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**

Regular Cost*

In-Network You Pay

Preventive & Diagnostic Services (includes cleanings, exams, X-rays, sealants and more)

$75-$110

$20 per office visit

Basic DentalServices 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