Siddhi Mehta, DMD
581 2nd St Manchester, NH 03102
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $113 | 0% | $113 | Medium |
| Child Dental Cleaning | $91 | 0% | $91 | Medium |
| Fluoride - Topical Application | $47 | 0% | $47 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $299 | 0% | $299 | Medium |
| Sealant placed on the tooth surface to prevent decay | $80 | 0% | $80 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $99 | 0% | $99 | Medium |
| Periodic dental exam - established patient | $55 | 0% | $55 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $96 | 0% | $96 | Medium |
| X-Ray Dental - Complete intraoral series | $159 | 0% | $159 | Medium |
| X-Ray Dental - Four images - bitewings | $78 | 0% | $78 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $37 | 0% | $37 | 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 | $30 | 0% | $30 | 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 | $205 | 0% | $205 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $286 | 0% | $286 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $205 | 0% | $205 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $286 | 0% | $286 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $179 | 0% | $179 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $218 | 0% | $218 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $164 | 0% | $164 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $197 | 0% | $197 | Medium |