Jeffrey N. Fasulo, DDS
60 Main Street Nashua, NH 03060
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $116 | 0% | $116 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Fluoride - Topical Application | $47 | 0% | $47 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $578 | 0% | $578 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
| Topical fluoride varnish application | $47 | 0% | $47 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $90 | 0% | $90 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $87 | 0% | $87 | Medium |
| X-Ray Dental - Complete intraoral series | $158 | 0% | $158 | Medium |
| X-Ray Dental - Four images - bitewings | $74 | 0% | $74 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $71 | 0% | $71 | Medium |
| X-Ray Dental - Two images - bitewings | $53 | 0% | $53 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $45 | 0% | $45 | 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 | $236 | 0% | $236 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $268 | 0% | $268 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $341 | 0% | $341 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $236 | 0% | $236 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $289 | 0% | $289 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $236 | 0% | $236 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $341 | 0% | $341 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $289 | 0% | $289 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $315 | 0% | $315 | Medium |