William J Devaney, DMD
230 Lafayette Road, Bldg C Portsmouth, NH 03801
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $103 | 0% | $103 | Medium |
| Child Dental Cleaning | $92 | 0% | $92 | Medium |
| Fluoride - Topical Application | $55 | 0% | $55 | Medium |
| Sealant placed on the tooth surface to prevent decay | $58 | 0% | $58 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $105 | 0% | $105 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $105 | 0% | $105 | Medium |
| X-Ray Dental - Complete intraoral series | $152 | 0% | $152 | Medium |
| X-Ray Dental - Four images - bitewings | $76 | 0% | $76 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | Medium |
| X-Ray Dental - Two images - bitewings | $69 | 0% | $69 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $40 | 0% | $40 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $137 | 0% | $137 | 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 | $226 | 0% | $226 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $257 | 0% | $257 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $299 | 0% | $299 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $226 | 0% | $226 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $215 | 0% | $215 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $299 | 0% | $299 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $247 | 0% | $247 | 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) | $236 | 0% | $236 | Medium |