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|
|
|
| Dental Procedure |
Regular Fee* |
MDP Fee** |
Savings |
| Initial Exam |
$90.00 |
FREE! |
$90.00
|
| Full Mouth Series
of X-Rays |
$100.00 |
$50.00 |
$50.00
|
| Periodic Exam
(once every 6 mos.) |
$60.00 |
FREE! |
$60.00
|
| Adult Prophy
(cleaning) |
$115.00 |
$60.00 |
$55.00
|
| Child Prophy |
$90.00 |
$40.00 |
$50.00
|
| Child Fluoride |
$50.00 |
$20.00 |
$30.00
|
| 1 surface amalgam (silver) filling |
$135.00 |
$65.00 |
$70.00
|
| 1 surface resin (tooth colored) filling |
$165.00 |
$75.00 |
$90.00
|
| Molar Root Canal |
$1050.00 |
$550.00 |
$500.00
|
| Routine Extraction |
$175.00 |
$85.00 |
$90.00
|
| Crown |
$1100.00 |
$680.00 |
$420.00
|
| Denture (Complete Upper or Lower) |
$1350.00 |
$710.00 |
$640.00
|
*Regular
Fee is based
upon an average of Dentist's Usual and Customary Fees.
**MDP Fee schedule is
subject to change (at the beginning of every calendar year.)
Mainline Dental Plan, Inc.
9 Furler Street
Totowa, NJ 07512
Phone:
1- 877- 880- PLAN (7526)
Fax: (702) 880-7531
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