Michael Stevener, DDS
39 Freetown Road Raymond, NH 03077
Dental Procedures
| Procedure | Estimate of Total Cost | Number of Visits | What You Will Pay Uninsured Discount: 0% |
|---|---|---|---|
| Dental Cleaning - Adult | $104 | N/A | $104 |
| Dental Cleaning - Child | $104 | N/A | $104 |
| Dental Exam - Comprehensive | $90 | N/A | $90 |
| Dental Exam - Periodic, Established Patient | $49 | N/A | $49 |
| Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent | $144 | N/A | $144 |
| Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $221 | N/A | $221 |
| Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent | $181 | N/A | $181 |
| Dental Filling - White (Resin): One Surface, Anterior | $164 | N/A | $164 |
| Dental Filling - White (Resin): One Surface, Posterior | $188 | N/A | $188 |
| Dental Filling - White (Resin): Two Surfaces, Anterior | $201 | N/A | $201 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $261 | N/A | $261 |
| Fluoride - Topical Application | $64 | N/A | $64 |
| Tooth Extraction - Elevation and/or Forceps Removal | $182 | N/A | $182 |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $63 | N/A | $63 |
| X-Ray - Intraoral, Periapical Radiographic Image | $33 | N/A | $33 |