Ernani S Domingo, DMD

33 Bay Street Manchester, NH 03104
Dental Procedures
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My Health Insurance:

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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1270%$127 Medium
Dental Cleaning - Child$990%$99 Medium
Dental Exam - Comprehensive$1130%$113 Medium
Dental Exam - Periodic, Established Patient$590%$59 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$3080%$308 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$4120%$412 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$4100%$410 Medium
Dental Filling - White (Resin): One Surface, Anterior$1970%$197 Medium
Dental Filling - White (Resin): One Surface, Posterior$3080%$308 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$4240%$424 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2540%$254 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$4100%$410 Medium
Flouride - Topical Varnish Application$550%$55 Medium
Fluoride - Topical Application$550%$55 Medium
Maintenance Therapy - Periodontal$1680%$168 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3080%$308 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$1100%$110 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$630%$63 Medium
Tooth Extraction - Elevation and/or Forceps Removal$2030%$203 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$400%$40 Medium
X-Ray - Complete Intraoral Series$1710%$171 Medium
X-Ray - Four Images, Bitewings$840%$84 Medium
X-Ray - Intraoral, Periapical Radiographic Image$420%$42 Medium
X-Ray - Two Images, Bitewings$660%$66 Medium
X-Ray - Whole Mouth from Outside Mouth$1460%$146 Medium