Randazzo Dental Associates
43 Bridge Street, #6 Pelham, NH 03076
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $106 | 0% | $106 | Medium |
| Child Dental Cleaning | $120 | 0% | $120 | Medium |
| Fluoride - Topical Application | $52 | 0% | $52 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $395 | 0% | $395 | Medium |
| Sealant placed on the tooth surface to prevent decay | $55 | 0% | $55 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $109 | 0% | $109 | Medium |
| Periodic dental exam - established patient | $48 | 0% | $48 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $86 | 0% | $86 | Medium |
| X-Ray Dental - Complete intraoral series | $218 | 0% | $218 | Medium |
| X-Ray Dental - Four images - bitewings | $88 | 0% | $88 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $32 | 0% | $32 | Medium |
| X-Ray Dental - Two images - bitewings | $49 | 0% | $49 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $32 | 0% | $32 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $126 | 0% | $126 | 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 | $177 | 0% | $177 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $245 | 0% | $245 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $299 | 0% | $299 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $177 | 0% | $177 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $321 | 0% | $321 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $164 | 0% | $164 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $391 | 0% | $391 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $245 | 0% | $245 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $79 | 0% | $79 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $212 | 0% | $212 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $172 | 0% | $172 | Medium |