Dental Treatment Plan Affordable Dental Plan
 
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Plan
   
ADP Plans ADP PLAN
Membership Plan Fees- Per Month-Per Member $6.67
Average Daily Fees -Per Member-Per Day $0.22
Minimum Contract Terms required 1 year
Billing Cycle 1 year
Billing Cycle total amount $79.99
Cost for Patient - PerYear $79.99
Sterilization & Disposable fees [per visit per member] $10.00
Most Commonly Used Dental Procedures and Fees Comparision*
BASIC & PREVENTATIVE: Regular Fees ADP PLAN
Exams & Consultation $90.00 $0.00
Prophylaxis $90.00 $45.00
Topical Fluoride $50.00 $25.00
Sealant Per Tooth $40.00 $35.00
     
X-Rays    
Limited X-rays upto 8 Films/X-rays $120.00 $0.00
Full Mouth X-rays (8 and above films/x-rays) $120.00 $70.00
Panoramic X-ray $120.00 $70.00
Ceph X-ray $180.00 $126.00
     
RESTORATIVE:    
Amalgam Restoration [Silver Filling]-Each Surface $115.00 $60.00
Composite Restoration [ Tooth Colored filling]Front teeth-Each Surface $140.00 $100.00
     
CROWNS & BRIDGES:    
Core Build-up and or Post & Core with Base Metal $300.00 $200.00
Stainless Steel Crown [ for Baby Teeth] $300.00 $175.00
Base Metal Inlay/Onlay $650.00 $455.00
Base Metal Porcelain Crown $950.00 $550.00
Metal Free Crown $1,200.00 $700.00
     
DENTAL IMPLANT    
Surgical placement of implant body: endosteal implant $3,000.00 $2,000.00
Implant Abutment $1,500.00 $600.00
Implant Crown $1,500.00 $700.00
     
ENDODONTIC/ROOT CANAL:    
Pulpotomy for Primary Teeth [ for Baby Teeth] $210.00 $147.00
Anterior Teeth [ front Teeth] $675.00 $425.00
Pre Molars $825.00 $500.00
Molars [Back Teeth] $950.00 $650.00
     
PERIODONTICS [GUM RELATED]:    
Scaling & Root Planning - Per Quadrant $225.00 $150.00
     
REGULAR DENTURES:    
Full Arch Denture- Per Arch - Regular Teeth & Acrylic $1,200.00 $900.00
Metal Partial Denture $1,200.00 $900.00
Metal free Partial Denture $1,800.00 $1,200.00
     
ORAL SURGERY:    
Simple Extraction $120.00 $90.00
Surgical extraction by General Dentist $250.00 $200.00
     
Any Specialty Services and other services NOT listed will be subject to
30% Discount off the Regular Fees
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Disclaimer  

This schedule applies to services provided by a participating general dentist in this plan. The purpose of this schedule is to establish the maximum fee that a general dentist will charge for each procedure. Member is responsible for all charges at the time of service. Specialty procedures or procedure performed by specialist will be up to 20% discount off of their normal fees. Fee schedule are subject to change without prior notice to members.
It is the member’s responsibility to verify that the dentist is a participating provider (general or specialist dentist) before seeking any treatment.

Procedure not listed on this schedule will be discounted at 20% of the general dentist’s normal fee. If any general dentist’s normal fee for any procedure is less than the fee listed in our discounted fee schedule than that dentist fee i.e. lowest fee will apply.

 The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment, many treatments may require more than one dental procedure. Please consult your Affordable Dental Plan provider for a detailed treatment plan prior to begin any work.

Work in progress prior to enrollment of the dental plan must be completed by the dentist who started the work and is subject to no discount.

Affordable Dental Plan cannot guarantee the continued participation of any dentist. If the dentist leaves the plan, you will need to select another participating Affordable dental Plan Provider. Not all types of dentists may be available in your area. Subscription Fees are non-refundable.

Any procedure involving lab fees will incur additional costs. All applicable lab fees are responsibility of the member.

While all participating Affordable Dental Plan Providers are professionally licensed in the state in which they practice. Affordable Dental Plan Provider does not guarantee the quality of services of the providers. Any quality of care concerns involving any participating Affordable Dental Plan Provider should be directed in writing to: Affordable Dental Plan USA, LLC, Attn.: Provider Relations, 401 Commerce Drive, # 108, Fort Washington, PA- 19034 Please Call: 1 888 303 0600 if you have any further questions.

 
   
 
 
   
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