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 | $105 | 0% | $105 | Medium |
| Child Dental Cleaning | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $44 | 0% | $44 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $299 | 0% | $299 | Medium |
| Sealant placed on the tooth surface to prevent decay | $62 | 0% | $62 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $97 | 0% | $97 | Medium |
| Periodic dental exam - established patient | $56 | 0% | $56 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $145 | 0% | $145 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Two images - bitewings | $51 | 0% | $51 | 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 | $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 | $195 | 0% | $195 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $260 | 0% | $260 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $338 | 0% | $338 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $195 | 0% | $195 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $260 | 0% | $260 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $171 | 0% | $171 | 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 | $165 | 0% | $165 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $181 | 0% | $181 | Medium |