Xiaoping Li, DMD
151 Main Street Nashua, NH 03060
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $189 | 0% | $189 | Medium |
| Child Dental Cleaning | $168 | 0% | $168 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $506 | 0% | $506 | Medium |
| Sealant placed on the tooth surface to prevent decay | $116 | 0% | $116 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $130 | 0% | $130 | Medium |
| Periodic dental exam - established patient | $82 | 0% | $82 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $130 | 0% | $130 | Medium |
| X-Ray Dental - Complete intraoral series | $237 | 0% | $237 | Medium |
| X-Ray Dental - Four images - bitewings | $130 | 0% | $130 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $57 | 0% | $57 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $242 | 0% | $242 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $300 | 0% | $300 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $370 | 0% | $370 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $321 | 0% | $321 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $439 | 0% | $439 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $563 | 0% | $563 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $390 | 0% | $390 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $216 | 0% | $216 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $319 | 0% | $319 | Medium |