Santavicca Dental Professionals

367 Route 120, Suite C Lebanon, NH 03766
https://www.santaviccadental.com/
(603) 782-0329

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).

Uninsured Discount: 0%
Additional X-Ray Image of Tooth from Crown to Root from Inside Mouth $27 N/A $27
Adult Dental Cleaning $107 N/A $107
Anterior Tooth Root Canal $978 N/A $978
Bicuspid Tooth Root Canal $983 N/A $983
Child Dental Cleaning $86 N/A $86
Complete Intraoral X-Ray Series $152 N/A $152
Comprehensive Dental Exam $99 N/A $99
Dental Crown, Porcelain/Ceramic $1,347 N/A $1,347
Four Bitewing X-Ray Images $75 N/A $75
Intraoral X-Ray, Periapical Radiographic Image $33 N/A $33
Maintenance Therapy $152 N/A $152
Periodic Dental Exam for an Established Patient $65 N/A $65
Placing Sealant on Tooth Surface to Prevent Decay $59 N/A $59
Plaque and Tartar Removal Around Teeth and Gums, Per Quadrant $540 N/A $540
Problem Focused Evaluation, Limited to a Specific Oral Health Problem or Complaint $92 N/A $92
Silver (Amalgam) Dental Filling: One Surface, Primary or Permanent $236 N/A $236
Silver (Amalgam) Dental Filling: Three Surfaces, Primary or Permanent $348 N/A $348
Silver (Amalgam) Dental Filling: Two Surfaces, Primary or Permanent $275 N/A $275
Tooth Extraction, Elevation and/or Forceps Removal $191 N/A $191
Topical Fluoride Application $44 N/A $44
Topical Varnish Fluoride Application $44 N/A $44
Two Bitewing X-Ray Images $54 N/A $54
White (Resin) Dental Filling: One Surface, Anterior $174 N/A $174
White (Resin) Dental Filling: One Surface, Posterior $196 N/A $196
White (Resin) Dental Filling: Three Surfaces, Posterior $348 N/A $348
White (Resin) Dental Filling: Two Surfaces, Anterior $216 N/A $216
White (Resin) Dental Filling: Two Surfaces, Posterior $275 N/A $275
Whole Mouth X-Ray from Outside Mouth $131 N/A $131