Join Now: California Dental Plan 411
| Rates | |
|---|---|
| Single | $12.95 |
| Two People | $19.95 |
| Family | $29.95 |
| One time enrollment fee | |
|---|---|
| Single – Two People – Family | $20 |
Lowest Monthly Fee
California Dental Plan 411 offers bigger savings at the dentist. It is a great choice for those who may need to see the dentist a little less often. Plan 411 includes:
Preventive services, including cleanings, x-rays and check-ups at no charge
Fillings from $15.00 to $25.00
Extractions from $19.00 to $65.00
Root Canals from $100.00 to $175.00
Specialty Coverage
With California Dental Plan 411 you will receive a 30% discount if you ever need to see a specialist. Why would you need to see a specialist? You might require treatment that is beyond the ability of a general dentist. Such treatment may require an expert that has been specially trained to treat your condition.
Summary Of Benefits and Copayments
Below is a summary of benefits that are available at participating California Dental Network providers.
For a complete list of benefits see the benefits schedule.
| I. Preventive Services | |
|---|---|
| Your Copayment | |
| Office Visit | $5.00 |
| Oral Examination | No Charge |
| Intraoral x-rays, complete series | No Charge |
| Bitewing x-rays, single film | No Charge |
| Panoramic x-ray | No Charge |
| Prophylaxis (cleaning) | No Charge |
| Topical fluoride (child) | No Charge |
| Oral hygiene instruction | No Charge |
| II. Basic Services | |
|---|---|
| Restorations | |
| Amalgam, one surface | $10.00 |
| Amalgam, two surfaces | $15.00 |
| Amalgam, three surfaces | $20.00 |
| Resin, up to 3 surfaces | $25.00 |
| Temporary sedative filling | $10.00 |
| Oral Surgery | |
| Extraction, Single Tooth | $25.00 |
| Surgical removal of erupted tooth | $45.00 |
| Removal of impacted tooth, soft tissue | $60.00 |
| Removal of impacted tooth, partially bony | $75.00 |
| Incision & drainage of abscess, intraoral soft tissue | $40.00 |
| Endodontics | |
| Pulp cap, direct | $15.00 |
| Pulp cap, indirect | $15.00 |
| Therapeutic pulpotomy | $25.00 |
| Root canal, anterior | $125.00 |
| Root canal, bicuspid | $150.00 |
| Root canal, molar | $185.00 |
| Periodontics | |
| Gingivectomy or gingivoplasty, 4 or more contiguous teeth, per quadrant | $150.00 |
| Scaling & root planing, per quadrant | $40.00 |
| III. Major Services | |
|---|---|
| Crowns | Your Copayment |
| Resin with metal* | $175.00 |
| Porcelain fused to high noble metal* (not for molars) | $275.00 |
| Porcelain fused to high noble metal* (for molars) | $350.00 |
| Full cast high noble metal* | $250.00 |
| 3/4 cast metallic* | $250.00 |
| Prefabricated stainless steel, primary tooth | $50.00 |
| Dentures & Prosthodontics | |
| Complete upper or lower denture | $350.00 |
| Upper or lower partial denture, resin base | $300.00 |
| Upper or lower partial denture, cast metal base with resin saddles | $350.00 |
| Adjust complete denture | $25.00 |
| Repair broken complete denture base | $50.00 |
| Replace missing or broken teeth, complete denture, each tooth | $25.00 |
| Add tooth to existing partial denture | $50.00 |
| Add clasp to existing partial denture | $50.00 |
| Reline complete or partial upper or lower denture, chair side | $65.00 |
| Reline complete or partial upper or lower denture, laboratory | $100.00 |
| Cast high noble metal* pontic | $200.00 |
| Porcelain fused to high noble metal* pontic | $200.00 |
| Resin with high noble metal* pontic | $175.00 |
| Re-cement bridge | $25.00 |
| IV. Orthodontics | |
|---|---|
| Standard 24-month case | |
| Full-banded, upper and lower, to age 19 | $1775.00 |
| Full-banded, upper and lower, adults | $1975.00 |
| Banded, upper or lower, children & adults | $1000.00 |
| Consultation | $25.00 |
| Broken appointments without 24 hour notice | $40.00 |
* Member is responsible for copayment plus actual lab cost of gold
Limitations
- Prophylaxis (cleaning) is limited to once every six months
- Bitewing x-rays are limited to one series of four films every 12 months
- Full mouth x-rays are limited to once every 24 months
- Periodontal treatments (subgingival curettage and root planing) are limited to one treatment per quadrant in any 12 month period
- Fixed bridgework will be covered only when a partial cannot satisfactorily restore the case
- Replacement of partial dentures is limited to once every five years
- Full upper and/or lower dentures are not to exceed one each in any five-year period
- Denture relines are limited to one per arch in any 12-month period
Exclusions
- General anesthesia, analgesia (nitrous oxide), intravenous sedation, or the services of an anesthesiologist
- Treatment of fractures or dislocations; congenital malformations; malignancies, cysts, or neoplasms; or Temporomandibular Joint Syndrome (TMJ)
- Extractions or X-rays for orthodontic purposes
- Prescription drugs and over the counter drugs
- Any services involving implants or experimental procedures
- Any procedures performed for cosmetic, elective or aesthetic purposes
- Any procedure to replace or stabilize tooth structure lost by attrition, abrasion, erosion or grinding