Gordon Francis Geick, DMD
50 Nashua Road Londonderry, NH 03053
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $128 | 0% | $128 | Medium |
| Child Dental Cleaning | $96 | 0% | $96 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $319 | 0% | $319 | Medium |
| Sealant placed on the tooth surface to prevent decay | $71 | 0% | $71 | Medium |
| Topical fluoride varnish application | $47 | 0% | $47 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $117 | 0% | $117 | Medium |
| Periodic dental exam - established patient | $65 | 0% | $65 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $107 | 0% | $107 | Medium |
| X-Ray Dental - Complete intraoral series | $202 | 0% | $202 | Medium |
| X-Ray Dental - Four images - bitewings | $91 | 0% | $91 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $45 | 0% | $45 | Medium |
| X-Ray Dental - Two images - bitewings | $67 | 0% | $67 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $37 | 0% | $37 | 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 | $231 | 0% | $231 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $309 | 0% | $309 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $377 | 0% | $377 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $231 | 0% | $231 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $309 | 0% | $309 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $205 | 0% | $205 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $377 | 0% | $377 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $258 | 0% | $258 | 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) | $68 | 0% | $68 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $190 | 0% | $190 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $384 | 0% | $384 | Medium |