Gregg T. Hillery, DMD
20 South State Street Concord, NH 03301
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $120 | 0% | $120 | Medium |
| Child Dental Cleaning | $92 | 0% | $92 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $275 | 0% | $275 | Medium |
| Sealant placed on the tooth surface to prevent decay | $67 | 0% | $67 | Medium |
| Topical fluoride varnish application | $34 | 0% | $34 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $118 | 0% | $118 | Medium |
| Periodic dental exam - established patient | $63 | 0% | $63 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $98 | 0% | $98 | Medium |
| X-Ray Dental - Complete intraoral series | $168 | 0% | $168 | Medium |
| X-Ray Dental - Four images - bitewings | $82 | 0% | $82 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Two images - bitewings | $57 | 0% | $57 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $30 | 0% | $30 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $143 | 0% | $143 | 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 | $189 | 0% | $189 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $227 | 0% | $227 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $297 | 0% | $297 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $233 | 0% | $233 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $294 | 0% | $294 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $206 | 0% | $206 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $361 | 0% | $361 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $251 | 0% | $251 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $172 | 0% | $172 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $182 | 0% | $182 | Medium |