Sajini Shetty, DMD
297 Daniel Webster Hwy, #6 Merrimack, NH 03054
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $118 | 0% | $118 | Medium |
| Child Dental Cleaning | $98 | 0% | $98 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $319 | 0% | $319 | Medium |
| Sealant placed on the tooth surface to prevent decay | $76 | 0% | $76 | 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 | $105 | 0% | $105 | Medium |
| Periodic dental exam - established patient | $61 | 0% | $61 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $104 | 0% | $104 | Medium |
| X-Ray Dental - Complete intraoral series | $168 | 0% | $168 | Medium |
| X-Ray Dental - Four images - bitewings | $84 | 0% | $84 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | Medium |
| X-Ray Dental - Two images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $37 | 0% | $37 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $168 | 0% | $168 | 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 | $263 | 0% | $263 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $350 | 0% | $350 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $423 | 0% | $423 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $271 | 0% | $271 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $350 | 0% | $350 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $276 | 0% | $276 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $423 | 0% | $423 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $305 | 0% | $305 | 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) | $141 | 0% | $141 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $168 | 0% | $168 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $265 | 0% | $265 | Medium |