North Manchester Oral and Maxillofacial Surgery
27 Sagamore Street Manchester, NH 03104
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Child Dental Cleaning | $126 | 0% | $126 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $166 | 0% | $166 | Medium |
| Periodic dental exam - established patient | $79 | 0% | $79 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $105 | 0% | $105 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $42 | 0% | $42 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $37 | 0% | $37 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $176 | 0% | $176 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Tooth Extraction (Elevation and/or forceps removal) | $289 | 0% | $289 | Medium |