Summit Dental
248 Pleasant Street, #202 Concord, NH 03301
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $131 | 0% | $131 | Medium |
| Child Dental Cleaning | $103 | 0% | $103 | Medium |
| Fluoride - Topical Application | $44 | 0% | $44 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $312 | 0% | $312 | Medium |
| Sealant placed on the tooth surface to prevent decay | $68 | 0% | $68 | Medium |
| Topical fluoride varnish application | $51 | 0% | $51 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $108 | 0% | $108 | Medium |
| Periodic dental exam - established patient | $78 | 0% | $78 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $126 | 0% | $126 | Medium |
| X-Ray Dental - Complete intraoral series | $198 | 0% | $198 | Medium |
| X-Ray Dental - Four images - bitewings | $147 | 0% | $147 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $50 | 0% | $50 | Medium |
| X-Ray Dental - Two images - bitewings | $97 | 0% | $97 | 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 | $126 | 0% | $126 | 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 | $209 | 0% | $209 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $271 | 0% | $271 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $351 | 0% | $351 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $209 | 0% | $209 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $271 | 0% | $271 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $198 | 0% | $198 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $343 | 0% | $343 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $236 | 0% | $236 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $89 | 0% | $89 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $177 | 0% | $177 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $245 | 0% | $245 | Medium |