Richard Michael Roy, DDS

103 Main Street Wilton, NH 03086
(603) 654-2555

All cost information is based on claims data collected in the New Hampshire Comprehensive Healthcare Information System which is updated quarterly. All quality information is based on claims and administrative data collected by the Centers for Medicare and Medicaid Services which is updated annually. For more information click the links above and review our methodology section.

Methodology
Procedure Estimate of Procedure Cost Estimate of Procedure Cost
This is an estimate of the total charge for the health care service before any discounts provided to the uninsured.
Number of Visits Number of Visits
When the number of visits varies, it is difficult to estimate the total cost of care. This indicates the number of visits you can expect, calculated using the median. To determine the total you might pay, multiply the Estimate of Procedure Cost and the Statewide Average for Number of Visits.
- Above Average: Expect to visit the provider more than the average number of visits.
- Near Average: Expect the visit the provider close to the average number of visits.
- Below Average: Expect to visit the provider less than the average number of visits.
What You Will Pay What You Will Pay
The estimated charge amount minus the uninsured discount (when available).
Additional X-Ray Image of Tooth from Crown to Root from Inside Mouth $33 N/A $33
Adult Dental Cleaning $122 N/A $122
Child Dental Cleaning $90 N/A $90
Complete Intraoral X-Ray Series $205 N/A $205
Comprehensive Dental Exam $104 N/A $104
Four Bitewing X-Ray Images $75 N/A $75
Intraoral X-Ray, Periapical Radiographic Image $44 N/A $44
Maintenance Therapy $171 N/A $171
Oral Hygiene Instructions $62 N/A $62
Periodic Dental Exam for an Established Patient $53 N/A $53
Placing Sealant on Tooth Surface to Prevent Decay $53 N/A $53
Plaque and Tartar Removal Around Teeth and Gums, Per Quadrant $293 N/A $293
Problem Focused Evaluation, Limited to a Specific Oral Health Problem or Complaint $102 N/A $102
Silver (Amalgam) Dental Filling: Three Surfaces, Primary or Permanent $329 N/A $329
Tooth Extraction, Elevation and/or Forceps Removal $204 N/A $204
Topical Varnish Fluoride Application $44 N/A $44
White (Resin) Dental Filling: One Surface, Posterior $208 N/A $208
White (Resin) Dental Filling: Three Surfaces, Posterior $329 N/A $329
White (Resin) Dental Filling: Two Surfaces, Anterior $259 N/A $259
White (Resin) Dental Filling: Two Surfaces, Posterior $271 N/A $271