Dental Discounts - Fee Schedule

Fee Schedule

This is a sample of over 200 different procedures covered by the Dental Plan.

The Fee Table Below is For The Following States AZ. CO. FL. IL. KS. LA. MO. OK. TX.
Sample Dental Procedures	Dental Office Fees up to*	Plan Fees	Plan Savings
Initial Oral Exam	$ 85	$ 23	73%
Periodic Oral Exam	$ 50	$ 10	80%
X-Rays - Complete Series	$ 110	$ 25	77%
Regular Teeth Cleaning (Light Scaling & Polishing)	$ 80	$ 20	75%
Deep Teeth Cleaning (Full Mouth Debridement / Removal of heavy tartar buildup)	$ 190	$ 60	69%
Amalgam Filling (Silver Colored) 1 Surface 2 Surfaces	$ 100 $ 135	$ 30 $ 45	70% 67%
Composite Filling (Tooth Colored) 1 Surface 2 Surfaces	$ 120 $ 158	$ 40 $ 55	67% 65%
Root Canal Anterior Bicuspid	$ 550 $ 650	$ 225 $ 280	59% 57%
Porcelain Crown w/ High Noble Metal	$ 900	$ 425	53%
Orthodontic Treatment Braces) by General Dentist Children (under Age 19) Adults (19 and over)	$ 4000 $ 4500	$ 1950 $ 2150	51% 52%

* American Dental Association (ADA) 1999 National Survey of Dental Fees Dental Economics, Annual Dental Fee Survey, 1998 Published 1999

The Fee Table Below is for the following States: AL. AR. GA. HI. IA. MN. MS. MT. NE. TN. UT. WADC. WI.
Sample Dental Procedures	Dental Office Fees up to*	Plan Fees	Plan Savings
Initial Oral Exam	$ 105	$ 18	83%
Periodic Oral Exam	$ 60	$ 8	87%
X-Rays - Complete Series	$ 130	$ 20	85%
Teeth Cleaning (Light Scaling & Polishing)	$ 100	$ 20	80%
Deep Teeth Cleaning	$ 230	$ 60	74%
Amalgam Filling (Silver Colored) 1 Surface 2 Surfaces	$ 130 $ 160	$ 30 $ 45	77% 72%
Composite Filling (Tooth Colored) 1 Surface 2 Surfaces	$ 155 $ 200	$ 50 $ 70	68% 65%
Root Canal Anterior Bicuspid	$ 685 $ 820	$ 250 $ 300	64% 64%
Porcelain Crown w/ High Noble Metal	$ 1100	$ 475	57%
Orthodontic Treatment (Braces) by General Dentist Children (under Age 19) Adults (19 and over)	$ 5800 $ 6100	$ 1950 $ 2050	66% 66%

* American Dental Association (ADA) 1999 National Survey of Dental Fees Dental Economics, Annual Dental Fee Survey, 1998 Published 1999

The fee Table Below is for the following States: CA. CT. DE. ID. IN. KY. MA. MD. ME. MI. NC. ND. NH. NJ. NM. NV. NY. OH. OR. PA. RI. SC. VA. VT. WA. WV.
Sample Dental Procedures	Dental Office Fees up to*	Plan Fees	Plan Savings
Initial Oral Exam	$ 100	$ 30	70%
Periodic Oral Exam	$ 55	$ 10	82%
X-Rays - Complete Series	$ 120	$ 50	58%
Regular Teeth Cleaning (Light Scaling & Polishing)	$ 90	$ 40	56%
Deep Teeth Cleaning (Full Mouth Debridement / Removal of heavy tartar buildup)	$ 210	$ 60	72%
Amalgam Filling (Silver Colored) 1 Surface 2 Surfaces	$ 115 $ 150	$ 55 $ 65	52% 57%
Composite Filling (Tooth Colored) 1 Surface 2 Surfaces	$ 140 $ 165	$ 70 $ 85	50% 49%
Root Canal Anterior Bicuspid	$ 620 $ 740	$ 275 $ 325	56% 56%
Porcelain Crown w/ High Noble Metal	$ 990	$ 500	50%
Orthodontic Treatment (Braces) by General Dentist Children (under Age 19) Adults (19 and over)	$ 4500 $ 4600	$ 1950 $ 2050	57% 56%

* American Dental Association (ADA) 1999 National Survey of Dental Fees Dental Economics, Annual Dental Fee Survey, 1998 Published 1999