New Hampshire Dental Design
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay |
|---|---|---|---|
| Dental Cleaning - Adult | $113 | 0% | $113 |
| Dental Exam - Comprehensive | $110 | 0% | $110 |
| Dental Exam - Periodic, Established Patient | $53 | 0% | $53 |
| Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent | $218 | 0% | $218 |
| Dental Filling - White (Resin): One Surface, Posterior | $208 | 0% | $208 |
| Dental Filling - White (Resin): Three Surfaces, Posterior | $369 | 0% | $369 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $296 | 0% | $296 |
| Maintenance Therapy - Periodontal | $164 | 0% | $164 |
| Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant | $348 | 0% | $348 |
| Root Canal - Bicuspid Tooth | $1,452 | 0% | $1,452 |
| Root Canal - Molar | $1,595 | 0% | $1,595 |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $28 | 0% | $28 |
| X-Ray - Complete Intraoral Series | $172 | 0% | $172 |
| X-Ray - Four Images, Bitewings | $83 | 0% | $83 |
| X-Ray - Intraoral, Periapical Radiographic Image | $37 | 0% | $37 |