Ramesh Durvasula, DMD
345 Cilley Road Manchester, NH 03103
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $86 | 0% | $86 | Medium |
| Child Dental Cleaning | $69 | 0% | $69 | Medium |
| Fluoride - Topical Application | $32 | 0% | $32 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $221 | 0% | $221 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Periodic dental exam - established patient | $42 | 0% | $42 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $72 | 0% | $72 | Medium |
| X-Ray Dental - Complete intraoral series | $165 | 0% | $165 | Medium |
| X-Ray Dental - Four images - bitewings | $58 | 0% | $58 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $26 | 0% | $26 | Medium |
| X-Ray Dental - Two images - bitewings | $42 | 0% | $42 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $21 | 0% | $21 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $107 | 0% | $107 | 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 | $116 | 0% | $116 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $158 | 0% | $158 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $158 | 0% | $158 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $125 | 0% | $125 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $147 | 0% | $147 | Medium |