Goodwin Community Health

311 NH-108 Somersworth, NH 03878
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1180%$118 Medium
Dental Cleaning - Child$820%$82 Medium
Dental Exam - Comprehensive$1030%$103 Medium
Dental Exam - Periodic, Established Patient$590%$59 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2030%$203 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3170%$317 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2630%$263 Medium
Dental Filling - White (Resin): One Surface, Anterior$1830%$183 Medium
Dental Filling - White (Resin): One Surface, Posterior$2130%$213 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3480%$348 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2330%$233 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2790%$279 Medium
Flouride - Topical Varnish Application$380%$38 Medium
Fluoride - Topical Application$440%$44 Medium
Maintenance Therapy - Periodontal$1770%$177 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2890%$289 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$980%$98 Medium
Root Canal - Anterior Tooth$9960%$996 Medium
Root Canal - Bicuspid Tooth$1,2210%$1,221 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$640%$64 Medium
Tooth Extraction - Elevation and/or Forceps Removal$2500%$250 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$330%$33 Medium
X-Ray - Complete Intraoral Series$1810%$181 Medium
X-Ray - Four Images, Bitewings$800%$80 Medium
X-Ray - Intraoral, Periapical Radiographic Image$360%$36 Medium
X-Ray - Two Images, Bitewings$570%$57 Medium
X-Ray - Whole Mouth from Outside Mouth$1690%$169 Medium