Vitali Bondar, DDS
15 Rye Street Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $86 | 0% | $86 | Medium |
| Child Dental Cleaning | $70 | 0% | $70 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $230 | 0% | $230 | Medium |
| Sealant placed on the tooth surface to prevent decay | $48 | 0% | $48 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $77 | 0% | $77 | Medium |
| Periodic dental exam - established patient | $42 | 0% | $42 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $74 | 0% | $74 | Medium |
| X-Ray Dental - Complete intraoral series | $124 | 0% | $124 | Medium |
| X-Ray Dental - Four images - bitewings | $60 | 0% | $60 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $28 | 0% | $28 | Medium |
| X-Ray Dental - Two images - bitewings | $43 | 0% | $43 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $23 | 0% | $23 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $109 | 0% | $109 | 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 | $154 | 0% | $154 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $215 | 0% | $215 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $281 | 0% | $281 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $154 | 0% | $154 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $216 | 0% | $216 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $139 | 0% | $139 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $281 | 0% | $281 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $170 | 0% | $170 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $126 | 0% | $126 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $183 | 0% | $183 | Medium |