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Bronze Individual Plan 250D
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Plan Overview

The plan has an extensive network of experienced dentists throughout the state of Florida.

It features great savings, including 2 free cleanings per member per year and free vision coverage.

This Plan Includes

  • Free Oral Exams
  • Free X-Rays
  • Free Routine Cleanings (once every 6 months)
  • Free Fluoride Treatment
  • Free Local Anesthesia
  • Free Oral Cancer Screening
  • No Deductibles
  • No Claim Form
  • No Annual Maximums
  • No Age Limits
  • No Exclusions for Pre-Existing Conditions
  • No Limit on Replacing Missing Teeth
  • No Pre-Authorization or Benefits Required
  • Self Referral to Specialists
  • Orthodontic (Braces) Coverage
  • Cosmetic Dentistry

Sample Savings With This Plan

ADA Code Dental Treatment Usual Fee Patient Charges Member Savings
D0120 Periodic Oral Exam $40.00 FREE $40.00
D0150 Comprehensive Oral Exam $60.00 FREE $60.00
D1110 Adult Cleaning (once every 12 months) $65.00 FREE $65.00
D1120 Child Cleaning (once every 12 months) $50.00 FREE $50.00
D9430 Office Visit $60.00 $10.00 $50.00
D0274 Bitewings (4) $45.00 $20.00 $25.00
D1351 Sealants per tooth (to age 14) $40.00 $20.00 $20.00
D0210 Intraoral Radiographs Complete Series (including bitewings) $100.00 $30.00 $70.00
D0330 X-Rays Panoramic Film $85.00 $30.00 $55.00
D2110 Silver Filling $80.00 $35.00 $45.00
D7110 Extraction of Single Tooth $110.00 $55.00 $55.00
D3310 Anterior Root Canal $539.00 $300.00 $239.00
D3320 Anterior Root Canal $645.00 $375.00 $270.00
D3330 Molar Root Canal $785.00 $475.00 $310.00
D5110 Complete Upper Denture (Standard) $1250.00 $625.00 $625.00
Bronze
250D Individual Plan
Plan Type: Commercial
Age Range: All
States Served: Florida
Member Services: 1-800-494-6262
Premium Rates
  Annual
Individual $79.00
Individual+1 $89.00
Family $109.00
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