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SAMPLE DENTAL PROCEDURES This is a sample of more than 200 different procedures covered by the dental plan.
The fee table below is for AZ, CO, FL, IL, KS, LA, MO, OK, PR, and 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)
|
-
-
- $ 100
- $ 135
|
- $ 30
- $ 45
|
-
-
- 70%
- 67%
|
Composite Filling (Tooth Colored)
|
-
-
- $ 120
- $ 158
|
-
-
- $ 40
- $ 55
|
-
-
- 67%
- 65%
|
| Root Canal
|
-
-
- $ 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%
|
AZ, CO, FL, IL, KS, LA, MO, OK, PR, and TX* 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 AL, AR, GA, HI, MS, and TN*.
- 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 (Full Mouth Debridement / Removal of Heavy Tartar Buildup) |
- $ 230
|
$ 60 |
74% |
Amalgam Filling (Silver Colored)
|
-
-
- $ 130
- $ 160
|
- $ 30
- $ 45
|
-
-
- 77%
- 72%
|
Composite Filling (Tooth Colored)
|
-
-
- $ 155
- $ 200
|
-
-
- $ 50
- $ 70
|
-
-
- 68%
- 65%
|
| Root Canal
|
-
-
- $ 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%
|
AL, AR, GA, HI, MS, and TN* American Dental Association (ADA) 1999 National Survey of Dental Fees Dental Economics, Annual Dental Fee Survey, 1998 Published 1999
The fee schedule below is for CA, CT, DE, ID, IN, IA, KY, ME, MD, MA, MI, MN, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OR, PA, RI, SC, SD, UT, VT, VA, WA, DC, WV, WI, and WY*.
- 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)
|
-
-
- $ 115
- $ 150
|
- $ 55
- $ 65
|
-
-
- 52%
- 57%
|
| Composite Filling (Tooth Colored)
|
-
-
- $ 140
- $ 165
|
-
-
- $ 70
- $ 85
|
-
-
- 50%
- 49%
|
| Root Canal
|
-
-
- $ 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%
|
CA, CT, DE, ID, IN, IA, KY, ME, MD, MA, MI, MN, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OR, PA, RI, SC, SD, UT, VT, VA, WA, DC, WV, WI, and WY* American Dental Association (ADA) 1999 National Survey of Dental Fees Dental Economics, Annual Dental Fee Survey, 1998 Published 1999
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