Manchester Smiles Youth Dentistry
8 Vinton 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 | $155 | 0% | $155 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Fluoride - Topical Application | $62 | 0% | $62 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $316 | 0% | $316 | Medium |
| Sealant placed on the tooth surface to prevent decay | $80 | 0% | $80 | Medium |
| Topical fluoride varnish application | $99 | 0% | $99 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $137 | 0% | $137 | Medium |
| Periodic dental exam - established patient | $61 | 0% | $61 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $137 | 0% | $137 | Medium |
| X-Ray Dental - Complete intraoral series | $231 | 0% | $231 | Medium |
| X-Ray Dental - Four images - bitewings | $120 | 0% | $120 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $50 | 0% | $50 | Medium |
| X-Ray Dental - Two images - bitewings | $76 | 0% | $76 | 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 | $143 | 0% | $143 | 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 | $215 | 0% | $215 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $305 | 0% | $305 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $300 | 0% | $300 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $233 | 0% | $233 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $380 | 0% | $380 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $185 | 0% | $185 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $460 | 0% | $460 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $328 | 0% | $328 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $233 | 0% | $233 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $273 | 0% | $273 | Medium |