Paul Thompson, DDS
222 River Road Manchester, NH 03104
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $102 | 0% | $102 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $260 | 0% | $260 | Medium |
| Sealant placed on the tooth surface to prevent decay | $68 | 0% | $68 | Medium |
| Topical fluoride varnish application | $37 | 0% | $37 | 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 | $51 | 0% | $51 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $105 | 0% | $105 | Medium |
| X-Ray Dental - Complete intraoral series | $143 | 0% | $143 | Medium |
| X-Ray Dental - Four images - bitewings | $81 | 0% | $81 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $44 | 0% | $44 | Medium |
| X-Ray Dental - Two images - bitewings | $65 | 0% | $65 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $35 | 0% | $35 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $137 | 0% | $137 | 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 | $196 | 0% | $196 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $257 | 0% | $257 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $334 | 0% | $334 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $223 | 0% | $223 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $209 | 0% | $209 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $334 | 0% | $334 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $222 | 0% | $222 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $156 | 0% | $156 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $243 | 0% | $243 | Medium |