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Dedicated Dental Individual/Family 1300 Plan

Fee Schedule Summary

Please refer to our full fee schedule Full Fee Schedule
UCR: Usual and customary rates
Diagnostic & Preventative Top
PROCEDURE YOU PAY USUAL FEE YOU SAVE*
Periodic oral evaluation $0.00 $67.00 100.00 %
Comprehensive oral evaluation $0.00 $117.00 100.00 %
Full-mouth x-rays $25.00 $168.00 85.00 %
Intraoral x-ray - first film $0.00 $37.00 100.00 %
Panoramic film $49.00 $141.00 65.00 %
Prophylaxis - adult (cleaning) $70.00 $117.00 40.00 %
Prophylaxis - child (cleaning) $50.00 $87.00 43.00 %
Sealant - per tooth $30.00 $70.00 57.00 %
Restorative (Fillings) Top
Resin-based composite (white fillings) - anterior
PROCEDURE YOU PAY USUAL FEE YOU SAVE*
One tooth surface $120.00 $212.00 43.00 %
Two tooth surfaces $140.00 $263.00 47.00 %
Three tooth surfaces $175.00 $331.00 47.00 %
Crowns & Single Restorations Top
PROCEDURE YOU PAY USUAL FEE YOU SAVE*
Crown - porcelain/ceramic $895.00 $1,474.00 39.00 %
Crown - porcelain/high noble $795.00 $1,436.00 45.00 %
Recement crown $63.00 $149.00 58.00 %
Core build up, including pins $125.00 $346.00 64.00 %
Periodontics Top
PROCEDURE YOU PAY USUAL FEE YOU SAVE*
Scaling/Root Planing (4+ teeth per quad) $139.00 $330.00 58.00 %
Full mouth debridement $109.00 $240.00 55.00 %
Periodontal maintenance $99.00 $180.00 45.00 %
Dentures (prices are per arch) Top
PROCEDURE YOU PAY USUAL FEE YOU SAVE*
Complete denture $795.00 $2,234.00 64.00 %
Immediate denture $795.00 $2,257.00 65.00 %
Other Dental Services Top
PROCEDURE YOU PAY USUAL FEE YOU SAVE*
Extraction, erupted tooth or exposed root $99.00 $236.00 58.00 %
Surgical removal of exposed tooth $170.00 $360.00 53.00 %
Nitrous Oxide $47.00 $106.00 56.00 %