Examples of discounted dental plan fees in: California, Connecticut, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, Nevada, New York, Ohio, Oregon, Pennsylvania, Utah, Virginia, Washington, Washington DC, Wisconsin: |
ADA Code |
Sample
General Dentist
Procedures
|
Dental Office
Fees Up To*
|
Dental Plan
Fees |
Dental Plan
Savings Up To
|
00120 |
Periodic Oral Exam |
$73 |
$14 |
81% |
00150 |
Initial Oral Exam |
$130 |
$39 |
70% |
00210 |
X-Ray: Intraoral Complete Series |
$181 |
$65 |
65% |
00330 |
X-Ray: Panoramic |
$156 |
$55 |
65% |
01110 |
Regular Teeth Cleaning (Light Scaling & Polishing) |
$127 |
$53 |
59% |
02140 |
Amalgam Filling (Silver Colored) 1 Surface (Anterior) |
$198 |
$70 |
65% |
02150 |
Amalgam Filling (Silver Colored) 2 Surface (Anterior) |
$258 |
$80 |
69% |
02330 |
Resin Based composite - 1 Surface, Anterior |
$226 |
$95 |
58% |
02331 |
Resin Based Composite - 2 Surface Anterior |
$280 |
$115 |
59% |
02750 |
Porcelain Crown with High Noble Metal |
$1,526 |
$575 |
63% |
03310 |
Root Canal Anterior |
$1,012 |
$400 |
61% |
03320 |
Root Canal Bicuspid |
$1,162 |
$440 |
63% |
04355 |
Deep Teeth Cleaning (Full Mouth Debridement / Removal of heavy tartar buildup) |
$289 |
$102 |
65% |
08080 |
Orthodontic Braces by General dentist - children under age 19 |
$6,726 |
$2,300 |
66% |
08090 |
Orthodontic Braces by General dentist - adult 19 and over |
$7,066 |
$2,450 |
66% |
*Current Dental Terminology® 2011
American Dental Association, All Rights Reserved.
*National Dental Advisory Service 2011
Invisalign discounts may not apply..
Lab Fees Billed Separately with 25% discount.
Fees will vary by region.
|
|
Dental Plans Include
Additional Healthcare Benefits
No Additional Charge |
|
