Lisa B. Schulman, DDS
200 Griffin Road, Suite 9 Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $124 | 0% | $124 | Medium |
| Sealant placed on the tooth surface to prevent decay | $68 | 0% | $68 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $154 | 0% | $154 | Medium |
| Periodic dental exam - established patient | $59 | 0% | $59 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $131 | 0% | $131 | Medium |
| X-Ray Dental - Complete intraoral series | $172 | 0% | $172 | Medium |
| X-Ray Dental - Four images - bitewings | $84 | 0% | $84 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | 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 | $33 | 0% | $33 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $152 | 0% | $152 | 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 | $223 | 0% | $223 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $311 | 0% | $311 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $263 | 0% | $263 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $223 | 0% | $223 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $311 | 0% | $311 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $194 | 0% | $194 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $404 | 0% | $404 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $238 | 0% | $238 | Medium |