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Step 3 - SAVE up to 60% on all your dental care for an entire year!

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Very Low YEARLY Enrollment Fee
(note...most dental plans charge $20-50 per month)

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AFFORDABLE CARE DENTAL PLAN FEE SCHEDULE

Listed below is the comprehensive discounted fee schedule for the Affordable Care Dental Plan. These are the fees that members pay to participating dentists. Members must refer to these prices before signing any treatment plans to ensure they are paying the correct discounted price. If a member finds any questionable fees, they must call (888) 380-6337 before beginning treatment.

Diagnostic

ADA Number

DESCRIPTION

General Fees

Specialist Fees

D0016

Failed Appointment (without 24 hours notice)

$25.00

$35.00

D0120

Periodic Oral Evaluation

$25.00

$40.00

D0140

Limited Oral Evaluation

$40.00

$70.00

D0150

Comprehensive Oral Evaluation – new or established

$27.50

$75.00

D0180

Comprehensive Periodental Evaluation – new or established

$19.00

$25.00

D0210

Intraoral – Complete Series (including Bitewings)

$49.50

$90.00

D0220

Intraoral – Periapical first film

$18.00

$24.00

D0230

Intraoral – Periapical each additional film

$3.30

$10.00

D0240

Intraoral – Occlusal Film

$7.70

$12.00

D0270

Bitewing – Single Film

$5.50

$12.00

D0272

Bitewings – Two Films

$11.00

$20.00

D0274

Bitewings – Four Films

$19.80

$30.00

D0290

Posterior- Anterior or lateral skull and facial bone survey film

 

$130.00

D0330

Panoramic Film

$57.00

$85.00

D0340

Cephalometric Film

$55.00

$100.00

D0460

Pulp Vitality Tests

$45.00

 

D0470

Diagnostic Casts

$70.00

$90.00

 

Preventative

ADA Number

DESCRIPTION

General Fees

Specialist Fees

D1110

Prophylaxis – Adult (cleaning)

$60.00

 

D1120

Prophylaxis – Child (cleaning)

$55.00

$55.00

D1203

Topical Application of Fluoride – Child

$35.00

 

D1205

Prophylaxis, Fluoride – Adult

$98.00

 

D1351

Sealant – per tooth

$35.00

$40.00

D1510

Space maintainer – fixed – unilateral

$275.00

$280.00

D1515

Space maintainer – fixed – bilateral

$320.00

$370.00

D1520

Space maintainer – removable – unilateral

$300.00

$350.00

D1525

Space maintainer – removable – bilateral

$400.00

$440.00

D1550

Re-cementation of Space maintainer

$55.00

$70.00

 

Restorative

ADA Number

DESCRIPTION

General Fees

Specialist Fee

D2140

Amalgam – One Surface, Primary or Permanent

$75.00

$100.00

D2150

Amalgam – Two Surface, Primary or Permanent

$100.00

$125.00

D2160

Amalgam – Three Surfaces, Primary or Permanent

$125.00

$150.00

D2161

Amalgam – Four or more Surfaces, Primary or Permanent

$150.00

$175.00

D2330

Resin-based Composite – One Surface, Anterior

$100.00

$125.00

D2331

Resin-based Composite – Two Surfaces, Anterior

$125.00

$150.00

D2332

Resin-based Composite – Three Surfaces, Anterior

$150.00

$175.00

D2335

Resin-based Composite – Four or more Surfaces/incisal angle- Ant.

