Which plan is right for you?
Below you can compare features and your cost for certain procedures for each Dental HMO dental option – Select Standard and Select High. For more details, you can view a Complete List of program details for each option at the bottom of the chart.
| Select Standard | Select High | ||
| Features | |||
| Office Visit Copay | $10 | $10 | |
| Deductibles | None | None | |
| Annual Maximum Limit | None | None | |
| Lifetime Maximum Limit for Orthodontics | None | None | |
| Waiting Periods | None | None | |
| Claims Forms | None | None | |
| Must Use a Network Dentist | Yes | Yes | |
| Comparison | Area Charge1 | Your Fee | Your Fee |
| Comprehensive Oral Examination | $85 | $0 | $0 |
| Complete Series X-rays | $161 | $0 | $0 |
| Bitewing X-Rays (4 Films) | $74 | $0 | $0 |
| Cleanings (Adults) | $102 | $0 | $0 |
| Cleanings (Children) | $74 | $0 | $0 |
| Flouride Varnish | $41 | $0 | $0 |
| Sealant | $58 | $0 | $0 |
| Filling (3-Surface/Silver) | $217 | $76 | $0 |
| Crown (Porcelain/Metal) | $1,299 | $555 | $380 |
| Endosteal Implant (Surgical) | $2,503 | $1,292 | $830 |
| Complete Denture | $1,785 | $702 | $455 |
| Root Canal (Anterior Tooth) | $747 | $391 | $260 |
| Perio Scaling/Root Planing | $247 | $105 | $31 |
| Extraction, Erupted Tooth | $170 | $58 | $47 |
| Child Orthodontics | $6,552 | $3,422 | $3,422 |
| Adult Orthodontics | $7,025 | $3,658 | $3,658 |
| Complete List of Program Details | Select Standard | Select High | |
1 Based on the Context4Healthcare’s 80th percentile fee information. Based on zip 220.
