John Lee Chiou, DMD Mmsc
475 Washington Road. Rye, NH 03870
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $104 | 0% | $104 | Medium |
| Child Dental Cleaning | $75 | 0% | $75 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $268 | 0% | $268 | Medium |
| Sealant placed on the tooth surface to prevent decay | $55 | 0% | $55 | Medium |
| Topical fluoride varnish application | $61 | 0% | $61 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $96 | 0% | $96 | Medium |
| Periodic dental exam - established patient | $55 | 0% | $55 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $85 | 0% | $85 | Medium |
| X-Ray Dental - Complete intraoral series | $165 | 0% | $165 | Medium |
| X-Ray Dental - Four images - bitewings | $77 | 0% | $77 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $33 | 0% | $33 | Medium |
| X-Ray Dental - Two images - bitewings | $55 | 0% | $55 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $29 | 0% | $29 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $144 | 0% | $144 | 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 | $197 | 0% | $197 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $332 | 0% | $332 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $172 | 0% | $172 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $332 | 0% | $332 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $212 | 0% | $212 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $166 | 0% | $166 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $217 | 0% | $217 | Medium |