$175.00

$200.00

D2391

Resin-based Composite – One Surface, Posterior

$105.00

$130.00

D2392

Resin-based Composite – Two Surfaces, Posterior

$130.00

$160.00

D2393

Resin-based Composite – Three Surfaces, Posterior

$160.00

$190.00

D2394

Resin-based Composite – Four or more Surfaces, Posterior

$190.00

$220.00

D2510

Inlay – Metal One Surface

$483.70

$495.00

D2520

Inlay – Metal Two Surfaces

$548.80

$560.00

D2530

Inlay – Metal Three or more Surfaces

$632.10

$644.00

D2542

Onlay – Metal Two Surfaces

$623.70

$635.00

D2543

Onlay – Metal Three Surfaces

$648.90

$660.00

D2544

Onlay – Metal Four or more Surfaces

$674.80

$686.00

D2610

Inlay – Porcelain One Surface

$568.40

$580.00

D2620

Inlay – Porcelain Two Surfaces

$599.90

$611.00

D2630

Inlay – Porcelain Three Surfaces

$639.80

$651.00

D2642

Onlay – Porcelain Two Surfaces

$621.60

$633.00

D2643

Onlay –Porcelain Three Surfaces

$669.90

$681.00

D2644

Onlay – Porcelain Four and more Surfaces

$710.50

$722.00

D2650

Inlay – Composite One Surface

$431.20

$433.00

D2651

Inlay – Composite Two Surfaces

$514.50

$526.00

D2652

Inlay – Composite Three or more Surfaces

$540.40

$552.00

D2662

Onlay – Composite One Surface

$508.20

$520.00

D2663

Onlay – Composite Two Surfaces

$597.80

$609.00

D2664

Onlay – Composite Three or more Surfaces

$640.50

$652.00

D2750

Crown – Porcelain Fused to High Noble Metal

$836.50

$836.50

D2751

Crown – Porcelain Fused to Predominantly Base Metal

$644.00

$644.00

D2752

Crown – Porcelain Fused to Noble Metal

$690.00

$690.00

D2780

Crown – พ Cast High Noble Metal

$751.10

$763.00

D2781

Crown – พ Cast Predominantly Base Metal

$412.50

$424.50

D2782

Crown – พ Cast Noble Metal

$693.00

$705.00

D2790

Crown – Full Cast Noble Metal

$515.60

$527.00

D2791

Crown – Full Cast High Noble Metal

$765.00

$777.00

D2792

Crown – Full Cast Predominantly Base Metal

$695.00

$707.00

D2910

Recement Inlay, Onlay, or Partial Coverage Restoration

$65.00

$70.00

D2915

Recement Cast or Prefabricated Post and Core

$55.00

$60.00

D2920

Recement Crown

$75.00

$80.00

D2930

Prefabricated Stainless Steel Crown – Primary Tooth

$160.00

$172.00

D2931

Prefabricated Stainless Steel Crown – Permanent Tooth

$190.00

$202.00

D2932

Prefabricated Resin Crown

$240.00

$252.00

D2940

Protective Restoration

$80.00

$92.00

D2950

Core Buildup, including Pins

$184.80

$184.80

D2951

Pin Retention – per Tooth, in Addition to Restoration

$45.00

$45.00

D2952

Post and Core in addition to Crown, Indirectly Fabricated

$200.00

$200.00

D2954

Prefabricated Post and Core in Addition to Crown

$175.00

$175.00

 

Endodontics

ADA Number

DESCRIPTION

General Fees

Specialist Fee

D3110

Pulp cap – direct

$60.00

$65.00

D3120

Pulp cap – indirect

$60.00

$65.00

D3220

Therapeutic Pulpotomy

$100.00

$120.00

D3220

Therapeutic Pulpotomy – Child

 

$140.00

D3310

Root Canal – Anterior

$470.00

$570.00

D3320

Root Canal – Bicuspid

$570.00

$670.00

D3330

Root Canal – Molar

$670.00

$770.00

D3346

Retreat/RCT-Anterior

$600.00

$700.00

D3347

Retreat/RCT – Bicuspid

$700.00

$800.00

D3348

Retreat/RCT – Molar

$800.00

$900.00

D3351

Apexification/Recalcification/Pulpal Regeneration – First Visit

$200.00

$300.00

D3352

Apexification/Recalcification/Pulpal Regeneration – Interim Med.

