| Dental Plans Applications |
| Anthem Blue Cross of California |
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| Blue Shield |
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| Delta Dental MorganWhite |
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| Golden West |
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| Kaiser Permanente |
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| Standard Life MorganWhite |
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Select HMO (ZE7N)
Select
Another Plan
Determine the rates for the medical plan you selected and other
available plans by clicking on the Get a Personalized Quote link
on the left.
| Office
Visit |
Office
Visit
|
$5 |
| Diagnostic
Care |
Oral
Exams
|
No
Charge |
X-rays
|
No
Charge |
| Preventive
Care |
Prophylaxis
- adult & child
|
No
Charge1 |
Topical
Fluoride - child
|
No
Charge |
| Restorative
Care |
Filling
- Permanent 1 surface amalgam
|
No
Charge2 |
Filling
- Permanent 2 surfaces amalgam
|
No
Charge2 |
Filling
- Permanent 3 surfaces amalgam
|
No
Charge2 |
Filling
- Permanent 4 or more surfaces amalgam
|
No
Charge2 |
| Cosmetic
Care |
Labial
Veneer(laminate)-chair side
|
$187 |
Resin
Filling - permanent,one surface, posterior
|
$75 |
| Endodontic
Care |
Pulpotomy
|
$62 |
Root
Canal - Anterior
|
$289 |
Root
Canal - Bicuspid
|
$341 |
Root
Canal - Molar
|
$459 |
| Periodontal
Care |
Gingivectomy
- per quadrant
|
$194 |
Gingivectomy
- per tooth
|
$72 |
Osseous
Surgery
|
$520 |
Scaling/Root
Planingper quadrant
|
$101 |
| Oral
Surgery |
Extraction
- of erupted tooth or exposed root
|
$60 |
Impaction
- complete bony
|
$200 |
Impaction
- partial bony
|
$176 |
Impaction
- soft tissue
|
$136 |
| Prosthodontic
Care |
Complete
Upper or
|
$577 |
Crowns
|
$432 |
Denture
(broken tooth repair)
|
$57 |
Partial
Denture
|
$430 |
| Orthodontic
Care |
Orthodontics
- Adult
|
$3045 |
Orthodontics
- Child
|
$2870 |
Retention
|
$210 |
| Other
Services |
Local
Anesthesia
|
$14 |
Office
Visit After Hours
|
$56 |
| 1 |
First
two treatments in 12 consecutive months. All additional
treatments within a 12 month period require co payments
of $44 for adults and $35 for children.
|
| 2 |
You
must meet a six-month waiting period before these benefits
are payable.
|
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| Standard Health Plans Applications |
| Aetna |
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| Anthem BC Life and Health Insurance Company Tonik |
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| Anthem Blue Cross of California |
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| Blue Shield of California |
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| Health Net of California |
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| Health Net of California Farm Bureau |
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| Kaiser Permanente |
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| Temporary Health Plans Applications |
| Anthem BC Life and Health Insurance Company |
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| Assurant |
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| Health Net of California |
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| Health Plans |
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