Procedure | ADA Code | Usual Fee1 | With Plan2 | You Save | % Saved |
---|---|---|---|---|---|
Routine 6 month check-up | ADA Code: D0120 | Usual Fee1: $56.00 | With Plan2: $0 | You Save: $56 | Saving Percentage: 100% |
In depth check-up | ADA Code: D0150 | Usual Fee1: $98.00 | With Plan2: $0 | You Save: $98 | Saving Percentage: 100% |
Full mouth x-rays | ADA Code: D0210 | Usual Fee1: $148.00 | With Plan2: $0 | You Save: $148 | Saving Percentage: 100% |
Four bitewing x-rays | ADA Code: D0274 | Usual Fee1: $70.00 | With Plan2: $24 | You Save: $46 | Saving Percentage: 66% |
Panoramic film | ADA Code: D0330 | Usual Fee1: $125.00 | With Plan2: $25 | You Save: $100 | Saving Percentage: 80% |
Adult teeth cleaning | ADA Code: D1110 | Usual Fee1: $99.00 | With Plan2: $0 | You Save: $99 | Saving Percentage: 100% |
Child teeth cleaning | ADA Code: D1120 | Usual Fee1: $76.00 | With Plan2: $0 | You Save: $76 | Saving Percentage: 100% |
Protective sealant / tooth | ADA Code: D1351 | Usual Fee1: $60.00 | With Plan2: $25 | You Save: $35 | Saving Percentage: 58% |
1 surface silver filling for primary or permanent tooth | ADA Code: D2140 | Usual Fee1: $180.00 | With Plan2: $50 | You Save: $130 | Saving Percentage: 72% |
1 surface white filling for u or l front tooth | ADA Code: D2330 | Usual Fee1: $195.00 | With Plan2: $45 | You Save: $150 | Saving Percentage: 77% |
Single crown - porcelain on high noble metal | ADA Code: D2750 | Usual Fee1: $1265.00 | With Plan2: $499 | You Save: $766 | Saving Percentage: 61% |
Single crown - porcelain on noble metal | ADA Code: D2752 | Usual Fee1: $1435.00 | With Plan2: $480 | You Save: $955 | Saving Percentage: 67% |
Core build-up with pins | ADA Code: D2950 | Usual Fee1: $300.00 | With Plan2: $85 | You Save: $215 | Saving Percentage: 72% |
Labial veneer (resin laminate) - direct | ADA Code: D2960 | Usual Fee1: $730.00 | With Plan2: $205 | You Save: $525 | Saving Percentage: 72% |
Labial veneer (porcelain laminate) - indirect | ADA Code: D2962 | Usual Fee1: $1489.00 | With Plan2: $425 | You Save: $1,064 | Saving Percentage: 71% |
Root canal treatment - front tooth | ADA Code: D3310 | Usual Fee1: $1015.00 | With Plan2: $310 | You Save: $705 | Saving Percentage: 69% |
Root canal treatment - bicuspid | ADA Code: D3320 | Usual Fee1: $1151.00 | With Plan2: $375 | You Save: $776 | Saving Percentage: 67% |
Root canal treatment - molar | ADA Code: D3330 | Usual Fee1: $1395.00 | With Plan2: $485 | You Save: $910 | Saving Percentage: 65% |
Bone replacement graft - retained natural tooth - first site in quadrant | ADA Code: D4263 | Usual Fee1: $600.00 | With Plan2: $200 | You Save: $400 | Saving Percentage: 67% |
Perio scaling and root planing (per quadrant) | ADA Code: D4341 | Usual Fee1: $289.00 | With Plan2: $80 | You Save: $209 | Saving Percentage: 72% |
Regular cleaning following periodontic procedure | ADA Code: D4910 | Usual Fee1: $150.00 | With Plan2: $55 | You Save: $95 | Saving Percentage: 63% |
Full upper denture | ADA Code: D5110 | Usual Fee1: $1975.00 | With Plan2: $625 | You Save: $1,350 | Saving Percentage: 68% |
Full lower denture | ADA Code: D5120 | Usual Fee1: $1988.00 | With Plan2: $625 | You Save: $1,363 | Saving Percentage: 69% |
Add clasp to existing partial denture | ADA Code: D5660 | Usual Fee1: $237.00 | With Plan2: $75 | You Save: $162 | Saving Percentage: 68% |
Tooth replacement part of permanent bridge | ADA Code: D6210 | Usual Fee1: $1400.00 | With Plan2: $499 | You Save: $901 | Saving Percentage: 64% |
Single tooth removal - simple extraction | ADA Code: D7140 | Usual Fee1: $215.00 | With Plan2: $70 | You Save: $145 | Saving Percentage: 67% |
Extraction - impacted wisdom tooth (soft tissue) | ADA Code: D7220 | Usual Fee1: $402.00 | With Plan2: $125 | You Save: $277 | Saving Percentage: 69% |
Extraction - impacted wisdom tooth (partial bony) | ADA Code: D7230 | Usual Fee1: $484.00 | With Plan2: $145 | You Save: $339 | Saving Percentage: 70% |
External bleaching – per arch – performed in office | ADA Code: D9972 | Usual Fee1: $250.00 | With Plan2: $150 | You Save: $100 | Saving Percentage: 40% |
The sample table above is a small selection of common procedures discounted by the Solstice Plus Plan One. Once you're a member, you will be provided with a complete fee schedule with discounted fees for nearly every dental procedure. All procedures discounted under the Solstice Plus Plan One offer similar savings to the sample above. If you are looking for a specific dental procedure that is not on this sample, please contact our Customer Care Center toll-free at (888) 632-5353 with the ADA Code of the procedure and we can provide the discounted fee.
1 The [“Usual Fee”] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. Actual fees charged by your provider may vary for a variety of reasons.
2 Discounted fees are listed for visits to a participating general dentist - this fee is guaranteed according to your fee schedule. Any procedure not listed on the complete fee schedule (provided in your Member's Area once you join) will be discounted 25% off the provider's usual and customary fee. Consult with your provider prior to beginning any treatment.
* Savings will be 20% off usual customary rate.
Savings on more than 99% of all commonly prescribed medications
Now you and your family can access savings on your prescriptions at a network of over 65,000 participating local retail pharmacies, or through the mail service pharmacies for home delivery of maintenance (longterm) medicines.
The network includes national chains, local chains and independent pharmacies. You will save money on all types of prescription medications at the time of purchase. Your physician’s choice of prescribed medications and your preference for brand or generic prescriptions will always be honored.
No Limits: You and your family may use the drug discount program any time your prescription is not covered by insurance. There are no restrictions and no limits on how many times you may use your card. Even your pet medication is included!
Save an average of 50% on generic medication when you order by mail.
Save an average of 20% on brand and generic medication when visiting a participating pharmacy.
Visit the link provided in your Member’s Area to check drug costs, locate a pharmacy, refill mail order prescriptions, and much more! Or call the toll free number provided in your Member’s Area.
Administered by CVS/Caremark. Accepted at more than 65,000 retail pharmacies nationally, including all major retail chains. This plan is not insurance. Savings are only available at participating pharmacies.