Robert J. Larocque, DDS FAGD
76 Northeastern Blvd Streete 35a Nashua, NH 03062
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $124 | 0% | $124 | Medium |
| Child Dental Cleaning | $102 | 0% | $102 | Medium |
| Fluoride - Topical Application | $47 | 0% | $47 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $297 | 0% | $297 | Medium |
| Sealant placed on the tooth surface to prevent decay | $62 | 0% | $62 | 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 | $165 | 0% | $165 | Medium |
| Periodic dental exam - established patient | $57 | 0% | $57 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $79 | 0% | $79 | Medium |
| X-Ray Dental - Complete intraoral series | $189 | 0% | $189 | Medium |
| X-Ray Dental - Four images - bitewings | $84 | 0% | $84 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $48 | 0% | $48 | Medium |
| X-Ray Dental - Two images - bitewings | $59 | 0% | $59 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $179 | 0% | $179 | 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 | $217 | 0% | $217 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $268 | 0% | $268 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $377 | 0% | $377 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $217 | 0% | $217 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $276 | 0% | $276 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $214 | 0% | $214 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $377 | 0% | $377 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $229 | 0% | $229 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $173 | 0% | $173 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $215 | 0% | $215 | Medium |