EXAMPLE OF SAVINGS ON THE MOST UTILIZED DENTAL PROCEDURES

TEAL Dental Plan Fee Schedule

Sample General Dentist Procedures *

Dental Office Fees
Up To:

Dental Plan

Fees

Dental Plan

Savings

Initial Dental Exam

$100

$32

68%

Periodic Dental Exam

$60

$12

80%

Dental X-Rays

Intraoral Complete Series

$122

$50

59%

Panoramic

$110

$50

55%

Regular Teeth Cleaning (Light Scalling & Polishing)

$95

$42

56%

Deep Teeth Cleaning (Full Mouth Debridement/Removal of heavy tartar buildup)

$215

$75

65%

Amalgam Filling (Silver Colored)

1 Surface - Primary or Permanent

$130

$60

54%

2 Surfaces - Primary or Permanent

$160

$70

56%

Composite Filling (Tooth Colored)

1 Surface (Anterior)

$150

$72

52%

2 Surfaces (Anterior)

$190

$88

54%

Root Canal (Excluding final restoration)

Anterior

$690

$325

53%

Bicuspid

$800

$375

53%

Porcelain Crown

w/High Noble Metal

$1050

$515

51%

Orthodontic Treatment* (Braces) by General Dentist

Children (under Age 19)

$5000

$2100

58%

Adults (19 and over)

$5500

$2250

59%

Dental Plan Fee Schedule Generally Used In Your Area

Keep in mind that some states use more than one dental plan fee schedule.  By using the "Find A Provider" feature, you can see the actual fee schedule used by a particular dental care provider in your area.

Red

Fee Schedule

Arizona, Colorado, Florida, Hawaii, Illinois, Tennessee

Lime

Fee Schedule

Alabama, Arkansas, Delaware, Georgia, Idaho, Iowa, Kansas, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Texas, Washington, West Virginia

Teal

Fee Schedule

California, Connecticut, Indiana, Kentucky, Maryland, Massachusetts, Nevada, New Jersey, Ohio, Pennsylvania, Utah, Virginia, Washington D C, Wisconsin

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