Dovetail Dentist Associates
282 Route 101 (5 Liberty Park) Amherst, NH 03031
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $107 | 0% | $107 | Medium |
| Child Dental Cleaning | $86 | 0% | $86 | Medium |
| Fluoride - Topical Application | $54 | 0% | $54 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $280 | 0% | $280 | Medium |
| Sealant placed on the tooth surface to prevent decay | $54 | 0% | $54 | Medium |
| Topical fluoride varnish application | $54 | 0% | $54 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $96 | 0% | $96 | Medium |
| Periodic dental exam - established patient | $50 | 0% | $50 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $90 | 0% | $90 | Medium |
| X-Ray Dental - Complete intraoral series | $150 | 0% | $150 | 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 | $51 | 0% | $51 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $27 | 0% | $27 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $150 | 0% | $150 | 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 | $193 | 0% | $193 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $270 | 0% | $270 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $351 | 0% | $351 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $193 | 0% | $193 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $270 | 0% | $270 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $168 | 0% | $168 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $351 | 0% | $351 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $206 | 0% | $206 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $98 | 0% | $98 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $149 | 0% | $149 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $228 | 0% | $228 | Medium |