|
Description |
Plan Cost |
Regular Cost |
Savings |
|
Periodic Oral Evaluation |
$24
|
$49
|
51% |
|
Bitewings – Four Films |
$31
|
$63
|
51% |
|
Prophylaxis – Adult (light) |
$48
|
$91
|
47% |
|
Prophylaxis – Child |
$34
|
$67
|
49% |
|
Amalgam – Three Surface, Primary or Permanent |
$99
|
$210
|
53% |
|
Crown – Porcelain Fused to High Noble Metal |
$600
|
$1,070
|
44% |
|
Root Canal – Molar (excluding final
restoration) |
$580
|
$1,000
|
42% |
|
Periodontal Scaling and Root Planning |
$124
|
$248
|
50% |
|
Extraction – Erupted Tooth or Exposed Root |
$81
|
$167
|
51% |
|
Comprehensive Orthodontic Treatment of Adolescent Dentition |
$4,465
|
$5,581
|
20% |
These fees represent the CI-5 fee schedule.
Normal cost is based on industry usual and customary dental data.
|
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