John A Nieskens, DDS
60 Hancock Road Peterborough, NH 03458
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $202 | 0% | $202 | Medium |
| Child Dental Cleaning | $149 | 0% | $149 | Medium |
| Fluoride - Topical Application | $53 | 0% | $53 | Medium |
| Sealant placed on the tooth surface to prevent decay | $101 | 0% | $101 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $145 | 0% | $145 | Medium |
| Periodic dental exam - established patient | $84 | 0% | $84 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $80 | 0% | $80 | Medium |
| X-Ray Dental - Four images - bitewings | $134 | 0% | $134 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $29 | 0% | $29 | Medium |
| X-Ray Dental - Two images - bitewings | $92 | 0% | $92 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $433 | 0% | $433 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $256 | 0% | $256 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $433 | 0% | $433 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $521 | 0% | $521 | Medium |