Mascoma Community Health Center

18 Roberts Road Caanan, NH 03741
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1040%$104
Dental Cleaning - Child$840%$84
Dental Exam - Comprehensive$900%$90
Dental Exam - Periodic, Established Patient$490%$49
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1880%$188
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3400%$340
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2610%$261
Dental Filling - White (Resin): One Surface, Anterior$1680%$168
Dental Filling - White (Resin): One Surface, Posterior$1880%$188
Dental Filling - White (Resin): Three Surfaces, Posterior$3400%$340
Dental Filling - White (Resin): Two Surfaces, Anterior$2010%$201
Dental Filling - White (Resin): Two Surfaces, Posterior$2610%$261
Flouride - Topical Varnish Application$410%$41
Fluoride - Topical Application$420%$42
Maintenance Therapy - Periodontal$1500%$150
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2750%$275
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$880%$88
Root Canal - Anterior Tooth$8520%$852
Sealant - Placed on Tooth Surface to Prevent Decay$580%$58
Tooth Extraction - Elevation and/or Forceps Removal$1820%$182
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$260%$26
X-Ray - Complete Intraoral Series$2030%$203
X-Ray - Four Images, Bitewings$710%$71
X-Ray - Intraoral, Periapical Radiographic Image$340%$34
X-Ray - Two Images, Bitewings$500%$50
X-Ray - Whole Mouth from Outside Mouth$1310%$131