Pamela Lynn Weitzel, DMD
656 Main Street Contoocook, NH 03229
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $91 | 0% | $91 | Medium |
| Child Dental Cleaning | $69 | 0% | $69 | Medium |
| Fluoride - Topical Application | $35 | 0% | $35 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $229 | 0% | $229 | Medium |
| Sealant placed on the tooth surface to prevent decay | $48 | 0% | $48 | Medium |
| Topical fluoride varnish application | $36 | 0% | $36 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $77 | 0% | $77 | Medium |
| Periodic dental exam - established patient | $42 | 0% | $42 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $74 | 0% | $74 | Medium |
| X-Ray Dental - Complete intraoral series | $126 | 0% | $126 | Medium |
| X-Ray Dental - Four images - bitewings | $63 | 0% | $63 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $29 | 0% | $29 | Medium |
| X-Ray Dental - Two images - bitewings | $43 | 0% | $43 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $23 | 0% | $23 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $116 | 0% | $116 | 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 | $126 | 0% | $126 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $151 | 0% | $151 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $187 | 0% | $187 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $153 | 0% | $153 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $138 | 0% | $138 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $280 | 0% | $280 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $169 | 0% | $169 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $250 | 0% | $250 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $305 | 0% | $305 | Medium |