Single
$350
Annually
Double*
$650
Annually
*Parent/Child or Married Couple only
Family of 3*
$850
Annually
*family members & children under 18 or full-time students under the age of 26.
Family of 4
$1000
Annually
+ $150 / each additional member
Diagnostic & X-Rays
- Comprehensive Exam (new patients, initial visit) 100%
- Periodic Exam (2 per year) 100%
- Limited Exam / Emergency Exam (1 per year) 100%
- Complete Series of X-rays / FMX (1 every 3 years) 100%
- Periapical, First Film 100%
- Periapical, Additional Film 100%
- Set of Bitewings (1 per year) 100%
Preventive
- Child Prophylaxis / Cleaning (2 per year) 100%
- Adult Prophylaxis / Cleaning (2 per year) 100%
- Periodontal Maintenance / Cleaning (2 per year) 100%
- Additional cleaning per year 20%
- Fluoride (2 per year) 100%
- Sealants 20%
All Other Procedures
- Fillings 20%
- Core build-ups 20%
- Crowns** 15%
- Veneers 15%
- Periodontics 15%
- Scaling and Root Planing / Deep Cleaning 15%
- Full and Partial Dentures** 15%
- Root Canals 15%
- Implant Crowns and Abutments** 15%
- Oral Surgery 15%
- Clear Aligners* $500 off
- Specialty Services 15%
*For clear aligners, the member must remain a plan member for the duration of the treatment to retain discount plan benefits
**Senior Citizen discount, an additional 5% off select treatments
This program is a discount plan, not a dental insurance plan, and is secondary to any other dental plan. It cannot be used:
- In conjunction with another dental plan
- For services for injuries covered under workers’ compensation
- For treatment which, in the sole opinion of the treating dentist or doctor, lies outside the realm of their capability
- For referrals to specialists
- For hospitalization or hospital charges of any kind
- For costs of dental care, which is covered under the automobile medical Program Guidelines
- There will be a $50 reinstatement fee if your plan lapses
- Cannot be used in conjunction with another dental plan
- Non-refundable
- No refunds or premiums will be issued at any time if the participant decides not to utilize the plan
- Patient’s portion of any bill is due on the same day as services
- The plan is in effect once the premiums have been paid
