 | 0% | $420 | Medium |