George H. Grabe, DMD
275 Maine Street Charlestown, NH 03603
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $101 | 0% | $101 | Medium |
| Child Dental Cleaning | $87 | 0% | $87 | Medium |
| Fluoride - Topical Application | $39 | 0% | $39 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $260 | 0% | $260 | Medium |
| Sealant placed on the tooth surface to prevent decay | $59 | 0% | $59 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $125 | 0% | $125 | Medium |
| Periodic dental exam - established patient | $45 | 0% | $45 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $77 | 0% | $77 | Medium |
| X-Ray Dental - Complete intraoral series | $139 | 0% | $139 | Medium |
| X-Ray Dental - Four images - bitewings | $69 | 0% | $69 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $30 | 0% | $30 | Medium |
| X-Ray Dental - Two images - bitewings | $46 | 0% | $46 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $25 | 0% | $25 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $120 | 0% | $120 | 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 | $166 | 0% | $166 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $207 | 0% | $207 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $259 | 0% | $259 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $267 | 0% | $267 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $338 | 0% | $338 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $395 | 0% | $395 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $282 | 0% | $282 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $146 | 0% | $146 | Medium |