Lyme Road Dental
7 Lyme Road Hanover, NH 03755
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $146 | 0% | $146 | Medium |
| Child Dental Cleaning | $118 | 0% | $118 | Medium |
| Sealant placed on the tooth surface to prevent decay | $71 | 0% | $71 | 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 | $161 | 0% | $161 | Medium |
| Periodic dental exam - established patient | $68 | 0% | $68 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $103 | 0% | $103 | Medium |
| X-Ray Dental - Complete intraoral series | $219 | 0% | $219 | Medium |
| X-Ray Dental - Four images - bitewings | $95 | 0% | $95 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $57 | 0% | $57 | Medium |
| X-Ray Dental - Two images - bitewings | $91 | 0% | $91 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $19 | 0% | $19 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $171 | 0% | $171 | 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 | $246 | 0% | $246 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $373 | 0% | $373 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $515 | 0% | $515 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $246 | 0% | $246 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $373 | 0% | $373 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $234 | 0% | $234 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $490 | 0% | $490 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $373 | 0% | $373 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $158 | 0% | $158 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $247 | 0% | $247 | Medium |