Peterson Family Dental

240 Locust Street Dover, NH 03820
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Dental Cleaning - Adult$1040%$104
Dental Cleaning - Child$760%$76
Dental Exam - Comprehensive$910%$91
Dental Exam - Periodic, Established Patient$500%$50
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1770%$177
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3130%$313
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2510%$251
Dental Filling - White (Resin): One Surface, Anterior$1590%$159
Dental Filling - White (Resin): One Surface, Posterior$1770%$177
Dental Filling - White (Resin): Three Surfaces, Posterior$3320%$332
Dental Filling - White (Resin): Two Surfaces, Anterior$2050%$205
Dental Filling - White (Resin): Two Surfaces, Posterior$2510%$251
Flouride - Topical Varnish Application$430%$43
Fluoride - Topical Application$410%$41
Maintenance Therapy - Periodontal$1390%$139
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2540%$254
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$890%$89
Root Canal - Anterior Tooth$8010%$801
Root Canal - Bicuspid Tooth$1,3940%$1,394
Sealant - Placed on Tooth Surface to Prevent Decay$560%$56
Tooth Extraction - Elevation and/or Forceps Removal$1770%$177
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$250%$25
X-Ray - Complete Intraoral Series$1450%$145
X-Ray - Four Images, Bitewings$710%$71
X-Ray - Intraoral, Periapical Radiographic Image$350%$35
X-Ray - Two Images, Bitewings$510%$51
X-Ray - Whole Mouth from Outside Mouth$1310%$131