Plaistow Dental
157 Main Street Plaistow, NH 03865
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $110 | 0% | $110 | Medium |
| Child Dental Cleaning | $88 | 0% | $88 | Medium |
| Fluoride - Topical Application | $46 | 0% | $46 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $314 | 0% | $314 | Medium |
| Sealant placed on the tooth surface to prevent decay | $65 | 0% | $65 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $102 | 0% | $102 | Medium |
| Periodic dental exam - established patient | $59 | 0% | $59 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $152 | 0% | $152 | Medium |
| X-Ray Dental - Four images - bitewings | $75 | 0% | $75 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | 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 | $29 | 0% | $29 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $152 | 0% | $152 | 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 | $205 | 0% | $205 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $273 | 0% | $273 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $338 | 0% | $338 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $205 | 0% | $205 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $273 | 0% | $273 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $175 | 0% | $175 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $338 | 0% | $338 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $226 | 0% | $226 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $173 | 0% | $173 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $181 | 0% | $181 | Medium |