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| PLATINUM CARD PLAN |
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Dental Savings Plan Chart
Your Alliance HealthCard membership
entitles you to discounts of
30% to 60% on all Dental plan services with more than 58,000 Dental
providers. Below is a sample Dental plan savings chart:
| ADA Code |
Procedure Description |
Usual Fee* |
Discounted Fee** |
Member Savings*** |
Savings
% |
| 0120 |
Routine 6-mth Check-up |
$35 |
$24 |
$11 |
31% |
| 0150 |
In-depth Check-up |
$60 |
$36 |
$24 |
40% |
| 0274 |
Bitewings - Four Films |
$45 |
$31 |
$14 |
31% |
| 1110 |
Adult Cleaning |
$65 |
$54 |
$11 |
17% |
| 1120 |
Child Cleaning |
$50 |
$38 |
$12 |
24% |
| 1351 |
Sealant - Per Tooth |
$40 |
$30 |
$10 |
25% |
| 2330 |
White Filling |
$110 |
$71 |
$39 |
35% |
| 2750 |
Crown - Porcelain |
$800 |
$535 |
$265 |
33% |
| 3330 |
Root Canal - Molar |
$785 |
$576 |
$209 |
27% |
| 4341 |
Perio Scaling and Root Planing (per quadrant) |
$188 |
$117 |
$71 |
38% |
| 5110 |
Upper Denture (complete) |
$1,250 |
$701 |
$549 |
44% |
| 6210 |
Tooth Replacement / Bridge Prosthetic |
$795 |
$504 |
$291 |
37% |
| 7110 |
Single Tooth Extraction |
$110 |
$65 |
$45 |
41% |
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Sources: American
Dental Association (ADA) 2001 Regional Survey of Dental Fees. |
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Discounted fees
are listed for visits to participating general dentists. |
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Actual savings may
vary based upon procedure, geographic location, and within zip
code. |
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Gold Card for Dental Care Discounts
- 30% to 60% savings on dental plan services
- Includes discount networks for pharmacy, vision, hearing
and more
- 24-hour nurse hotline, chiropractic, health clubs, diabetes
supplies
- Unlimited use; valid for your entire family
- No service limitations or spending caps
- Learn more about the discount
dental plan
Only $9.95 per month or $99.95 for
an annual membership!
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Platinum Card Option
- Includes pharmacy, dental, vision, hearing and
more
- (all Gold Card plans shown above)
- Plus more than 400,000 physicians and specialists
- And over 5,000 hospitals and 75,000 ancillary facilities
Only $15.95 per month or $159.95
for an annual membership! |
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