Benefits at a Glance
More than 3,400 dentists throughout Maryland, DC and Northern Viriginia
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Common Dental Procedures and Their Costs
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Regular Cost*
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You Pay
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Biannual check-ups,including routine exams, cleanings and x-rays
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$225
(2 visits per year)
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No charge in-network
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Simple tooth extraction
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$135
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Reduced rates from in-network providers typically between $69 - $93**
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Periodontal scaling and root > >planning (four or more teeth per section of the mouth)
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$210
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Reduced rates from in-network providers typically between $116 - $137**
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Porcelain crown (High noble metal)
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$915
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Reduced rates from in-network providers typically between $575 - $680**
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Complete Upper Dentures
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$1,375
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Reduced rates from in-network providers typically between $665 - $800**
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Orthodontics (Adolescent)
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$4,890
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Reduced rates from in-network providers typically between $2,900 - $4,700**
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>* 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, DCand Northern Virginia
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Regular Cost*
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In-Network You Pay
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Preventive & Diagnostic Services (includes cleanings, exams, X-rays, sealants and more)
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$75-$110
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$20 per office visit
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Basic DentalServices includes fillings, simple extractions and more)
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$110-$280
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$20 per office visit
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Soft Tissue Management includes periodontal scaling, periodontal maintenance and more)
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$170
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$70 per office visit
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Root Canal Therapy
(excludes final restoration)
Anterior
Molar
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$600
$840
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$300 Primary Dentist
$400 Specialty Care Dentist
$450 Primary Dentist
$600 Specialty Care Dentist
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Complete Dentures
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$1,375 each
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$495 each
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Orthodontic (Braces)
Comprehensive Adolescent
Comprehensive Adult
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$4,890
$5,110
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$2,500
$2,700
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>*Based on National Dentistry Advisory Service Fee Report (2006) >
.Please see the brochure for details of the benefits
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