Mark Wirant, DDS
650 Court Street Keene, NH 03431
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $103 | 0% | $103 | Medium |
| Child Dental Cleaning | $79 | 0% | $79 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $236 | 0% | $236 | Medium |
| Sealant placed on the tooth surface to prevent decay | $47 | 0% | $47 | Medium |
| Topical fluoride varnish application | $40 | 0% | $40 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $100 | 0% | $100 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $83 | 0% | $83 | Medium |
| X-Ray Dental - Complete intraoral series | $124 | 0% | $124 | Medium |
| X-Ray Dental - Four images - bitewings | $69 | 0% | $69 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $32 | 0% | $32 | 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 | $21 | 0% | $21 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $124 | 0% | $124 | 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 | $179 | 0% | $179 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $189 | 0% | $189 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $179 | 0% | $179 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $247 | 0% | $247 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $179 | 0% | $179 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $294 | 0% | $294 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $222 | 0% | $222 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Tooth Extraction (Elevation and/or forceps removal) | $177 | 0% | $177 | Medium |