Private Dental Plan

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Private Dental Plan Cost

PDP001 Individual
PDP002 Couple
PDP003 Family with up to 4 Members

No charge: dental exam, x-rays (unlimited), two cleanings (prophylaxis) one every 6 months per membership year, fluoride treatment for children, unlimited emergency consultations.


Private Detal Plan vs. Dental Insurance



Diagnostic Standard Fee Fee With Plan
D0110 Initial Exam
D0120 Periodic Oral Exam
D0220 Intraoral Periapical 1st Film
D0230 Intraoral Periapical Each Additional Film
D0272 Bitewings Two Films
D0274 Bitewings Four Films
D0330 Panoramic Film
D9999 3D Panoramic Film
Preventive Standard Fee Fee With Plan
D1110 Prophylaxis – Adult (every 6 months)
D1120 Prophylaxis – Child (every 6 months)
D1203 Fluoride – Child
D1351 Sealant – Per Tooth
Restorative Basic Standard Fee Fee With Plan
D2330 Resin Anterior 1 Surface
D2331 Resin Anterior 2 Surface
D2332 Resin Anterior 3 Surface
D2335 Resin Anterior 4+ Surface
D2391 Resin Posterior 1 Surface
D2392 Resin Posterior 2 Surface
D2393 Resin Posterior 3 Surface
D2394 Resin Posterior 4+ Surface
Restorative Major Standard Fee Fee With Plan
D2610 Inlay – porcelain/ceramic – one surface
D2642 Onlay – porcelain/ceramic – two surface
D2740 Crown – porcelain / ceramic substrate
D2783 3/4 porcelain/ceramic
D2799 Provisional crown
D2940 Sedative Filling
D2950 Core Build Up
D2954 Post Core Build Up
Periodontal Standard Fee Fee With Plan
D4210 Gingivectomy – Per Quadrant
D4221 Gingivectomy – Per Tooth
D4247 Distal Wedge Procedure
D4249 Crown Lengthening – Per Tooth
D4260 Periodontal Oss. Surgery – Per Quadrant
D4263 Bone Graft – Socket Fill
D4266 Guided Tissue Regeneration – Resorbable Barrier
D4341 Root Planning/Scaling – Per Quadrant
D4342 Root Planning/Scaling – 1-3 Teeth
D4355 Full Mouth Debridement
D4381 Localized Delivery of Antimicrobial Agents – Per Tooth
D4910 Periodontal Maintenance
Endodontal Standard Fee Fee With Plan
D3220 Theraputic pulpotomy
D3230 Pulpal therapy (resorbable filling) anterior primary teeth
D3240 Pulpal therapy (resorbable filling) posterior primary teeth
D3310 Root canal-anterior – excl. Final Restoration
D3320 Root canal-bicuspid
D3330 Root canal-molar
D3950 Post space preparation
Oral Surgery Standard Fee Fee With Plan
D7140 Simple Extraction
D7210 Surgical Extraction
D7310 Alveoloplasty – Per Quadrant
D7311 Alveoloplasty – 1-3 Teeth
Dental Implants Standard Fee Fee With Plan
D6010 Endosseous Implant
D6056 Implant Abutment – Titanium
D6057 Implant Abutment – Ceramic
D6059 Implant Crown
Miscellaneous Standard Fee Fee With Plan
D0470 Diagnostic Cast
D0471 Diagnostic Photos
D7510 Incision and Drainage of Abscess- Intraoral Soft Tissue
D9110 Palliative Treatment
D9215 Local Anesthesia
D9940 Occlusal Guard
D9951 Occlusal Adjustment (One Visit) – Limited