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MedicalPPO HMO
DentalLife Insurance |
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Prepaid Dental Plans
The Prepaid Dental Plans pay benefits only when you use network providers. These plans do not have a deductible and cover most preventive care at no charge. You pay a specific dollar amount for other care you receive. All the pre-paid plans provide adult and child orthodontia.
| Pre-paid Dental Plans (In-Network Only) | |||||
|
|
CompBenefits Network Plus |
UnitedHealthcare Solstice S700 |
Assurant Heritage Plus |
CIGNA Dental |
CompBenefits (formerly ADP) Select 15 |
|
Monthly Premiums |
$16.22 |
$10.91 |
$13.59 |
$25.08 |
$12.64 |
|
Calendar Year Deductible |
$0 |
$0 |
$0 |
$0 |
$0 |
|
Calendar Year Maximum |
$0 |
$0 |
$0 |
$0 |
$0 |
|
***Preventive Care (no deductible) |
|||||
|
Periodic oral exam (ADA 120) |
$0 |
$0 |
$0 |
$0 |
$0 |
|
Bite-wing X-rays four films (ADA 274) |
$0 |
$0 |
$0 |
$0 |
$0 |
|
Cleanings - Dental Prophylaxis Adult (ADA 1110) |
$0 |
$0 |
$0 |
$0 |
$0 |
|
Fluoride treatment, child (ADA 1203) |
$0 |
$0 |
$0 |
$0 |
$0 |
|
Sealant, per tooth (ADA 1351) |
$0 |
$0 |
$10/tooth |
$10/tooth |
$7/tooth |
|
Space maintainers - fixed bilateral (ADA 1515) |
$0 |
$0 |
$60 |
$155 |
$45 |
|
***Basic and Major Care (for PPO and Indemnity plans, deductible applies) |
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|
X-rays - intraoral - complete series including bitewings (ADA 210) |
$0 |
$0 |
$0 |
$0 |
$0 |
|
Amalgam fillings - 2 surfaces, primary or permanent (ADA 2150) |
$8 |
$0 |
$15 |
$0 |
$0 |
|
Resin-based composite - 2 surfaces, anterior (ADA 2331) |
$10 |
$37 |
$45 |
$0 |
$37 |
|
Root canal - endodontic therapy - molar, excluding final restoration (ADA 3330) |
$64 |
$245 |
$245 |
$280 |
$240 |
|
Periodontal surgery – gingivecotomy/gingivoplasty - 4 or more contiguous teeth per quadrant (ADA 4210) |
$39 |
$175 |
$175 |
$140 |
$120 |
|
Periodontal scaling and root planing, 4 or more contiguous teeth per quadrant (ADA 4341) |
$14 |
$50 |
$50 |
$70 |
$45 |
|
Surgical extraction of tooth, including wisdom teeth (ADA 7240) |
$27 |
$80 |
$100 |
$95 |
$75 |
|
General anesthesia, first 30 minutes (ADA 9220) |
$23 |
$125 |
$180 |
$145 |
75% |
|
Porcelain Crowns fused to high noble metal (ADA 2750)++ |
$150 |
$245 |
$265 |
$425 |
$220 |
|
Fixed bridges - pontic, pocelain fused to high noble metal (ADA 6240)++ |
$150 |
$245 |
$265 |
$425 |
$240 |
|
Full lower denture (ADA 5120)++ |
$320 |
$325 |
$375 |
$535 |
$260 |
|
Metalic inlay - 2 surfaces (ADA 2520)++ |
$115 |
$235 |
$125 |
$380 |
$95 |
|
Lower partial dentures, cast metal - acrylic (ADA 5214)++ |
$354 |
$425 |
$380 |
$615 |
$350 |
|
Re-cement crowns (ADA 2920) |
$6 |
$15 |
$15 |
$40 |
$10 |
|
Relining complete upper denture - chairside (ADA 5730) |
$18 |
$65 |
$60 |
$110 |
$45 |
|
Repairs to broken denture base (ADA 5510)++ |
$9 |
$35 |
$30 |
$70 |
$15 |
|
***Orthodontia Care |
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|
Comprehensive orthodontic treatment of the adolescent dentition (full treatment case up to 24 months – including fixed/removable appliances) (ADA 8080) |
$1,580 |
$2,250 |
75% |
$1,700 |
75% |
|
Comprehensive orthodontic treatment of the adult dentition (full treatment case up to 24 months – including fixed/removable appliances) (ADA 8090) |
$1,580 |
$2,350 |
75% |
$2,100 |
75% |
*75% for first year; 50% for subsequent years of consecutive coverage
**limited to children under age 16
***A sample of American Dental Association (ADA) codes are shown to help
you more easily compare costs across plans.
++With some plans, these services may also require a separate payment
for metal and/or laboratory charges
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