Stiles Family Dentistry
32 Streetiles Road, #205 Salem, NH 03079
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $121 | 0% | $121 | Medium |
| Child Dental Cleaning | $101 | 0% | $101 | Medium |
| Fluoride - Topical Application | $49 | 0% | $49 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $314 | 0% | $314 | Medium |
| Sealant placed on the tooth surface to prevent decay | $76 | 0% | $76 | Medium |
| Topical fluoride varnish application | $53 | 0% | $53 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $121 | 0% | $121 | Medium |
| Periodic dental exam - established patient | $59 | 0% | $59 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $142 | 0% | $142 | Medium |
| X-Ray Dental - Complete intraoral series | $194 | 0% | $194 | Medium |
| X-Ray Dental - Four images - bitewings | $81 | 0% | $81 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $38 | 0% | $38 | Medium |
| X-Ray Dental - Two images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $35 | 0% | $35 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $168 | 0% | $168 | 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 | $257 | 0% | $257 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $324 | 0% | $324 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $443 | 0% | $443 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $249 | 0% | $249 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $324 | 0% | $324 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $226 | 0% | $226 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $443 | 0% | $443 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $227 | 0% | $227 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $184 | 0% | $184 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $221 | 0% | $221 | Medium |