New Hampshire Dental Design
101 Shattuck Way Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $108 | 0% | $108 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $272 | 0% | $272 | Medium |
| Topical fluoride varnish application | $26 | 0% | $26 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $112 | 0% | $112 | Medium |
| Periodic dental exam - established patient | $50 | 0% | $50 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $86 | 0% | $86 | Medium |
| X-Ray Dental - Complete intraoral series | $164 | 0% | $164 | Medium |
| X-Ray Dental - Four images - bitewings | $75 | 0% | $75 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $26 | 0% | $26 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $267 | 0% | $267 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $330 | 0% | $330 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $234 | 0% | $234 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $316 | 0% | $316 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $234 | 0% | $234 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $334 | 0% | $334 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $156 | 0% | $156 | Medium |