Charles C Banister, DMD
1 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 | $100 | 0% | $100 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $92 | 0% | $92 | Medium |
| Periodic dental exam - established patient | $42 | 0% | $42 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $92 | 0% | $92 | Medium |
| X-Ray Dental - Complete intraoral series | $142 | 0% | $142 | Medium |
| X-Ray Dental - Four images - bitewings | $68 | 0% | $68 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $32 | 0% | $32 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| White (Resin) Dental Filling - One surface, posterior | $184 | 0% | $184 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $257 | 0% | $257 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $196 | 0% | $196 | Medium |