Which plan is right for you?

Below you can compare features and your cost for certain procedures for each EPO dental option – EPO Standard and EPO High. For more details, you can view a Complete List of program details for each option at the bottom of the chart.  

  EPO Standard EPO 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 Fee2 Your Fee
Oral Exam $77 $0 $0
Complete Series X-rays $202 $0 $0
Bitewing X-Rays (2 Films) $67 $0 $0
Semiannual (2) Teeth Cleanings $128 $0 $0
Topical Fluoride for Children $61 $0 $0
Sealants $80 $0 $0
Filling (3-Surface/Silver) $367 $76 $0
Crown (Porcelain/Metal) $1,576 $555 $380
Implants $2,965 $1,292 $830
Complete Denture $2,246 $702 $455
Root Canal (Anterior Tooth) $1,198 $391 $260
Perio Scaling/Root Planing $357 $105 $31
Extraction, Erupted Tooth $247 $58 $47
Child Orthodontics $6,120 $3,422 $3,422
Adult Orthodontics $6,330 $3,658 $3,658
Complete List of Program Details EPO

Standard

EPO

High


NEW FOR 2022: SmileDirectClub Orthodontic Clear Aligners3

Dominion enrollees now have access to a discounted rate of $1,850 on clear aligners. This could save you up to 67% compared to the national average cost of traditional braces. Learn more at DominionNational.com/sdc.



1 Based on the Context4Healthcare’s 80th percentile for zip 220. Coverage for orthodontia is based on Dominion National’s 80th percentile of in-network and out-of-network claims data for D8080 and D8090 from 2016 to 2019.
2 There is an additional $10 for the office visit fee (per visit, not per procedure).
3 Cost of traditional braces based on average total fees for treatment of mild-to-moderate malocclusion. Data on file at SmileDirectClub. Not all individuals are suitable candidates for clear aligners. These services, which are offered and arranged for by SmileDirectClub, are intended for certain individuals who have mild or moderate orthodontic needs and only if approved by a state-licensed dentist or orthodontist. Dominion National is not a provider of dental care services. For complete details, visit DominionNational.com/sdc.