$150.00

$175.00

D3353

Apexification/Recalcification/Pulpal Regeneration – Final Visit

$300.00

$400.00

D3410

Apicoectomy/Periradicular Surgery – Anterior

$300.00

$350.00

D3421

Apicoectomy/Periradicular Surgery – Biscupid (First Root)

$350.00

$400.00

D3425

Apicoectomy/Periradicular Surgery – Molar

$450.00

$500.00

D3426

Apicoectomy/Periradicular Surgery (Each additional root)

$250.00

$275.00

D3430

Retrograde filling – per root

$200.00

$225.00

D3450

Root Amputation – per root

$430.00

$440.00

D3420

Hemisection (including any root removal), not including root canal therapy

$300.00

$350.00

 

Periodontics

ADA Number

DESCRIPTION

General Fees

Specialist Fees

D4210

Gingivectomy or Gingivoplasty – four or more teeth

$400.00

$500.00

D4211

Gingivectomy or Gingivoplasty – one to three teeth

$200.00

$230.00

D4240

Gingival Flap Procedure, including root planning – four or more teeth

$652.00

$700.00

D4241

Gingival Flap Procedure, including root planning – one to three teeth

$420.00

$580.00

D4260

Osseous Surgery (including Flap Entry & Closure) Four or more teeth

$600.00

$800.00

D4261

Osseous Surgery (including Flap Entry & Closure) one to three teeth

$400.00

$600.00

D4270

Pedicle Soft Tissue graft procedure

$600.00

$620.00

D4271

Free Soft Tissue Graft Procedure (including donor site surgery)

$635.00

$650.00

D4341

Periodontal Scaling and Root Planning – Four or more teeth per quadrant

$110.00

$150.00

D4342

Periodontal Scaling and Root Planning – One to Three teeth per quadrant

$75.00

$125.00

D4355

Full Mouth Debridement

$140.00

$165.00

D4381

Localized delivery of Antimicrobial agents – per tooth

$75.00

 

D4910

Periodontal Release

$105.00

$120.00

 

Prosthodontics- Removable

ADA Number

DESCRIPTION

General Fees

Specialist Fees

D5110

Complete Denture – Maxillary

$595.00

 

D5120

Complete Denture - Mandibular

$595.00

 

D5130

Immediate Denture – Maxillary

$695.00

 

D5140

Immediate Denture – Mandibular

$695.00

 

D5211

Maxillary Partial Denture – Resin base

$456.50

 

D5212

Mandibular Partial Denture – Resin base

$456.50

 

D5213

Maxillary Partial Denture – Cast Metal Framework – Resin base

$550.00

 

D5214

Mandibular Partial Denture – Cast Metal Framework – Resin base

$550.00

 

D5225

Maxillary Partial Denture – Flexible Base

$340.00

 

D5226

Mandibular Partial Denture – Flexible Base

$340.00

 

D5410

Adjust Complete Denture – Maxillary

$65.00

 

D5411

Adjust Complete Denture – Mandibular

$65.00

 

D5421

Adjust Partial Denture – Maxillary

$65.00

 

D5422

Adjust Partial Denture – Mandibular

$65.00

 

D5510

Repair broken Complete Denture base

$100.00

 

D5520

Replace Missing or Broken Teeth – Complete Denture – per tooth

$100.00

 

D5610

Repair Resin Denture Base

$100.00

 

D5620

Repair Cast Framework

$150.00

 

D5630

Repair or Replace Broken Clasp

$150.00

 

D5640

Replace Broken Teeth – per tooth

$100.00

 

D5650

Add Tooth to existing Partial Denture

$125.00

 

D5660

Add Clasp to existing Partial Denture

$125.00

 

D5710

Rebase Complete Maxillary Denture

$250.00

 

D5711

Rebase Complete Mandibular Denture

$250.00

 

D5720

Rebase Maxillary Partial Denture

$230.00

 

D5721

Rebase Mandibular Partial Denture

$230.00

 

D5730

Reline Complete Maxillary Denture (Chairside)

$175.00

 

D5731

Reline Complete Mandibular Denture (Chairside)

$175.00

 

