Upper Valley Pediatric Dentistry

30 Airport Road, Suite 1 West Lebanon, NH 03784
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$1220%$122 Medium
Dental Cleaning - Child$980%$98 Medium
Dental Exam - Comprehensive$1060%$106 Medium
Dental Exam - Periodic, Established Patient$580%$58 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$2210%$221 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$2730%$273 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$3080%$308 Medium
Dental Filling - White (Resin): One Surface, Anterior$2000%$200 Medium
Dental Filling - White (Resin): One Surface, Posterior$2210%$221 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$4010%$401 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$2420%$242 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$3080%$308 Medium
Flouride - Topical Varnish Application$530%$53 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$1030%$103 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$680%$68 Medium
Tooth Extraction - Elevation and/or Forceps Removal$2210%$221 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$320%$32 Medium
X-Ray - Complete Intraoral Series$2340%$234 Medium
X-Ray - Four Images, Bitewings$830%$83 Medium
X-Ray - Intraoral, Periapical Radiographic Image$390%$39 Medium
X-Ray - Two Images, Bitewings$590%$59 Medium
X-Ray - Whole Mouth from Outside Mouth$1510%$151 Medium