Derek R Blackwelder, DMD
944 Laconia Road Tilton, NH 03276
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $106 | 0% | $106 | Medium |
| Child Dental Cleaning | $85 | 0% | $85 | Medium |
| Fluoride - Topical Application | $42 | 0% | $42 | Medium |
| Sealant placed on the tooth surface to prevent decay | $59 | 0% | $59 | 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 | $91 | 0% | $91 | Medium |
| Periodic dental exam - established patient | $57 | 0% | $57 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $89 | 0% | $89 | Medium |
| X-Ray Dental - Complete intraoral series | $179 | 0% | $179 | Medium |
| X-Ray Dental - Four images - bitewings | $72 | 0% | $72 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Two images - bitewings | $53 | 0% | $53 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $28 | 0% | $28 | 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 | $191 | 0% | $191 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $265 | 0% | $265 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $345 | 0% | $345 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $191 | 0% | $191 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $265 | 0% | $265 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $172 | 0% | $172 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $345 | 0% | $345 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $210 | 0% | $210 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Tooth Extraction (Elevation and/or forceps removal) | $179 | 0% | $179 | Medium |