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SMILE BRIGHTLY AND THE WORLD WILL SMILE BACK!


Preventive
Member Fee
Without Smile Bright Dental Plan
Office Visits (Unlimited)
No Charge
30
Oral Examinations & Diagnosis (Unlimited)
No Charge
25
Home Care Prevention
No Charge
20
X-Ray (Bitewings) - Adult & Child
No Charge
55
Floride Treatment - Child (One per year)
No Charge
35
Twice Yearly Maintenance
     Routine Cleaning- Adult
38
120
     Routine Cleaning - Child
34
110
Difficult Prophylaxis (Heavy calculus)
59
210
Additional Floride Treatment
15
35
Panoramic X-Ray
52
127
Full Mouth X-Ray
32
98
Single Film X-Ray
4
18
Sealants (Necidenus, Permanent)
18
38
Sterilization Fee (Per visit)
12
24
Emergency Treatment (Office hours)
25
48
Missed Appointments without 24 hr. notice
20
25
Extractions
Member Fee
Without Smile Bright Dental Plan
Simple, Local Anesthetic
58
102
Surgical Extraction
146
255
Restorative (Fillings)
Member Fee
Without Smile Bright Dental Plan
Amalgam Restorations in Primary & Permanent Teeth

     1 Tooth Surface
58
88
     2 Tooth Surfaces
69
129
     3 Tooth Surfaces
84
158
     4 Tooth Surfaces
96
182
Resin Restorations in Anterior Permanent Teeth

     1 Tooth Surface
68
112
     2 Tooth Surfaces
83
142
     3 Tooth Surfaces
109
205
Resin Restorations in Posterior Permanent Teeth

     1 Tooth Surface
84
149
     2 Tooth Surfaces
109
205
     3 Tooth Surfaces
129
224
Acid Etch
10
20
Sedative Base (Dycal)
10
20
Cosmetic Bonding
Member Fee
Without Smile Bright Dental Plan
Facail Direct Bonding
119
149
Porcelain Laminate Veneer
712
1311
Bleaching (Per arch)
175
205
Pontics
Member Fee
Without Smile Bright Dental Plan
Cast
398
952
Porcelain with Semi-Precious
521
1141
Porcelain with Meta
422
1009
Recementation
45
75
Crowns and Bridge Work
Member Fee
Without Smile Bright Dental Plan
Stainless Steel Crown
92
172
Porcelain Crown with Metal
509
964
3/4 Cown
413
925
Full Crown with Semi-Precious
540
1086
Porcelain Crown with Semi-Precious
552
1122
Porcelain Crown Jacket
723
1400
Inlays

     1 Surface
403
791
     2 Surfaces
456
802
     3 Surfaces
487
910
Pin Retention
29
44
Core BU
127
203
Performed Post/Care
131
212
Perionontics 
Gum Treatment by a General Practictioner
Member Fee
Without Smile Bright Dental Plan
Full Mouth Debridement
119
219
Periodontal Prophylaxis (Post Maintenance)
63
95
Root Planning per Quad
135
206
Subgingival Curettage Per Quad
132
209
Gingivectomy, Per Quad
231
427
Gingivectomy, Per Tooth
78
152
Osseus Surgery
378
612
Endodontics 
Root Canal by a General Practictioner
Member Fee
Without Smile Bright Dental Plan
Vitality Test
19
46
Pulp Treatment
75
93
Pulp Cap
37
78
Pulpotomy
68
123
Recalcification per Tooth
26
65
Root Canal 1
382
724
Root Canal 2
475
935
Root Canal 3
598
1110
Apicoectomy
238
383
Anterior, Bicuspid, Molar Retro Fill
131
182
Prosthodontics 
Or Denture & Partials
Member Fee
Without Smile Bright Dental Plan
Complete Maxillary Denture
752
1489
Complete Mandibular Denture
752
1489
Partial U or L Acrylic with Chrome
798
1590
Reline (Chair Side)
124
210
Reline (Lab)
188
297
Stayplate
225
310
Denture Repair, No Teeth
53
98
Replace Tooth (Plus Lab Fee)
31
78
Orthodontics 
Or Braces
Member Fee
Discount
25%
Oral Surgury
Member Fee
Discount
25%


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