| 2012-PDP Plans |
|
PLAN RED |
PLAN WHITE |
PLAN BLUE |
| Membership Plan Fees- Per Month-Per Member |
|
$9.99 |
$29.99 |
$49.99 |
| Average Daily Fees -Per Member-Per Day |
|
$0.33 |
$0.99 |
$1.64 |
| Minimum Contract Terms required |
|
1 year |
2 years |
3 years |
| Billing Cycle |
|
1 year |
6 months |
3 months |
| Billing Cycle total amount |
|
$119.88 |
$179.94 |
$149.97 |
| Cost for Patient - Per Year |
|
$119.88 |
$359.88 |
$599.88 |
| Sterilization & Disposable fees [ per visit per member ] |
|
$10.00 |
$10.00 |
$5.00 |
| ROUTINE CHECKUP (EXAM, Necessary X-RAYS) |
|
2/YEAR |
2/YEAR |
2/YEAR |
| Most Commonly Used Dental Procedures and Fees Comparision* |
| |
Regular Fees |
PLAN RED |
PLAN WHITE |
PLAN BLUE |
 |
|
Up to
40%off |
Up to
60%off |
Up to
80%off |
| BASIC & PREVENTATIVE: |
|
|
|
|
| Exams & Consultation |
$90.00 |
$0.00 |
$0.00 |
$0.00 |
| Prophylaxis |
$85.00 |
$30.00 |
$20.00 |
$10.00 |
| Topical Fluoride |
$45.00 |
$20.00 |
$15.00 |
$10.00 |
| Sealant Per Tooth |
$40.00 |
$25.00 |
$18.00 |
$12.00 |
| |
|
|
|
|
| X-Rays: |
|
|
|
|
| Full Mouth X-rays |
$120.00 |
$0.00 |
$0.00 |
$0.00 |
| Panoramic X-ray |
$100.00 |
$70.00 |
$50.00 |
$30.00 |
| Ceph X-ray |
$180.00 |
$126.00 |
$90.00 |
$54.00 |
| |
|
|
|
|
| RESTORATIVE: |
|
|
|
|
| Amalgam Restoration [Silver Filling]-Each Surface |
$115.00 |
$40.00 |
$30.00 |
$20.00 |
| Composite Restoration [ Tooth Colored filling] - Front teeth-Each Surface |
$140.00 |
$60.00 |
$50.00 |
$40.00 |
| |
|
|
|
|
| CROWNS & BRIDGES: |
|
|
|
|
| Core Build-up and or Post & Core with Base Metal |
$300.00 |
$175.00 |
$150.00 |
$90.00 |
| Stainless Steel Crown [ for Baby Teeth] |
$225.00 |
$160.00 |
$125.00 |
$75.00 |
| Base Metal Inlay/Onlay |
$650.00 |
$455.00 |
$325.00 |
$195.00 |
| Base Metal Porcelain Crown |
$950.00 |
$550.00 |
$425.00 |
$255.00 |
| Metal Free Crown |
$1200.00 |
$700.00 |
$600.00 |
$360.00 |
| |
|
|
|
|
| Dental Implants: |
|
|
|
|
| Surgical placement of implant body:endosteal implant |
$3000.00 |
$1300.00 |
$1100.00 |
$900.00 |
| |
|
|
|
|
| ENDODONTIC/ROOT CANAL: |
|
|
|
|
| Pulpotomy for Primary Teeth [ for Baby Teeth] |
$210.00 |
$147.00 |
$105.00 |
$63.00 |
| Anterior Teeth [ front Teeth] |
$675.00 |
$425.00 |
$330.00 |
$200.00 |
| Pre Molars |
$825.00 |
$500.00 |
$400.00 |
$240.00 |
| Molars [Back Teeth] |
$950.00 |
$590.00 |
$475.00 |
$285.00 |
| |
|
|
|
|
| PERIODONTICS [GUM RELATED]: |
|
|
|
|
| Scaling & Root Planning - Per Quadrant |
$225.00 |
$150.00 |
$125.00 |
$75.00 |
| |
|
|
|
|
| DENTURES: |
|
|
|
|
| Full Arch Denture- Per Arch - Regular Teeth & Acrylic |
$1200.00 |
$840.00 |
$600.00 |
$360.00 |
| Metal Partial Denture |
$1200.00 |
$750.00 |
$600.00 |
$360.00 |
| Metal free Partial Denture |
$1800.00 |
$1,125.00 |
$900.00 |
$540.00 |
| |
|
|
|
|
| ORAL SURGERY: |
|
|
|
|
| Simple Extraction |
$120.00 |
$70.00 |
$60.00 |
$36.00 |
| Surgical extraction by General Dentist |
$250.00 |
$175.00 |
$125.00 |
$75.00 |
| |
| * Complete list of fees is available at the office. |
| |
