Thomas R. Bacon, DDS
200 Broad Street Claremont, NH 03743
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $107 | 0% | $107 | Medium |
| Child Dental Cleaning | $82 | 0% | $82 | Medium |
| Sealant placed on the tooth surface to prevent decay | $61 | 0% | $61 | Medium |
| Topical fluoride varnish application | $27 | 0% | $27 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Periodic dental exam - established patient | $62 | 0% | $62 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $87 | 0% | $87 | Medium |
| X-Ray Dental - Complete intraoral series | $149 | 0% | $149 | Medium |
| X-Ray Dental - Four images - bitewings | $72 | 0% | $72 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $33 | 0% | $33 | Medium |
| X-Ray Dental - Two images - bitewings | $49 | 0% | $49 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $26 | 0% | $26 | 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 | $196 | 0% | $196 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $196 | 0% | $196 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $182 | 0% | $182 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $334 | 0% | $334 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $223 | 0% | $223 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $158 | 0% | $158 | Medium |