Peraza Dermatology Group
367 Route 120, Suite A1 Lebanon, NH 03766
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $98 | 0% | $98 | Medium |
| Child Dental Cleaning | $72 | 0% | $72 | Medium |
| Sealant placed on the tooth surface to prevent decay | $55 | 0% | $55 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $76 | 0% | $76 | Medium |
| Periodic dental exam - established patient | $45 | 0% | $45 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $69 | 0% | $69 | Medium |
| X-Ray Dental - Complete intraoral series | $135 | 0% | $135 | Medium |
| X-Ray Dental - Four images - bitewings | $62 | 0% | $62 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $27 | 0% | $27 | Medium |
| X-Ray Dental - Two images - bitewings | $44 | 0% | $44 | 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 | $108 | 0% | $108 | 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 | $156 | 0% | $156 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $201 | 0% | $201 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $208 | 0% | $208 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $156 | 0% | $156 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $205 | 0% | $205 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $143 | 0% | $143 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $272 | 0% | $272 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $175 | 0% | $175 | 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) | $161 | 0% | $161 | Medium |