Dental Plan 500A
Low Option- Plan Dentist
| Members Services | Member Pays 1st year |
| Diagnostic Services-100% Savings
Oral Examination and diagnosis |
10.00 15.00 10.00 8.00 |
| Restorative Dentistry-100% savings
Amalgam filling, primary and permanent teeth (One Surface) |
16.00 20.00 |
| Crown and Bridge- 75% savings
Porcelain with Metal (non-precious) Crown/Bridge (per unit) |
355.00 18.00 |
| Periodontics / Endodontics- 80% savings
Subingival curettage, per quadrant |
75.00 15.00 20.00 105.00 |
| Prosthetics- 85% savings
Complete upper and lower denture, per denture |
495.00 10.00 |
| Oral Surgery- 90% savings
Alveolectomy, per quadrant |
10.00 25.00 28.00 8.00< |
