Mascoma Community Health Center

18 Roberts Road Caanan, NH 03741
Dental Procedures
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ProcedureEstimate of Total Cost Number of Visits What You Will Pay Uninsured Discount: 0%
Dental Cleaning - Adult$104N/A$104
Dental Cleaning - Child$84N/A$84
Dental Exam - Comprehensive$90N/A$90
Dental Exam - Periodic, Established Patient$49N/A$49
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$188N/A$188
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$342N/A$342
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$261N/A$261
Dental Filling - White (Resin): One Surface, Anterior$168N/A$168
Dental Filling - White (Resin): One Surface, Posterior$188N/A$188
Dental Filling - White (Resin): Three Surfaces, Posterior$340N/A$340
Dental Filling - White (Resin): Two Surfaces, Anterior$204N/A$204
Dental Filling - White (Resin): Two Surfaces, Posterior$261N/A$261
Flouride - Topical Varnish Application$41N/A$41
Fluoride - Topical Application$42N/A$42
Maintenance Therapy - Periodontal$150N/A$150
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$280N/A$280
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$89N/A$89
Root Canal - Anterior Tooth$868N/A$868
Sealant - Placed on Tooth Surface to Prevent Decay$58N/A$58
Tooth Extraction - Elevation and/or Forceps Removal$186N/A$186
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$27N/A$27
X-Ray - Complete Intraoral Series$203N/A$203
X-Ray - Four Images, Bitewings$71N/A$71
X-Ray - Intraoral, Periapical Radiographic Image$34N/A$34
X-Ray - Two Images, Bitewings$53N/A$53
X-Ray - Whole Mouth from Outside Mouth$131N/A$131