DentaCard Discount Dental Plan | Save 20-50% on Dental Visits – See Savings Below
Discounted fees are Sample Savings based on General Dentist Fees. Dental Fees for this program vary by Dentist.
| Procedure Description | ADA Code | Price Without Plan1 | Sample Price with Plan | Savings Percentage |
| Routine 6 Month Check-Up | D0120 | $50.00 | $25.00 | 50% |
| In Depth Check-Up | D0150 | $85.00 | $38.00 | 55% |
| Full Mouth X-Rays | D0210 | $137.00 | $72.00 | 47% |
| Four Bitewing X-Rays | D0274 | $64.00 | $33.00 | 48% |
| Panoramic Film | D0330 | $115.00 | $63.00 | 45% |
| Adult Teeth Cleaning | D1110 | $88.00 | $47.00 | 47% |
| Child Teeth Cleaning | D1120 | $66.00 | $34.00 | 48% |
| Protective Sealant / Tooth | D1351 | $53.00 | $28.00 | 47% |
| Perio Scaling and Root Planing (Per Quadrant) | D4341 | $249.00 | $130.00 | 48% |
| Regular Cleaning Following Periodontic Procedure | D4910 | $137.00 | $76.00 | 45% |
Discounted fees are Sample Savings based on General Dentist Fees. Dental Fees for this program vary by Dentist.
| Procedure Description | ADA Code | Price Without Plan1 | Sample Price with Plan | Savings Percentage |
| 1 Surface Silver Filling for Primary or Permanent Tooth | D2140 | $145.00 | $64.00 | 56% |
| 1 Surface White Filling for U or L Front Tooth | D2330 | $160.00 | $73.00 | 54% |
| Single Crown – Porcelain on High Noble Metal | D2750 | $1200.00 | $620.00 | 48% |
| Single Crown – Porcelain on Noble Metal | D2752 | $1170.00 | $595.00 | 49% |
| Core Build-Up With Pins | D2950 | $275.00 | $137.00 | 50% |
| Root Canal Treatment – Front Tooth | D3310 | $895.00 | $380.00 | 58% |
| Root Canal Treatment – Bicuspid | D3320 | $1040.00 | $466.00 | 55% |
| Root Canal Treatment – Molar | D3330 | $1195.00 | $588.00 | 51% |
| Bone replacement graft – retained natural tooth – first site in quadrant | D4263 | $627.00 | $196.00 | 69% |
Discounted fees are Sample Savings based on General Dentist Fees. Dental Fees for this program vary by Dentist.
| Procedure Description | ADA Code | Price Without Plan1 | Sample Price with Plan | Savings Percentage |
| comprehensive orthodontic treatment of the transitional dentition | D8070 | $5562.00 | $4307.00 | 23% |
| Full Orthodontic Child Treatment (Braces) | D8080 | $5658.00 | $4307.00 | 24% |
| Full Orthodontic Adult Treatment (Braces) | D8090 | $5936.00 | $4307.00 | 27% |
| Procedure Description | ADA Code | Price Without Plan1 | Sample Price with Plan | Savings Percentage |
| Labial veneer (resin laminate) – direct | D2960 | $598.00 | $419.00 | 30% |
| Labial veneer (porcelain laminate) – indirect | D2962 | $1214.00 | $506.00 | 58% |
| external bleaching – per tooth | D9973 | $185.00 | $56.00 | 70% |
| internal bleaching – per tooth | D9974 | $275.00 | $274.00 | 0% |
Discounted fees are Sample Savings based on General Dentist Fees. Dental Fees for this program vary by Dentist.
| Procedure Description | ADA Code | Price Without Plan1 | Sample Price with Plan | Savings Percentage |
| Full Upper Denture | D5110 | $1500.00 | $714.00 | 52% |
| add clasp to existing partial denture | D5660 | $250.00 | $117.00 | 53% |
| surgical placement of implant body: endosteal implant | D6010 | $2050.00 | $1617.00 | 21% |
| abutment supported cast metal crown (predominantly base metal) | D6063 | $1292.00 | $793.00 | 39% |
| Implant supported crown high noble alloys | D6067 | $1575.00 | $906.00 | 42% |
| Tooth Replacement Part of Permanent Bridge | D6210 | $1075.00 | $587.00 | 45% |
| Procedure Description | ADA Code | Price Without Plan1 | Sample Price with Plan | Savings Percentage |
| Single Tooth Removal – Simple Extraction | D7140 | $171.00 | $73.00 | 57% |
| Extraction – Impacted Wisdom Tooth (Soft Tissue) | D7220 | $350.00 | $168.00 | 52% |
| Extraction – Impacted Wisdom Tooth (Partial Bony) | D7230 | $426.00 | $224.00 | 47% |
1 The [“Price Without Plan”] is determined using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. Actual fees charged by your provider may vary for a variety of reasons.
2 Discounted Fees / Price With Plan Fees are listed for visits to a participating general dentist. Members will be charged the provider’s DenteMax contracted fees. Charges may vary from the sample fee schedule above. Consult with your provider prior to beginning any treatment.
