Raynor Dental
650 Court Street, Suite 4 Keene, NH 03431
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $112 | 0% | $112 | Medium |
| Child Dental Cleaning | $85 | 0% | $85 | Medium |
| Fluoride - Topical Application | $48 | 0% | $48 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $305 | 0% | $305 | Medium |
| Sealant placed on the tooth surface to prevent decay | $71 | 0% | $71 | Medium |
| Topical fluoride varnish application | $48 | 0% | $48 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $104 | 0% | $104 | Medium |
| Periodic dental exam - established patient | $57 | 0% | $57 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $89 | 0% | $89 | Medium |
| X-Ray Dental - Complete intraoral series | $160 | 0% | $160 | Medium |
| X-Ray Dental - Four images - bitewings | $81 | 0% | $81 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $38 | 0% | $38 | Medium |
| X-Ray Dental - Two images - bitewings | $50 | 0% | $50 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $30 | 0% | $30 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $134 | 0% | $134 | 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 | $218 | 0% | $218 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $289 | 0% | $289 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $372 | 0% | $372 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $218 | 0% | $218 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $289 | 0% | $289 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $203 | 0% | $203 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $372 | 0% | $372 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $246 | 0% | $246 | 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) | $107 | 0% | $107 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $162 | 0% | $162 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $252 | 0% | $252 | Medium |