Eugene Stanley Hulshult, DDS
54 South Street Concord, NH 03301
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $104 | 0% | $104 | Medium |
| Child Dental Cleaning | $93 | 0% | $93 | Medium |
| Fluoride - Topical Application | $50 | 0% | $50 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $276 | 0% | $276 | Medium |
| Sealant placed on the tooth surface to prevent decay | $63 | 0% | $63 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $90 | 0% | $90 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $200 | 0% | $200 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $42 | 0% | $42 | Medium |
| X-Ray Dental - Two images - bitewings | $55 | 0% | $55 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $42 | 0% | $42 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $128 | 0% | $128 | 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 | $189 | 0% | $189 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $261 | 0% | $261 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $342 | 0% | $342 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $189 | 0% | $189 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $261 | 0% | $261 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $168 | 0% | $168 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $340 | 0% | $340 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $201 | 0% | $201 | 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) | $58 | 0% | $58 | 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) | $189 | 0% | $189 | Medium |