D5740

Reline Maxillary Partial Denture (Chairside)

$170.00

 

D5741

Reline Mandibular Partial Denture (Chairside)

$170.00

 

D5750

Reline Complete Maxillary Denture (Lab)

$200.00

 

D5751

Reline Complete Mandibular Denture (Lab)

$200.00

 

D5760

Reline Maxillary Partial Denture (Lab)

$200.00

 

D5761

Reline Mandibular Partial Denture (Lab)

$200.00

 

D5820

Interim Partial Denture (Maxillary)

$300.00

 

D5821

Interim Partial Denture (Mandibular)

$300.00

 

D5850

Tissue Conditioning, Maxillary

$100.00

 

D5851

Tissue Conditioning, Mandibular

$100.00

 

D5999

Temporary Stay Plate

$100.00

 

 

Prosthodontics (Fixed)

ADA Number

Description

General Fees

Specialist Fees

D6210

Pontic – Cast High Noble – Metal

$769.30

 

D6211

Pontic – Cast Predominantly Base Metal

$500.00

 

D6212

Pontic – Cast Noble Metal

$600.00

 

D6240

Pontic – Porcelain Fused to High Noble Metal

$825.00

 

D6241

Pontic – Porcelain Fused to Predominantly Base Metal

$600.00

 

D6242

Pontic – Porcelain Fused to Noble Metal

$700.00

 

D6750

Crown - Porcelain Fused to High Noble Metal

$825.00

 

D6751

Crown – Porcelain Fused to Predominantly Base Metal

$500.00

 

D6752

Crown – Porcelain Fused to Noble Metal

$600.00

 

D6780

Crown – พ Cast High Noble Metal

$645.00

 

D6781

Crown – 3/4 Cast Predominantly Base Metal

$520.00

 

D6782

Crown – พ Cast Noble Metal

$580.00

 

D6790

Crown – Full Cast High Noble Metal

$769.00

 

D6791

Crown – Full Cast Predominantly Base Metal

$515.00

 

D6792

Crown – Full Cast Noble Metal

$693.00

 

D6930

Recement Fixed Partial Denture

$100.00

 

D6970

Post and Core in Addition to Fixed Partial Retainer

$300.00

 

D6972

Prefabricated Post & Core in Addition to Fixed Partial Retainer

$250.00

 

D6973

Core Build up for Retainers – Including any pins

$175.00

 

 

Oral & Maxillofacial Surgery

ADA Number

Description

General Fees

Specialist Fees

D7111

Extraction – Coronal Remnants – Deciduous Tooth

$80.00

$100.00

D7140

Extraction, Erupted Tooth or Exposed Root

$90.50

$115.00

D7210

Surgical Removal of Erupted Tooth

$93.50

$145.00

D7220

Removal of Impacted Tooth – Soft Tissue

$110.00

$165.00

D7230

Removal of Impacted Tooth – Partially Bony

$148.00

$195.00

D7240

Removal of Impacted Tooth – Completely Bony

$181.50

$265.00

D7241

Removal of Impacted Tooth – Bony Complex

$181.50

$325.00

D7250

Surgical Removal of Residual Tooth – Cutting Procedure

$150.00

$200.00

D7471

Removal of Lateral Exostosis – Maxilla or Mandible

$500.00

$680.00

D7472

Removal of Torus Palatinus

$300.00

$560.00

D7473

Removal of Torus Mandibularis

$300.00

$540.00

D7510

Incision and Drainage of Abcesses – Intraoral Soft Tissue

$75.00

$145.00

D7960

Frenulectomy – Frenectomy – frenotomy

$200.00

$250.00

D7963

Frenuloplasty

$250.00

 

D7970

Excision of Hyperplastic Tissue – Per Arch

$200.00

$250.00

D7971

Excision of Pericoronal Gingiva

$150.00

$170.00

 

Orthodontics

ADA Number

Description

General Fees

Specialist Fees

D8030

Limited Orthodontic Treatment of the Adolescent Dentition

 

