Sample Dental Procedure Savings Chart*

Below are just a few of the sample savings you can expect.

Product/Service

Fee
Schedule (A)
ADA
Mean1
Total
Savings
Your
Discount
Exam No Charge2  $76  $76  100% 
Full X-rays No Charge2  $125  $125  100% 
Total Adult Check Up3 $55  $290  $235  81% 
Total Child Check Up3 $38  $268  $230  86% 
Couple Savings One Check Up (2 Adults) $110  $580  $470  81% 
Family Savings 0n One Check Up (2 Adults, 2 Children) $186  $1,116  $930  83% 
Filling One Surface Permanent $45  $125  $80  64% 
Root Canal Anterior Tooth $255  $655  $400  61% 
Full Denture, Upper or Lower $560  $1,500  $940  63% 
Orthodontists $3149  $5,500  $2,351  43% 

1Source: American Dental Association, Survey Center, 2005 Survey of Dental Fees.
2In conjunction with annual checkup cleaning provided by participating general practitioners under Fee Schedule A.
3There is no payment to the dentist through the Plan.
*Not available in all area. Prices on schedule are subject to change without notice.

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