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Plan Features and Highlights
- Periodic Oral Examination and One set of X-rays FREE per year at participating general dentist *
- FREE Bitewing X-Rays (once per year) at participating general dentist *
- Orthodontia (orthodontics) included up to age 16
- No annual limits
- Quick activation, start saving soon
- No health restrictions
- No referral required to see a Specialist
- Group rates available
Individual
Plan Membership Fee
1
Join now & get
3 extra months FREE!
Family 2
Plan Membership Fee
1
Join now & get
3 extra months FREE!
1Your plan will activate on Tuesday, November 22, 2011 if you join today.
2Those eligible for discounts under this plan include spouse and any other financially dependent family member living in the member's household.
Plan Summary
The Patriot Plan was created to make DENTAL care affordable to more Americans. Patriot Plan helps you receive the dental care you need while saving you money. Your complete dental fee schedule is on average of up to 50% off usual and customary fees as compared with ADA regional survey averages. The Patriot Plan reduced fee-for-service dental program provides quality dental care at more than 7,900 participating dentists nationwide.
Sample Plan Savings for ZIP code 92801
| ADA Code | Procedure Description | Usual Fee 1 |
Discounted Fee
(for Plan Members) 2 |
Member Savings | Savings Percentage |
| D0120 | Routine 6 Month Check-Up * | $57 | FREE* | $57 | 100% |
| D0150 | In Depth Check-Up * | $99 | FREE* | $99 | 100% |
| D0210 | Full Mouth X-Rays * | $144 | FREE* | $144 | 100% |
| D0274 | Four Bitewing X-Rays * | $70 | FREE* | $70 | 100% |
| D0330 | Panoramic Film * | $122 | FREE* | $122 | 100% |
| D1110 | Adult Teeth Cleaning * | $102 | $58 | $44 | 43% |
| D1110 | Adult Teeth Cleaning (additional in same membership year) | $102 | $39 | $63 | 62% |
| D1120 | Child Teeth Cleaning * | $75 | $40 | $35 | 47% |
| D1120 | Child Teeth Cleaning (additional in same membership year) | $75 | $28 | $47 | 63% |
| D1351 | Protective Sealant / Tooth | $61 | $18 | $43 | 70% |
| D2330 | 1 Surface White Filling for U or L Front Tooth | $175 | $61 | $114 | 65% |
| D2750 | Single Crown - Porcelain on High Noble Metal | $1,227 | $534 | $693 | 56% |
| D2752 | Single Crown - Porcelain on Noble Metal | $1,162 | $501 | $661 | 57% |
| D2950 | Core Build-Up With Pins | $296 | $111 | $185 | 62% |
| D3310 | Root Canal Treatment - Front Tooth | $826 | $284 | $542 | 66% |
| D3320 | Root Canal Treatment - Bicuspid | $967 | $342 | $625 | 65% |
| D3330 | Root Canal Treatment - Molar | $1,170 | $428 | $742 | 63% |
| D4341 | Perio Scaling and Root Planing (Per Quadrant) | $271 | $101 | $170 | 63% |
| D5110 | Full Upper Denture | $1,855 | $623 | $1,232 | 66% |
| D6210 | Tooth Replacement Part of Permanent Bridge | $1,197 | $501 | $696 | 58% |
| D7140 | Single Tooth Removal - Simple Extraction | $197 | $75 | $122 | 62% |
The sample table above is a small selection of common procedures covered by the Patriot Plan. Once you’re a member, you will be provided with a complete fee schedule with discounted fees for nearly every dental procedure. All procedures covered under the Patriot Plan offer similar savings to the sample above. If you are looking for a specific dental procedure that is not on this sample, please contact our Customer Care Center toll-free at (888) 632-5353 with the ADA Code of the procedure and we can provide the discounted fee.
1 Source: DentalPlans.com (DP.C) 2010 Survey of Sample Average National Dental Fees (updated March 2011). Fees may vary slightly by region.
2 Discounted fees are listed for visits to a participating provider. Any procedure not listed on the complete fee schedule (provided in your Member's Area once you join) will be discounted 25% off the provider's usual and customary fee. Any services not listed at either the general dentist or specialist (including pedodontics, prosthodontics and implantology) are available at a 25% discount from usual and customary fees charged by participating providers. One should verify provider participation and fees prior to beginning any treatment.
* Annual Check-up: one per membership year: Any combination of exam procedures Routine 6 Month Check-Up, Limited Oral Evaluation - Problem Focused, In Depth Check-Up , and X-Ray procedures Full Mouth X-Rays, Individual X-Ray Showing Tooth Roots, Intraoral - Periapical each additional film, Bitewing - Single/Two/Four Films, Panoramic Film FREE WITH prophylaxis procedures Adult Teeth Cleaning or Child Teeth Cleaning : $58 Adult, $40 Child.
All Patriot Plan dental charges are set at the fees shown on DentalPlans.com website at the time of plan purchase. These fees are good for 12 months from the date of plan purchase. The remaining 3 months on the plan may be subject a higher fee schedule, and fees are subject to change without notice.
All participating providers may charge an OSHA sterilization fee per visit.
All participating providers may charge a lab fee for crown and bridge work.
Click on the links below for more details
Individual
Plan Membership Fee
1
Join now & get
3 extra months FREE!
Family 2
Plan Membership Fee
1
Join now & get
3 extra months FREE!
1Your plan will activate on Tuesday, November 22, 2011 if you join today.
2Those eligible for discounts under this plan include spouse and any other financially dependent family member living in the member's household.
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