PPO Plan (High)

typical cost for an adult

no coverage

PPO Plan

  Two periodic exams

$72

$0

 
  Four bitewing X-rays

$47

$0

 
  Two quadrants of periodontal scaling and root planing

$290

$116*

 
  Three routine cleanings

$140

$0

 
  One resin/ Composite 1-Surface filing (anterior)

$115

$12*

 
  Anterior Root Canal (excluding final restoration)

$576

$230*

 
  Porcelain Crown

$912

$365*

 
 

Subtotal

$2,152

$723

 
 

You Would Save

 

$1,429

 

* based on In-network providers with the deductible having been satisfied

typical cost for a child

no coverage

PPO Plan

  Two periodic Exams

$72

$0

 
  Two Bitewing X-rays

$31

$0

 
  Three routine cleanings

$100

$0

 
  Two Fluoride Treatments

$148

$0

 
  Single Extraction

$109

$44*

 
 

Subtotal

$460

$44

 
 

You Would Save

 

$416

 

* based on In-network providers with the deductible having been satisfied

Plan HighLights

UNLIMITED CALENDAR YEAR MAXIMUM!

THREE (3) COVERED DENTAL CLEANINGS PER YEAR

No Waiting Periods

Freedom to go to any dentist

Most Diagnostic and Preventive care at No Charge

Prenatal care included

Oral Cancer Screenings included