Brenda D Berkal, DMD
4 Birch Street Derry, NH 03038
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $131 | 0% | $131 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $289 | 0% | $289 | Medium |
| Sealant placed on the tooth surface to prevent decay | $63 | 0% | $63 | Medium |
| Topical fluoride varnish application | $46 | 0% | $46 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $118 | 0% | $118 | Medium |
| Periodic dental exam - established patient | $57 | 0% | $57 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $98 | 0% | $98 | Medium |
| X-Ray Dental - Complete intraoral series | $158 | 0% | $158 | Medium |
| X-Ray Dental - Four images - bitewings | $79 | 0% | $79 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $45 | 0% | $45 | Medium |
| X-Ray Dental - Two images - bitewings | $82 | 0% | $82 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $39 | 0% | $39 | 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 | $196 | 0% | $196 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $270 | 0% | $270 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $196 | 0% | $196 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $270 | 0% | $270 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $171 | 0% | $171 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $348 | 0% | $348 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $167 | 0% | $167 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $180 | 0% | $180 | Medium |