Piscataqua Dental Partners
288 Lafayette Road, #3, Bldg A Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $107 | 0% | $107 | Medium |
| Child Dental Cleaning | $74 | 0% | $74 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $297 | 0% | $297 | Medium |
| Sealant placed on the tooth surface to prevent decay | $66 | 0% | $66 | 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 | $106 | 0% | $106 | Medium |
| Periodic dental exam - established patient | $62 | 0% | $62 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $93 | 0% | $93 | Medium |
| X-Ray Dental - Complete intraoral series | $172 | 0% | $172 | Medium |
| X-Ray Dental - Four images - bitewings | $76 | 0% | $76 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Two images - bitewings | $54 | 0% | $54 | 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 | $151 | 0% | $151 | 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 | $171 | 0% | $171 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $213 | 0% | $213 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $250 | 0% | $250 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $212 | 0% | $212 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $291 | 0% | $291 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $195 | 0% | $195 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $354 | 0% | $354 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $238 | 0% | $238 | 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) | $51 | 0% | $51 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $149 | 0% | $149 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $223 | 0% | $223 | Medium |