Viena Posada, DMD
111 Bow Street, Suite 2 Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $125 | 0% | $125 | Medium |
| Child Dental Cleaning | $101 | 0% | $101 | Medium |
| Fluoride - Topical Application | $38 | 0% | $38 | Medium |
| Sealant placed on the tooth surface to prevent decay | $69 | 0% | $69 | Medium |
| Topical fluoride varnish application | $49 | 0% | $49 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $114 | 0% | $114 | Medium |
| Periodic dental exam - established patient | $59 | 0% | $59 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $106 | 0% | $106 | 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 | $61 | 0% | $61 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $33 | 0% | $33 | 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 | $265 | 0% | $265 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $408 | 0% | $408 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $226 | 0% | $226 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $314 | 0% | $314 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $196 | 0% | $196 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $408 | 0% | $408 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $271 | 0% | $271 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $43 | 0% | $43 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Tooth Extraction (Elevation and/or forceps removal) | $218 | 0% | $218 | Medium |