Gorham Family Dentistry

2 Broadway Avenue Gorham, NH 03581
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1040%$104
Dental Cleaning - Child$840%$84
Dental Exam - Comprehensive$900%$90
Dental Exam - Periodic, Established Patient$640%$64
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1880%$188
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3400%$340
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2610%$261
Dental Filling - White (Resin): One Surface, Anterior$1640%$164
Dental Filling - White (Resin): One Surface, Posterior$1880%$188
Dental Filling - White (Resin): Three Surfaces, Posterior$3400%$340
Dental Filling - White (Resin): Two Surfaces, Anterior$2010%$201
Dental Filling - White (Resin): Two Surfaces, Posterior$2610%$261
Flouride - Topical Varnish Application$430%$43
Fluoride - Topical Application$430%$43
Maintenance Therapy - Periodontal$1500%$150
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2750%$275
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$880%$88
Root Canal - Anterior Tooth$8520%$852
Root Canal - Bicuspid Tooth$9700%$970
Root Canal - Molar$1,8140%$1,814
Sealant - Placed on Tooth Surface to Prevent Decay$630%$63
Tooth Extraction - Elevation and/or Forceps Removal$1580%$158
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$340%$34
X-Ray - Complete Intraoral Series$1450%$145
X-Ray - Four Images, Bitewings$800%$80
X-Ray - Intraoral, Periapical Radiographic Image$350%$35
X-Ray - Two Images, Bitewings$650%$65
X-Ray - Whole Mouth from Outside Mouth$1450%$145