Matthew Joseph Cielinski, DMD
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 | $91 | 0% | $91 | Medium |
| Child Dental Cleaning | $79 | 0% | $79 | Medium |
| Fluoride - Topical Application | $42 | 0% | $42 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $272 | 0% | $272 | Medium |
| Sealant placed on the tooth surface to prevent decay | $56 | 0% | $56 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $90 | 0% | $90 | Medium |
| Periodic dental exam - established patient | $44 | 0% | $44 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $86 | 0% | $86 | Medium |
| X-Ray Dental - Complete intraoral series | $143 | 0% | $143 | Medium |
| X-Ray Dental - Four images - bitewings | $63 | 0% | $63 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $30 | 0% | $30 | Medium |
| X-Ray Dental - Two images - bitewings | $44 | 0% | $44 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $26 | 0% | $26 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $129 | 0% | $129 | 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 | $186 | 0% | $186 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $263 | 0% | $263 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $337 | 0% | $337 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $186 | 0% | $186 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $259 | 0% | $259 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $162 | 0% | $162 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $337 | 0% | $337 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $202 | 0% | $202 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $143 | 0% | $143 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $180 | 0% | $180 | Medium |