Charles C Banister, DMD
1 Birch Street Derry, NH 03038
Dental Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What You Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Dental Cleaning - Adult | $100 | 0% | $100 | Medium |
| Dental Exam - Comprehensive | $92 | 0% | $92 | Medium |
| Dental Exam - Periodic, Established Patient | $42 | 0% | $42 | Medium |
| Dental Filling - White (Resin): One Surface, Posterior | $184 | 0% | $184 | Medium |
| Dental Filling - White (Resin): Two Surfaces, Anterior | $196 | 0% | $196 | Medium |
| Dental Filling - White (Resin): Two Surfaces, Posterior | $257 | 0% | $257 | Medium |
| Problem Focused Evaluation - Limited to a Specific Oral Health Problem or Complaint | $92 | 0% | $92 | Medium |
| X-Ray - Complete Intraoral Series | $142 | 0% | $142 | Medium |
| X-Ray - Four Images, Bitewings | $68 | 0% | $68 | Medium |
| X-Ray - Intraoral, Periapical Radiographic Image | $32 | 0% | $32 | Medium |
