| Procedure
Description |
Usual Fee 1 |
Discounted Fee
(for Plan Members) 2 |
Member Savings |
| Routine 6 Month
Check-Up |
$40 |
$0 |
$40 |
| In Depth Check-Up |
$70 |
$0 |
$70 |
| Full Mouth X-Rays |
$104 |
$0 |
$104 |
| Four Bitewing
X-Rays |
$50 |
$0 |
$50 |
| Panoramic Film |
$98 |
$0 |
$98 |
| Adult Teeth
Cleaning |
$75 |
$0 |
$75 |
| Child Teeth
Cleaning |
$52 |
$0 |
$52 |
| Protective
Sealant / Tooth |
$38 |
$30.40 |
$7.60 |
| 1 Surface White
Filling for U or L Front Tooth |
$114.70 |
$91.76 |
$22.94 |
| Single Crown -
Porcelain on High Noble Metal |
$870 |
$696 |
$174 |
| Single Crown -
Porcelain on Noble Metal |
$860 |
$688 |
$172 |
| Core Build-Up
With Pins |
$167 |
$157.60 |
$39.40 |
| Root Canal
Treatment - Front Tooth |
$556 |
$444.80 |
$111.20 |
| Root Canal
Treatment - Bicuspid |
$681 |
$544.80 |
$136.20 |
| Root Canal
Treatment - Molar |
$845 |
$676 |
$169 |
| Perio Scaling and
Root Planing (Per Quadrant) |
$223 |
$178.40 |
$44.60 |
| Full Upper
Denture |
$1448 |
$1158.40 |
$289.60 |
| Tooth Replacement
Part of Permanent Bridge |
$200 |
$160 |
$40 |
| Single Tooth
Removal - Simple Extraction |
$123 |
$98.40 |
$24.60 |
|
The Ninth East Dental Discount Plan offers an average savings of
30% on over 170 common dental procedures 1. Members
receive a discount on the fees normally charged by the provider.
The sample table above is a small selection of
common procedures discounted by the Ninth East Dental Discount
Plan. Once
you're a member, you will be provided with a complete schedule of
benefits with discounted fees for many common dental procedures.
Other procedures discounted under the Ninth East Dental Discount
Plan offer
savings similar to the sample above. Please contact our
office at 801-921-6702 with the ADA Code
of the procedure and we can provide the discounted fee.
 |