Salem Family Dental
220 Main Street Salem, NH 03079
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $104 | 0% | $104 | Medium |
| Child Dental Cleaning | $78 | 0% | $78 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Sealant placed on the tooth surface to prevent decay | $61 | 0% | $61 | Medium |
| Topical fluoride varnish application | $43 | 0% | $43 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $90 | 0% | $90 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $87 | 0% | $87 | Medium |
| X-Ray Dental - Complete intraoral series | $145 | 0% | $145 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Two images - bitewings | $56 | 0% | $56 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $35 | 0% | $35 | 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 | $168 | 0% | $168 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $215 | 0% | $215 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $252 | 0% | $252 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $168 | 0% | $168 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $166 | 0% | $166 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $252 | 0% | $252 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $213 | 0% | $213 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $153 | 0% | $153 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $200 | 0% | $200 | Medium |