Derry Dental Associates
7 Peabody Road Derry, NH 03038
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $108 | 0% | $108 | Medium |
| Child Dental Cleaning | $120 | 0% | $120 | Medium |
| Fluoride - Topical Application | $44 | 0% | $44 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $395 | 0% | $395 | Medium |
| Sealant placed on the tooth surface to prevent decay | $80 | 0% | $80 | Medium |
| Topical fluoride varnish application | $53 | 0% | $53 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $120 | 0% | $120 | Medium |
| Periodic dental exam - established patient | $62 | 0% | $62 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $88 | 0% | $88 | Medium |
| X-Ray Dental - Complete intraoral series | $218 | 0% | $218 | Medium |
| X-Ray Dental - Four images - bitewings | $76 | 0% | $76 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $34 | 0% | $34 | Medium |
| X-Ray Dental - Two images - bitewings | $76 | 0% | $76 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $27 | 0% | $27 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $137 | 0% | $137 | 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 | $208 | 0% | $208 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $280 | 0% | $280 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $326 | 0% | $326 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $233 | 0% | $233 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $321 | 0% | $321 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $182 | 0% | $182 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $391 | 0% | $391 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $223 | 0% | $223 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $30 | 0% | $30 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $212 | 0% | $212 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $260 | 0% | $260 | Medium |