Jennifer A Charland, DMD
31 Sonja Drive, #3 Rindge, NH 03461
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 | $99 | 0% | $99 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $278 | 0% | $278 | Medium |
| Sealant placed on the tooth surface to prevent decay | $61 | 0% | $61 | 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 | $55 | 0% | $55 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $145 | 0% | $145 | Medium |
| X-Ray Dental - Four images - bitewings | $74 | 0% | $74 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | Medium |
| X-Ray Dental - Two images - bitewings | $58 | 0% | $58 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $40 | 0% | $40 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $139 | 0% | $139 | 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 | $208 | 0% | $208 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $266 | 0% | $266 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $340 | 0% | $340 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $205 | 0% | $205 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $266 | 0% | $266 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $185 | 0% | $185 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $342 | 0% | $342 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $210 | 0% | $210 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $160 | 0% | $160 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $200 | 0% | $200 | Medium |