Village Green Family Dentistry
33 Indian Rock Road Windham, NH 03087
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $116 | 0% | $116 | Medium |
| Child Dental Cleaning | $172 | 0% | $172 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $316 | 0% | $316 | Medium |
| Sealant placed on the tooth surface to prevent decay | $70 | 0% | $70 | Medium |
| Topical fluoride varnish application | $56 | 0% | $56 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $102 | 0% | $102 | Medium |
| Periodic dental exam - established patient | $56 | 0% | $56 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $97 | 0% | $97 | Medium |
| X-Ray Dental - Complete intraoral series | $170 | 0% | $170 | Medium |
| X-Ray Dental - Four images - bitewings | $83 | 0% | $83 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $38 | 0% | $38 | Medium |
| X-Ray Dental - Two images - bitewings | $59 | 0% | $59 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $44 | 0% | $44 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $140 | 0% | $140 | 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 | $228 | 0% | $228 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $298 | 0% | $298 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $377 | 0% | $377 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $228 | 0% | $228 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $298 | 0% | $298 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $228 | 0% | $228 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $377 | 0% | $377 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $261 | 0% | $261 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $332 | 0% | $332 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $222 | 0% | $222 | Medium |