MID-STATE Health Center

859 Lake Street Bristol, NH 03222
Dental Procedures
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ProcedureEstimate of Total Cost Number of Visits What You Will Pay Uninsured Discount: 0%
Dental Cleaning - Adult$110N/A$110
Dental Cleaning - Child$84N/A$84
Dental Exam - Comprehensive$100N/A$100
Dental Exam - Periodic, Established Patient$58N/A$58
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$215N/A$215
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$368N/A$368
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$268N/A$268
Dental Filling - White (Resin): One Surface, Anterior$189N/A$189
Dental Filling - White (Resin): One Surface, Posterior$215N/A$215
Dental Filling - White (Resin): Three Surfaces, Posterior$368N/A$368
Dental Filling - White (Resin): Two Surfaces, Anterior$221N/A$221
Dental Filling - White (Resin): Two Surfaces, Posterior$268N/A$268
Flouride - Topical Varnish Application$47N/A$47
Maintenance Therapy - Periodontal$152N/A$152
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$278N/A$278
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$95N/A$95
Sealant - Placed on Tooth Surface to Prevent Decay$58N/A$58
Tooth Extraction - Elevation and/or Forceps Removal$210N/A$210
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$27N/A$27
X-Ray - Complete Intraoral Series$158N/A$158
X-Ray - Four Images, Bitewings$74N/A$74
X-Ray - Intraoral, Periapical Radiographic Image$37N/A$37
X-Ray - Two Images, Bitewings$53N/A$53
X-Ray - Whole Mouth from Outside Mouth$137N/A$137