White Mountain Community Health Center

298 White Mountain Highway Conway, NH 03818
Dental Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay Typical Patient Complexity
Dental Cleaning - Adult$870%$87 Medium
Dental Cleaning - Child$700%$70 Medium
Dental Exam - Comprehensive$770%$77 Medium
Dental Exam - Periodic, Established Patient$420%$42 Medium
Dental Filling - Silver (Amalgam): One Surface, Primary or Permanent$1340%$134 Medium
Dental Filling - Silver (Amalgam): Three Surfaces, Primary or Permanent$2250%$225 Medium
Dental Filling - Silver (Amalgam): Two Surfaces, Primary or Permanent$2000%$200 Medium
Dental Filling - White (Resin): One Surface, Anterior$1390%$139 Medium
Dental Filling - White (Resin): One Surface, Posterior$1550%$155 Medium
Dental Filling - White (Resin): Three Surfaces, Posterior$2820%$282 Medium
Dental Filling - White (Resin): Two Surfaces, Anterior$1710%$171 Medium
Dental Filling - White (Resin): Two Surfaces, Posterior$2160%$216 Medium
Fluoride - Topical Application$260%$26 Medium
Maintenance Therapy - Periodontal$1260%$126 Medium
Plaque and Tartar Removal - Around Teeth and Gums, Per Quadrant$2310%$231 Medium
Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint$740%$74 Medium
Root Canal - Bicuspid Tooth$8130%$813 Medium
Root Canal - Molar$2,3980%$2,398 Medium
Sealant - Placed on Tooth Surface to Prevent Decay$480%$48 Medium
Tooth Extraction - Elevation and/or Forceps Removal$1530%$153 Medium
X-Ray - Additional Image of Tooth from Crown to Root from Inside Mouth$230%$23 Medium
X-Ray - Complete Intraoral Series$1250%$125 Medium
X-Ray - Four Images, Bitewings$600%$60 Medium
X-Ray - Intraoral, Periapical Radiographic Image$280%$28 Medium
X-Ray - Two Images, Bitewings$430%$43 Medium