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
Dental Cleaning - Adult$1320%$132
Dental Cleaning - Child$1030%$103
Dental Exam - Comprehensive$1180%$118
Dental Exam - Periodic, Established Patient$610%$61
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$3080%$308
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$4240%$424
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$4100%$410
Dental Filling - White (Resin): One Surface, Anterior$1970%$197
Dental Filling - White (Resin): One Surface, Posterior$3080%$308
Dental Filling - White (Resin): Three Surfaces, Posterior$4240%$424
Dental Filling - White (Resin): Two Surfaces, Anterior$2540%$254
Dental Filling - White (Resin): Two Surfaces, Posterior$4100%$410
Flouride - Topical Varnish Application$550%$55
Fluoride - Topical Application$550%$55
Maintenance Therapy - Periodontal$1680%$168
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3170%$317
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$1140%$114
Sealant - Placed on Tooth Surface to Prevent Decay$650%$65
Tooth Extraction - Elevation and/or Forceps Removal$2080%$208
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$400%$40
X-Ray - Complete Intraoral Series$1710%$171
X-Ray - Four Images, Bitewings$840%$84
X-Ray - Intraoral, Periapical Radiographic Image$420%$42
X-Ray - Two Images, Bitewings$660%$66
X-Ray - Whole Mouth from Outside Mouth$1490%$149