Portsmouth Pediatric Dentistry
150 Griffin Road, #1 Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $103 | 0% | $103 | Medium |
| Child Dental Cleaning | $101 | 0% | $101 | Medium |
| Fluoride - Topical Application | $51 | 0% | $51 | Medium |
| Sealant placed on the tooth surface to prevent decay | $69 | 0% | $69 | Medium |
| Topical fluoride varnish application | $61 | 0% | $61 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $117 | 0% | $117 | Medium |
| Periodic dental exam - established patient | $61 | 0% | $61 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $105 | 0% | $105 | Medium |
| X-Ray Dental - Complete intraoral series | $152 | 0% | $152 | Medium |
| X-Ray Dental - Four images - bitewings | $86 | 0% | $86 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | Medium |
| X-Ray Dental - Two images - bitewings | $61 | 0% | $61 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $33 | 0% | $33 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $153 | 0% | $153 | 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 | $203 | 0% | $203 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $216 | 0% | $216 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $265 | 0% | $265 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $236 | 0% | $236 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $311 | 0% | $311 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $208 | 0% | $208 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $404 | 0% | $404 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $239 | 0% | $239 | 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) | $221 | 0% | $221 | Medium |