Tri-County Community Action
448b White Mountain Highway Tamworth, NH 03886
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay |
|---|---|---|---|
| Dental Cleaning - Adult | $89 | 0% | $89 |
| Dental Exam - Comprehensive | $77 | 0% | $77 |
| Dental Exam - Periodic, Established Patient | $62 | 0% | $62 |
| Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent | $281 | 0% | $281 |
| Dental Filling - White (Resin): One Surface, Posterior | $168 | 0% | $168 |
| Dental Filling - White (Resin): Two Surfaces, Anterior | $236 | 0% | $236 |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $221 | 0% | $221 |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $74 | 0% | $74 |
| Tooth Extraction - Elevation and/or Forceps Removal | $167 | 0% | $167 |
| X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth | $32 | 0% | $32 |
| X-Ray - Complete Intraoral Series | $157 | 0% | $157 |
| X-Ray - Four Images, Bitewings | $63 | 0% | $63 |
| X-Ray - Intraoral, Periapical Radiographic Image | $32 | 0% | $32 |
| X-Ray - Whole Mouth from Outside Mouth | $126 | 0% | $126 |