Douglas E Duval, DDS
1142 Somervill Street Manchester, NH 03103
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $90 | 0% | $90 | Medium |
| Child Dental Cleaning | $122 | 0% | $122 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Sealant placed on the tooth surface to prevent decay | $49 | 0% | $49 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $168 | 0% | $168 | Medium |
| Periodic dental exam - established patient | $38 | 0% | $38 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $77 | 0% | $77 | Medium |
| X-Ray Dental - Complete intraoral series | $132 | 0% | $132 | Medium |
| X-Ray Dental - Four images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $28 | 0% | $28 | Medium |
| X-Ray Dental - Two images - bitewings | $46 | 0% | $46 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $110 | 0% | $110 | 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 | $155 | 0% | $155 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $215 | 0% | $215 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $280 | 0% | $280 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $155 | 0% | $155 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $138 | 0% | $138 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $280 | 0% | $280 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $169 | 0% | $169 | 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) | $152 | 0% | $152 | Medium |