Dental Plan 500A
Low Option- Plan Dentist
$avings of Over $5000
| Members Services* | Pay Amount |
|---|---|
| Diagnostic Services-90% Savings
Oral Examination and diagnosis |
10.00 25.00 15.00 10.00 |
| Restorative Dentistry- 85% savings
Amalgam filling, primary and permanent teeth (One Surface) |
20.00 25.00 |
| Crown and Bridge- 65% savings
Porcelain with Metal (non-precious) Crown/Bridge (per unit) |
445.00 15.00 |
| Periodontics / Endodontics- 70% savings
Subingival curettage, per quadrant |
95.00 25.00 30.00 130.00 |
| Prosthetics- 70% savings
Complete upper and lower denture, per denture |
595.00 15.00 55.00 |
| Oral Surgery- 80% savings
Alveolectomy, per quadrant |
10.00 10.00 45.00 95.00 15.00 |
* These are amounts the member pays for the dental expenses, if work is performed by Preferred Provider / Selected Panel of General Dentists only. Member payments will be higher if you choose to use a dentist of your own choice, and some reimbursement will be paid by the insurance carrier. Savings approximates costs for usual and customary charges.