$2,064.80

D8040

Limited Orthodontic Treatment of the Adult Dentition

 

$2,064.80

D8080

Comprehensive Orthodontic Treatment of the Adolescent Dentition

 

$4,050.50

D8090

Comprehensive Orthodontic Treatment of the Adult Dentition

 

$4,050.50

D8210

Removable Appliance Therapy

$500.00

 

D8220

Fixed Appliance Therapy

$525.00

 

D8670

Periodontal Orthodontic Treatment Visit

$106.00

 

D8680

Orthodontic Retention (Removal of Appliances, Construction, and Placement of Retainers)

 

$400.00

 

Adjunctive General Services

ADA Number

Description

General Fees

Specialist Fees

D9110

Palliative (Emergency) Treatment

$75.00

$85.00

D9215

Local Anesthesia in Conjunction with Operative or Surgical Procedure

$0.00

$0.00

D9220

General Anesthesia per 30 minutes

$110.00

$120.00

D9230

Analgesia/N20

$90.00

$100.00

D9241

IV Sedative – First 30 Minutes

$280.00

$290.00

D9242

IV Sedative – Additional 15 minutes

$117.60

$130.00

D9310

Consultation – Oral Surgeon/Pedo/Endodontist/Periodontist

 

$75.00

D9430

Office Visit for Observation – No other Services Performed

$30.00

$40.00

D9440

Office Visit – After Hours

$40.00

$100.00

D9450

Case Presentation, Detailed and Extensive Treatment Planning

$5.00

$10.00

D9930

Treatment of Complications (Post-Surgical)

 

$30.00

D9940

Occlusal Guard

$400.00

 

D9941

Fabrication of Athletic mouthguard

$85.00

 

D9942

Repair and/or recline of Occlusal Guard

$60.00

 

D9950

Occlusion Analysis – Mounted Case

$200.00

$250.00

D9951

Occlusal Adjustment – Limited

$75.00

$85.00

D9972

External Bleaching – Per Arch

$200.00

 

D9973

External Bleaching – Per Tooth

$145.00

 

 

Any unlisted Procedures at a 30% off Dentist’s Fee Schedule

 

 

Affordable Care Dental Plans are listed above to be paid to participating dentists. Please note that general dentists and specialist charge a different fee for the same procedure. Please consult with dental provider for payment plans. For any questionable fees, please call Affordable Care Dental Plan before approving any treatment.

REFUND POLICY

Affordable Care Dental is not an insurance company. Affordable Care Dental does not make any payments to healthcare providers and/or members. Participating providers are independent contractors. Affordable Care has NO clinical personnel. All clinical decisions are made directly between the healthcare provider and patient. All pricing decisions in the offices are between the healthcare provider and the patient. Patients can agree to a price that is not listed as an Affordable Care Dental Discounts price. Any agreed upon prices and work done does not effect the 30 day satisfaction guarantee. The 30 day money back guarantee is for unauthorized charges over the listed fees.

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Global Health Discounts, Inc 1998
Global Health Discounts (GHD) is not an insurance company.  GHD does not make any payments to healthcare providers and/or members. Participating providers are independent contractors.  GHD has NO clinical personnel.  All clinical decisions are made directly between the healthcare provider and patient.  All pricing decisions in the offices are between the healthcare provider and the patient.  Patients can agree to a price that is not listed as a contract GHD price.  Any agreed upon prices and work done does not effect the 30 day satisfaction guarantee.  The 30 day money back guarantee is for unauthorized charges over the listed fees.  GHD staff will not interfere in any financial or clinical negotiations between the provider and the patient.  Prices may vary by provider and location, but patients should be told in advance if there is a difference in price.  Prices may change without notice.  Unless otherwise stated, prices do not include travel and recuperation expenses.  Information on this website is for shopping comparison purposes only.  The clinical information is not intended to be used to help people make clinical decisions.  To get accurate clinical information, consumers are expected to speak with their dentists, physicians and other appropriate licensed health care professionals.

 

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