Stephen Lee Langlois, DMD
765 S Main Street Manchester, NH 03102
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $151 | 0% | $151 | Medium |
| Child Dental Cleaning | $83 | 0% | $83 | Medium |
| Fluoride - Topical Application | $50 | 0% | $50 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $340 | 0% | $340 | Medium |
| Sealant placed on the tooth surface to prevent decay | $76 | 0% | $76 | Medium |
| Topical fluoride varnish application | $49 | 0% | $49 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $197 | 0% | $197 | Medium |
| Periodic dental exam - established patient | $63 | 0% | $63 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $103 | 0% | $103 | Medium |
| X-Ray Dental - Complete intraoral series | $200 | 0% | $200 | Medium |
| X-Ray Dental - Four images - bitewings | $80 | 0% | $80 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $35 | 0% | $35 | Medium |
| X-Ray Dental - Two images - bitewings | $58 | 0% | $58 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $21 | 0% | $21 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $130 | 0% | $130 | 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 | $269 | 0% | $269 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $345 | 0% | $345 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $431 | 0% | $431 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $269 | 0% | $269 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $345 | 0% | $345 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $269 | 0% | $269 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $443 | 0% | $443 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $322 | 0% | $322 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $161 | 0% | $161 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $296 | 0% | $296 | Medium |