Herold Family Dentistry
313 Islington Street Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $102 | 0% | $102 | Medium |
| Child Dental Cleaning | $77 | 0% | $77 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Sealant placed on the tooth surface to prevent decay | $59 | 0% | $59 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $95 | 0% | $95 | Medium |
| Periodic dental exam - established patient | $51 | 0% | $51 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $149 | 0% | $149 | Medium |
| X-Ray Dental - Four images - bitewings | $72 | 0% | $72 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $34 | 0% | $34 | Medium |
| X-Ray Dental - Two images - bitewings | $51 | 0% | $51 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $34 | 0% | $34 | 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 | $160 | 0% | $160 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $197 | 0% | $197 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $244 | 0% | $244 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $197 | 0% | $197 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $261 | 0% | $261 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $184 | 0% | $184 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $340 | 0% | $340 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $224 | 0% | $224 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $300 | 0% | $300 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $187 | 0% | $187 | Medium |