Tri-Town Family Dental
50 Pinwood Road Suncook, NH 03275
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $105 | 0% | $105 | Medium |
| Child Dental Cleaning | $92 | 0% | $92 | Medium |
| Fluoride - Topical Application | $59 | 0% | $59 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $330 | 0% | $330 | Medium |
| Sealant placed on the tooth surface to prevent decay | $60 | 0% | $60 | Medium |
| Topical fluoride varnish application | $41 | 0% | $41 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $89 | 0% | $89 | Medium |
| Periodic dental exam - established patient | $59 | 0% | $59 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $105 | 0% | $105 | Medium |
| X-Ray Dental - Complete intraoral series | $174 | 0% | $174 | Medium |
| X-Ray Dental - Four images - bitewings | $86 | 0% | $86 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | Medium |
| X-Ray Dental - Two images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $27 | 0% | $27 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $153 | 0% | $153 | 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 | $208 | 0% | $208 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $264 | 0% | $264 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $334 | 0% | $334 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $208 | 0% | $208 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $264 | 0% | $264 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $166 | 0% | $166 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $391 | 0% | $391 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $201 | 0% | $201 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $210 | 0% | $210 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $229 | 0% | $229 | Medium |