Charles J Burliss, DMD MSCD

29 Stiles Road Salem, NH 03079
http://www.perionh.com/
(603) 898-1961

All cost information is based on claims data collected in the New Hampshire Comprehensive Healthcare Information System which is updated quarterly. All quality information is based on claims and administrative data collected by the Centers for Medicare and Medicaid Services which is updated annually. For more information click the links above and review our methodology section.

Methodology
Procedure Estimate of Procedure Cost Estimate of Procedure Cost
This is an estimate of the total charge for the health care service before any discounts provided to the uninsured. 		Number of Visits Number of Visits
When the number of visits varies, it is difficult to estimate the total cost of care. This indicates the number of visits you can expect, calculated using the median. To determine the total you might pay, multiply the Estimate of Procedure Cost and the Statewide Average for Number of Visits.
- Above Average: Expect to visit the provider more than the average number of visits.
- Near Average: Expect the visit the provider close to the average number of visits.
- Below Average: Expect to visit the provider less than the average number of visits.
 		What You Will Pay What You Will Pay
The estimated charge amount minus the uninsured discount (when available).
Uninsured Discount: 0%
Additional X-Ray Image of Tooth from Crown to Root from Inside Mouth $33 N/A $33
Adult Dental Cleaning $125 N/A $125
Complete Intraoral X-Ray Series $174 N/A $174
Four Bitewing X-Ray Images $86 N/A $86
Intraoral X-Ray, Periapical Radiographic Image $40 N/A $40
Maintenance Therapy $181 N/A $181
Periodic Dental Exam for an Established Patient $59 N/A $59
Plaque and Tartar Removal Around Teeth and Gums, Per Quadrant $330 N/A $330
Problem Focused Evaluation, Limited to a Specific Oral Health Problem or Complaint $106 N/A $106
Tooth Extraction, Elevation and/or Forceps Removal $218 N/A $218