Charles J Burliss, DMD Mscd
29 Streetiles Road Salem, NH 03079
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $181 | 0% | $181 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $330 | 0% | $330 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $108 | 0% | $108 | Medium |
| Periodic dental exam - established patient | $59 | 0% | $59 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $106 | 0% | $106 | Medium |
| X-Ray Dental - Complete intraoral series | $174 | 0% | $174 | Medium |
| X-Ray Dental - Four images - bitewings | $86 | 0% | $86 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $40 | 0% | $40 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $33 | 0% | $33 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $181 | 0% | $181 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $218 | 0% | $218 | Medium |