Gutgsell & Phipps, DDS
299 Mian Street New London, NH 03257
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $99 | 0% | $99 | Medium |
| Child Dental Cleaning | $72 | 0% | $72 | Medium |
| Fluoride - Topical Application | $40 | 0% | $40 | 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 | $56 | 0% | $56 | Medium |
| Topical fluoride varnish application | $40 | 0% | $40 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $88 | 0% | $88 | Medium |
| Periodic dental exam - established patient | $48 | 0% | $48 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $63 | 0% | $63 | Medium |
| X-Ray Dental - Complete intraoral series | $183 | 0% | $183 | Medium |
| X-Ray Dental - Four images - bitewings | $66 | 0% | $66 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $34 | 0% | $34 | Medium |
| X-Ray Dental - Two images - bitewings | $46 | 0% | $46 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $23 | 0% | $23 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $128 | 0% | $128 | 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 | $162 | 0% | $162 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $181 | 0% | $181 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $221 | 0% | $221 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $181 | 0% | $181 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $231 | 0% | $231 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $164 | 0% | $164 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $315 | 0% | $315 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $201 | 0% | $201 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $143 | 0% | $143 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $177 | 0% | $177 | Medium |