Exceptional Dentistry
1 Streetiles Road, Suite 102 Salem, NH 03079
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $121 | 0% | $121 | Medium |
| Child Dental Cleaning | $181 | 0% | $181 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $282 | 0% | $282 | Medium |
| Topical fluoride varnish application | $64 | 0% | $64 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $100 | 0% | $100 | Medium |
| Periodic dental exam - established patient | $58 | 0% | $58 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $96 | 0% | $96 | Medium |
| X-Ray Dental - Complete intraoral series | $198 | 0% | $198 | Medium |
| X-Ray Dental - Four images - bitewings | $77 | 0% | $77 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $38 | 0% | $38 | Medium |
| X-Ray Dental - Two images - bitewings | $80 | 0% | $80 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $33 | 0% | $33 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $146 | 0% | $146 | 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 | $212 | 0% | $212 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $277 | 0% | $277 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $366 | 0% | $366 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $212 | 0% | $212 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $277 | 0% | $277 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $340 | 0% | $340 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $477 | 0% | $477 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $350 | 0% | $350 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $181 | 0% | $181 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $213 | 0% | $213 | Medium |