My Dentist
25 Buttrick Road Londonderry, NH 03053
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $126 | 0% | $126 | Medium |
| Child Dental Cleaning | $100 | 0% | $100 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $331 | 0% | $331 | Medium |
| Sealant placed on the tooth surface to prevent decay | $68 | 0% | $68 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $131 | 0% | $131 | Medium |
| Periodic dental exam - established patient | $68 | 0% | $68 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $105 | 0% | $105 | Medium |
| X-Ray Dental - Complete intraoral series | $184 | 0% | $184 | Medium |
| X-Ray Dental - Four images - bitewings | $89 | 0% | $89 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $55 | 0% | $55 | Medium |
| X-Ray Dental - Two images - bitewings | $47 | 0% | $47 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $47 | 0% | $47 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $168 | 0% | $168 | 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 | $223 | 0% | $223 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $404 | 0% | $404 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $194 | 0% | $194 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $404 | 0% | $404 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $236 | 0% | $236 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $179 | 0% | $179 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $231 | 0% | $231 | Medium |