Benefits at a Glance
- More than 3,400 dentists throughout Maryland, DC
and Northern Virginia |
|
Common Dental Procedures and Their Costs |
Regular Cost* |
You Pay |
|
Biannual check-ups,including routine exams, cleanings and x-rays |
$225
(2 visits per year) |
No charge in-network |
|
Simple tooth extraction |
$135 |
Reduced rates from in-network providers typically between $69 - $93** |
|
Periodontal scaling and root planning (four or more teeth per section of the mouth) |
$210 |
Reduced rates from in-network providers typically between $116 - $137** |
|
Porcelain crown (High noble metal) |
$915 |
Reduced rates from in-network providers typically between $575 - $680** |
|
Complete Upper Dentures |
$1,375 |
Reduced rates from in-network providers typically between $665 - $800** |
|
Orthodontics (Adolescent) |
$4,890 |
Reduced rates from in-network providers typically between $2,900 - $4,700** |
|
* Based on National Dental Advisory Service Fee Report (2006).
** This portion of the plan is not an insurance product. Member charges are based on Individual Select Preferred allowances with the participating providers. Since rates vary by provider, members should check with their participating dentist to determine the costs of specific procedures. Members must pay these reduced rates directly to the provider during the office visit.
Please see the brochure for details of the benefits
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Benefits at a Glance
-Lower cost
- More than 800 dentists throughout Maryland, DC
and Northern Virginia |
|
|
Regular Cost* |
In-Network You Pay |
|
Preventive & Diagnostic Services (includes cleanings, exams, X-rays, sealants and more) |
$75-$110 |
$20 per office visit |
|
Basic Dental Services (includes fillings, simple extractions and more) |
$110-$280 |
$20 per office visit |
|
Soft Tissue Management (includes periodontal scaling, periodontal maintenance and more) |
$170 |
$70 per office visit |
|
Root Canal Therapy
(excludes final restoration)
Anterior
Molar |
$600
$840 |
$300 Primary Dentist
$400 Specialty Care Dentist
$450 Primary Dentist
$600 Specialty Care Dentist |
|
Complete Dentures |
$1,375 each |
$495 each |
|
Orthodontic (Braces)
Comprehensive - Adolescent
Comprehensive - Adult |
$4,890
$5,110 |
$2,500
$2,700 |
|
*Based on National Dentistry Advisory Service Fee Report (2006)
.Please see the brochure for details of the benefits |
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