Karelitz, King, Caroll Dental
400 Central Avenue Dover, NH 03820
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $114 | 0% | $114 | Medium |
| Child Dental Cleaning | $83 | 0% | $83 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $288 | 0% | $288 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $182 | 0% | $182 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $114 | 0% | $114 | Medium |
| X-Ray Dental - Complete intraoral series | $188 | 0% | $188 | Medium |
| X-Ray Dental - Four images - bitewings | $80 | 0% | $80 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Two images - bitewings | $61 | 0% | $61 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $35 | 0% | $35 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $173 | 0% | $173 | 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 | $186 | 0% | $186 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $209 | 0% | $209 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $228 | 0% | $228 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $209 | 0% | $209 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $271 | 0% | $271 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $198 | 0% | $198 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $338 | 0% | $338 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $235 | 0% | $235 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $200 | 0% | $200 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $238 | 0% | $238 | Medium |