Hampstead Family Dental
2 Picker Road Hampstead, NH 03841
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $107 | 0% | $107 | Medium |
| Child Dental Cleaning | $85 | 0% | $85 | Medium |
| Fluoride - Topical Application | $45 | 0% | $45 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $314 | 0% | $314 | Medium |
| Sealant placed on the tooth surface to prevent decay | $62 | 0% | $62 | Medium |
| Topical fluoride varnish application | $45 | 0% | $45 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $133 | 0% | $133 | Medium |
| Periodic dental exam - established patient | $57 | 0% | $57 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $99 | 0% | $99 | Medium |
| X-Ray Dental - Complete intraoral series | $162 | 0% | $162 | Medium |
| X-Ray Dental - Four images - bitewings | $91 | 0% | $91 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Two images - bitewings | $60 | 0% | $60 | 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 | $167 | 0% | $167 | 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 | $191 | 0% | $191 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $265 | 0% | $265 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $342 | 0% | $342 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $191 | 0% | $191 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $265 | 0% | $265 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $172 | 0% | $172 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $342 | 0% | $342 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $208 | 0% | $208 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $151 | 0% | $151 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $219 | 0% | $219 | Medium |