Upper Valley Pediatric Dentistry
30 Airport Road, Suite 1 West Lebanon, NH 03784http://uvpediatricdentistry.com/ (603) 790-8130
All cost information is based on claims data collected in the New Hampshire Comprehensive Healthcare Information System which is updated quarterly. All quality information is based on claims and administrative data collected by the Centers for Medicare and Medicaid Services which is updated annually. For more information click the links above and review our methodology section.
Methodology| Procedure |
Estimate of Procedure Cost
Estimate of Procedure Cost This is an estimate of the total charge for the health care service before any discounts provided to the uninsured. |
Number of Visits
Number of Visits When the number of visits varies, it is difficult to estimate the total cost of care. This indicates the number of visits you can expect, calculated using the median. To determine the total you might pay, multiply the Estimate of Procedure Cost and the Statewide Average for Number of Visits. - Above Average: Expect to visit the provider more than the average number of visits. - Near Average: Expect the visit the provider close to the average number of visits. - Below Average: Expect to visit the provider less than the average number of visits. |
What You Will Pay
What You Will Pay The estimated charge amount minus the uninsured discount (when available). |
|---|---|---|---|
| Additional X-Ray Image of Tooth from Crown to Root from Inside Mouth | $32 | N/A | $32 |
| Adult Dental Cleaning | $122 | N/A | $122 |
| Child Dental Cleaning | $98 | N/A | $98 |
| Complete Intraoral X-Ray Series | $234 | N/A | $234 |
| Comprehensive Dental Exam | $106 | N/A | $106 |
| Four Bitewing X-Ray Images | $83 | N/A | $83 |
| Intraoral X-Ray, Periapical Radiographic Image | $39 | N/A | $39 |
| Periodic Dental Exam for an Established Patient | $58 | N/A | $58 |
| Periodic Orthodontic Treatment Visit, Part of a Contract | $72 | N/A | $72 |
| Placing Sealant on Tooth Surface to Prevent Decay | $68 | N/A | $68 |
| Problem Focused Evaluation, Limited to a Specific Oral Health Problem or Complaint | $103 | N/A | $103 |
| Silver (Amalgam) Dental Filling: One Surface, Primary or Permanent | $221 | N/A | $221 |
| Silver (Amalgam) Dental Filling: Three Surfaces, Primary or Permanent | $401 | N/A | $401 |
| Silver (Amalgam) Dental Filling: Two Surfaces, Primary or Permanent | $308 | N/A | $308 |
| Tooth Extraction, Elevation and/or Forceps Removal | $221 | N/A | $221 |
| Topical Varnish Fluoride Application | $53 | N/A | $53 |
| Two Bitewing X-Ray Images | $83 | N/A | $83 |
| White (Resin) Dental Filling: One Surface, Anterior | $210 | N/A | $210 |
| White (Resin) Dental Filling: One Surface, Posterior | $221 | N/A | $221 |
| White (Resin) Dental Filling: Three Surfaces, Posterior | $401 | N/A | $401 |
| White (Resin) Dental Filling: Two Surfaces, Anterior | $242 | N/A | $242 |
| White (Resin) Dental Filling: Two Surfaces, Posterior | $308 | N/A | $308 |
| Whole Mouth X-Ray from Outside Mouth | $151 | N/A | $151 |
Before seeking care, contact your health or dental insurance company to confirm if a provider is covered by your plan.