Sullivan County Oral Health Collaborative

1 Tremont Street Claremont, NH 03743
http://www.communitydentalnh.org/
(603) 287-1300

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 $25 N/A $25
Adult Dental Cleaning $104 N/A $104
Complete Intraoral X-Ray Series $147 N/A $147
Comprehensive Dental Exam $109 N/A $109
Dental Crown, Porcelain/Ceramic $1,213 N/A $1,213
Four Bitewing X-Ray Images $69 N/A $69
Intraoral X-Ray, Periapical Radiographic Image $37 N/A $37
Maintenance Therapy $150 N/A $150
Periodic Dental Exam for an Established Patient $54 N/A $54
Problem Focused Evaluation, Limited to a Specific Oral Health Problem or Complaint $79 N/A $79
Silver (Amalgam) Dental Filling: One Surface, Primary or Permanent $189 N/A $189
Tooth Extraction, Elevation and/or Forceps Removal $203 N/A $203
Topical Varnish Fluoride Application $43 N/A $43
White (Resin) Dental Filling: One Surface, Anterior $168 N/A $168
White (Resin) Dental Filling: One Surface, Posterior $189 N/A $189
White (Resin) Dental Filling: Three Surfaces, Posterior $342 N/A $342
White (Resin) Dental Filling: Two Surfaces, Anterior $210 N/A $210
White (Resin) Dental Filling: Two Surfaces, Posterior $263 N/A $263
Whole Mouth X-Ray from Outside Mouth $131 N/A $131