James B. Haas, DDS
4 Manchester Ave Derry, NH 03038
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $116 | 0% | $116 | Medium |
| Child Dental Cleaning | $89 | 0% | $89 | Medium |
| Fluoride - Topical Application | $37 | 0% | $37 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $278 | 0% | $278 | Medium |
| Sealant placed on the tooth surface to prevent decay | $71 | 0% | $71 | Medium |
| Topical fluoride varnish application | $46 | 0% | $46 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $102 | 0% | $102 | Medium |
| Periodic dental exam - established patient | $63 | 0% | $63 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $104 | 0% | $104 | Medium |
| X-Ray Dental - Complete intraoral series | $147 | 0% | $147 | Medium |
| X-Ray Dental - Four images - bitewings | $80 | 0% | $80 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $42 | 0% | $42 | Medium |
| X-Ray Dental - Two images - bitewings | $57 | 0% | $57 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $26 | 0% | $26 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $131 | 0% | $131 | 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 | $226 | 0% | $226 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $187 | 0% | $187 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $278 | 0% | $278 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $226 | 0% | $226 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $278 | 0% | $278 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $187 | 0% | $187 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $340 | 0% | $340 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $224 | 0% | $224 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $147 | 0% | $147 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $209 | 0% | $209 | Medium |