Tri-County Community Action

448b White Mountain Highway Tamworth, NH 03886
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$990%$99 Medium
Dental Cleaning - Child$990%$99 Medium
Dental Exam - Comprehensive$960%$96 Medium
Dental Exam - Periodic, Established Patient$540%$54 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1840%$184 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$3110%$311 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2420%$242 Medium
Dental Filling - White (Resin): One Surface, Anterior$1670%$167 Medium
Dental Filling - White (Resin): One Surface, Posterior$1930%$193 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$2960%$296 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2130%$213 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2540%$254 Medium
Fluoride - Topical Application$480%$48 Medium
Maintenance Therapy - Periodontal$1530%$153 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2750%$275 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$830%$83 Medium
Root Canal - Molar$1,7850%$1,785 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$570%$57 Medium
Tooth Extraction - Elevation and/or Forceps Removal$1930%$193 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$260%$26 Medium
X-Ray - Complete Intraoral Series$1460%$146 Medium
X-Ray - Four Images, Bitewings$710%$71 Medium
X-Ray - Intraoral, Periapical Radiographic Image$300%$30 Medium
X-Ray - Two Images, Bitewings$760%$76 Medium
X-Ray - Whole Mouth from Outside Mouth$1520%$152 Medium