Ralph Peter Ergas, DMD
700 Central Ave Dover, NH 03820
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 | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $29 | 0% | $29 | Medium |
| Sealant placed on the tooth surface to prevent decay | $68 | 0% | $68 | Medium |
| Topical fluoride varnish application | $49 | 0% | $49 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $79 | 0% | $79 | Medium |
| Periodic dental exam - established patient | $58 | 0% | $58 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $84 | 0% | $84 | Medium |
| X-Ray Dental - Complete intraoral series | $231 | 0% | $231 | Medium |
| X-Ray Dental - Four images - bitewings | $86 | 0% | $86 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Two images - bitewings | $63 | 0% | $63 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $37 | 0% | $37 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $168 | 0% | $168 | 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 | $168 | 0% | $168 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $194 | 0% | $194 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $227 | 0% | $227 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $171 | 0% | $171 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $221 | 0% | $221 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $166 | 0% | $166 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $249 | 0% | $249 | 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) | $184 | 0% | $184 | Medium |