New Hampshire Family Dentistry
2626 Brown Ave Manchester, NH 03103
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $104 | 0% | $104 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $289 | 0% | $289 | Medium |
| Sealant placed on the tooth surface to prevent decay | $63 | 0% | $63 | Medium |
| Topical fluoride varnish application | $43 | 0% | $43 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $95 | 0% | $95 | Medium |
| Periodic dental exam - established patient | $60 | 0% | $60 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $95 | 0% | $95 | Medium |
| X-Ray Dental - Complete intraoral series | $158 | 0% | $158 | Medium |
| X-Ray Dental - Four images - bitewings | $86 | 0% | $86 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Two images - bitewings | $67 | 0% | $67 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $36 | 0% | $36 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $158 | 0% | $158 | 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 | $194 | 0% | $194 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $273 | 0% | $273 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $341 | 0% | $341 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $194 | 0% | $194 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $273 | 0% | $273 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $173 | 0% | $173 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $341 | 0% | $341 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $205 | 0% | $205 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $93 | 0% | $93 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $168 | 0% | $168 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $202 | 0% | $202 | Medium |