Dental Program Summary
Enjoy savings on dental services at over 169,000* dental practice locations nationwide. In most instances, save 15% to 50% per visit**. Use your card over and over again to keep your teeth healthy and sparkling clean!
- No paperwork, pay the discounted amount at the time of your visit.
- No referral required to see a Specialist.
- Prescription drug card included.
- Simply print the card, present to participating provider, and start saving!
*As of August 2015. **Actual costs and savings vary by provider.
The card works for your whole family. Family members include card holder, spouse, and legal dependents up to the age of 18 or up to the age of 25 as long as they are full time students.
Examples of Potential Savings
| ADA | Procedure Description | Usual Fee | Discounted Fee | Member Savings |
|---|---|---|---|---|
| D0120 | Periodic Oral Exam | $61 | $32 | $29 |
| D0150 | Comprehensive Oral Exam | $96 | $45 | $51 |
| D0210 | X-Ray, Intraoral - Complete Series Including Bitewing | $150 | $80 | $70 |
| D0274 | X-Ray, Bitewings - Four Films | $71 | $38 | $33 |
| D0330 | X-Ray Panoramic Film | $127 | $67 | $60 |
| D1110 | Cleaning (Prophylaxis) - Adult | $113 | $62 | $51 |
| D1120 | Cleaning (Prophylaxis) - Child | $82 | $45 | $37 |
| D1351 | Sealant Per Tooth | $67 | $32 | $35 |
| D2330 | Filling - 1 Surface Resin (White) Filling, Front (Anterior) Tooth | $182 | $94 | $88 |
| D2750 | Crown - Porcelain Fused to High Noble Metal (i.e. gold) | $1,176 | $799 | $377 |
| D2752 | Restorative Crown - Porcelain Fused to Noble Metal | $1,144 | $747 | $397 |
| D3310 | Root Canal Front Tooth (Anterior) Excluding Final Restoration | $814 | $480 | $334 |
| D3320 | Root Canal Premolar Tooth (Bicuspid), Excluding Final Restoration | $906 | $582 | $324 |
| D3330 | Root Canal Molar, Excluding Final Restoration | $1,120 | $784 | $336 |
| D4341 | Scaling/Root Planing Four or More Contiguous Teeth | $250 | $152 | $98 |
| D5110 | Complete Upper Denture (Maxillary) | $1,310 | $937 | $373 |
| D7140 | Extraction of Erupted Tooth or Exposed Root - Includes Local Anesthesia and Suturing If Needed | $198 | $90 | $108 |
| D8080 | Comprehensive Orthodontic Treatment Child | $5,605 | $3,550 | $2,055 |
NOTE: Actual costs and savings may vary by provider, service and geographic location. We use the average of negotiated fees from participating providers to determine the discounted fee, as shown on the chart.
The select regional Usual Fee represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the cost of care tool as of August 2015.
Prescription Program Summary
The Rx card is a nationwide Prescription Assistance Program (PAP) which will lower your prescription drug costs at retail pharmacies. This program has LOWEST PRICE LOGIC* to guarantee that you get the best deal on your prescriptions. This card will provide you with Rx medication savings of up to 75% at more than 68,000 national and regional pharmacies across the country. This drug card is pre-activated and can be used immediately at the pharamacies listed below!
* LOWEST PRICE LOGIC - This means that you pay the lower of a discount off Average Wholesale Price-AWP, discount based off MAC (maximum allowable cost) Pricing, or Pharmacy Promotional/Retail price).
Discounts are only available at participating pharmacies.
This program/card is a discount program. THIS IS NOT INSURANCE.