David C. Frost, DMD
75 Clinton Street Concord, NH 03301
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $131 | 0% | $131 | Medium |
| Child Dental Cleaning | $101 | 0% | $101 | Medium |
| Fluoride - Topical Application | $61 | 0% | $61 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $404 | 0% | $404 | Medium |
| Sealant placed on the tooth surface to prevent decay | $81 | 0% | $81 | Medium |
| Topical fluoride varnish application | $65 | 0% | $65 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $78 | 0% | $78 | Medium |
| Periodic dental exam - established patient | $76 | 0% | $76 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $121 | 0% | $121 | Medium |
| X-Ray Dental - Complete intraoral series | $198 | 0% | $198 | Medium |
| X-Ray Dental - Four images - bitewings | $147 | 0% | $147 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $50 | 0% | $50 | Medium |
| X-Ray Dental - Two images - bitewings | $97 | 0% | $97 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $47 | 0% | $47 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $177 | 0% | $177 | 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 | $222 | 0% | $222 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $261 | 0% | $261 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $387 | 0% | $387 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $261 | 0% | $261 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $345 | 0% | $345 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $251 | 0% | $251 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $330 | 0% | $330 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $177 | 0% | $177 | Medium |