Rothenwitz Dental Partnership

19d Manchester Road Derry, NH 03038
Dental Procedures
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My Health Insurance:

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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1280%$128 Medium
Dental Cleaning - Child$1030%$103 Medium
Dental Exam - Comprehensive$1280%$128 Medium
Dental Exam - Periodic, Established Patient$770%$77 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2700%$270 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3930%$393 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$3210%$321 Medium
Dental Filling - White (Resin): One Surface, Anterior$2570%$257 Medium
Dental Filling - White (Resin): One Surface, Posterior$2700%$270 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$3930%$393 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2860%$286 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$3210%$321 Medium
Fluoride - Topical Application$460%$46 Medium
Maintenance Therapy - Periodontal$1910%$191 Medium
Orthodontic Treatment - Periodic Visit, Part of a Contract$1390%$139 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$3570%$357 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$1100%$110 Medium
Root Canal - Anterior Tooth$1,0210%$1,021 Medium
Root Canal - Bicuspid Tooth$1,1690%$1,169 Medium
Root Canal - Molar$1,4580%$1,458 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$790%$79 Medium
Tooth Extraction - Elevation and/or Forceps Removal$2750%$275 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$360%$36 Medium
X-Ray - Complete Intraoral Series$2000%$200 Medium
X-Ray - Four Images, Bitewings$890%$89 Medium
X-Ray - Intraoral, Periapical Radiographic Image$460%$46 Medium
X-Ray - Two Images, Bitewings$610%$61 Medium
X-Ray - Whole Mouth from Outside Mouth$1580%$158 Medium