Donald Philip Hyde, DMD
395 Main Street Salem, NH 03079
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $113 | 0% | $113 | Medium |
| Child Dental Cleaning | $88 | 0% | $88 | Medium |
| Fluoride - Topical Application | $52 | 0% | $52 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $98 | 0% | $98 | Medium |
| Periodic dental exam - established patient | $58 | 0% | $58 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $96 | 0% | $96 | Medium |
| X-Ray Dental - Complete intraoral series | $165 | 0% | $165 | Medium |
| X-Ray Dental - Four images - bitewings | $87 | 0% | $87 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | Medium |
| X-Ray Dental - Two images - bitewings | $58 | 0% | $58 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $39 | 0% | $39 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $363 | 0% | $363 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $212 | 0% | $212 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $285 | 0% | $285 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $197 | 0% | $197 | 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) | $405 | 0% | $405 | Medium |