Paul C Schoenbeck, DMD
22 Exchange Street Gorham, NH 03581
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 | $88 | 0% | $88 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $331 | 0% | $331 | Medium |
| Sealant placed on the tooth surface to prevent decay | $61 | 0% | $61 | 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 | $104 | 0% | $104 | Medium |
| Periodic dental exam - established patient | $51 | 0% | $51 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $92 | 0% | $92 | Medium |
| X-Ray Dental - Complete intraoral series | $182 | 0% | $182 | Medium |
| X-Ray Dental - Four images - bitewings | $82 | 0% | $82 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $36 | 0% | $36 | Medium |
| X-Ray Dental - Two images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $28 | 0% | $28 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $135 | 0% | $135 | 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 | $216 | 0% | $216 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $286 | 0% | $286 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $372 | 0% | $372 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $216 | 0% | $216 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $286 | 0% | $286 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $206 | 0% | $206 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $372 | 0% | $372 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $255 | 0% | $255 | 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) | $92 | 0% | $92 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $160 | 0% | $160 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $215 | 0% | $215 | Medium |