George T. Felt, DDS
9 Northview Drive Meredith, NH 03253
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $107 | 0% | $107 | Medium |
| Child Dental Cleaning | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $294 | 0% | $294 | Medium |
| Sealant placed on the tooth surface to prevent decay | $63 | 0% | $63 | Medium |
| Topical fluoride varnish application | $44 | 0% | $44 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $99 | 0% | $99 | Medium |
| Periodic dental exam - established patient | $56 | 0% | $56 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $87 | 0% | $87 | Medium |
| X-Ray Dental - Complete intraoral series | $149 | 0% | $149 | Medium |
| X-Ray Dental - Four images - bitewings | $74 | 0% | $74 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $34 | 0% | $34 | Medium |
| X-Ray Dental - Two images - bitewings | $53 | 0% | $53 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $16 | 0% | $16 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $198 | 0% | $198 | 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 | $164 | 0% | $164 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $200 | 0% | $200 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $298 | 0% | $298 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $208 | 0% | $208 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $267 | 0% | $267 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $192 | 0% | $192 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $344 | 0% | $344 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $229 | 0% | $229 | 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) | $72 | 0% | $72 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $150 | 0% | $150 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $200 | 0% | $200 | Medium |