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 | $168 | 0% | $168 | 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 | $148 | 0% | $148 | Medium |
| Periodic dental exam - established patient | $56 | 0% | $56 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | 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 | $79 | 0% | $79 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $134 | 0% | $134 | 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 | $213 | 0% | $213 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $267 | 0% | $267 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $344 | 0% | $344 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $213 | 0% | $213 | 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 | $234 | 0% | $234 | 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) | $91 | 0% | $91 | 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) | $206 | 0% | $206 | Medium |