Jonathan C Palazzo, DMD
1140 Somerville Street Manchester, NH 03103
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $90 | 0% | $90 | Medium |
| Child Dental Cleaning | $85 | 0% | $85 | Medium |
| Fluoride - Topical Application | $34 | 0% | $34 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $276 | 0% | $276 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
| Topical fluoride varnish application | $41 | 0% | $41 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $84 | 0% | $84 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $76 | 0% | $76 | Medium |
| X-Ray Dental - Complete intraoral series | $132 | 0% | $132 | Medium |
| X-Ray Dental - Four images - bitewings | $59 | 0% | $59 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $28 | 0% | $28 | Medium |
| X-Ray Dental - Two images - bitewings | $46 | 0% | $46 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $27 | 0% | $27 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $118 | 0% | $118 | 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 | $155 | 0% | $155 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $197 | 0% | $197 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $246 | 0% | $246 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $155 | 0% | $155 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $197 | 0% | $197 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $128 | 0% | $128 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $246 | 0% | $246 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $216 | 0% | $216 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $150 | 0% | $150 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $200 | 0% | $200 | Medium |