Keene Smiles Dental
69 Island Street, Suite G Keene, NH 03431
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $105 | 0% | $105 | Medium |
| Child Dental Cleaning | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $272 | 0% | $272 | Medium |
| Sealant placed on the tooth surface to prevent decay | $57 | 0% | $57 | 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 | $90 | 0% | $90 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $89 | 0% | $89 | Medium |
| X-Ray Dental - Complete intraoral series | $146 | 0% | $146 | Medium |
| X-Ray Dental - Four images - bitewings | $70 | 0% | $70 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Two images - bitewings | $50 | 0% | $50 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $32 | 0% | $32 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $127 | 0% | $127 | 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 | $184 | 0% | $184 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $257 | 0% | $257 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $231 | 0% | $231 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $187 | 0% | $187 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $263 | 0% | $263 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $184 | 0% | $184 | 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 | $149 | 0% | $149 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $195 | 0% | $195 | Medium |