Stephen A Sewall, DDS
9 Hampton Road Exeter, NH 03833
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $105 | 0% | $105 | Medium |
| Child Dental Cleaning | $84 | 0% | $84 | Medium |
| Fluoride - Topical Application | $42 | 0% | $42 | Medium |
| Sealant placed on the tooth surface to prevent decay | $53 | 0% | $53 | Medium |
| Topical fluoride varnish application | $42 | 0% | $42 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $63 | 0% | $63 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $139 | 0% | $139 | Medium |
| X-Ray Dental - Four images - bitewings | $71 | 0% | $71 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $26 | 0% | $26 | Medium |
| X-Ray Dental - Two images - bitewings | $44 | 0% | $44 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $16 | 0% | $16 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $116 | 0% | $116 | 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 | $147 | 0% | $147 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $179 | 0% | $179 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $226 | 0% | $226 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $186 | 0% | $186 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $261 | 0% | $261 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $505 | 0% | $505 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $397 | 0% | $397 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $131 | 0% | $131 | Medium |