Dental Services

Plan 460

Plan 460 is designed for those who are looking for basic dental coverage with the lowest cost. When you review the plan benefits you will see the great dental coverage you get.

For a complete listing of all benefits covered in plan 460 click the link below.

We know you will love our plan. If you are ready to sign up, fill out the form on the Enroll  Now tab or give us a call if you have any questions. We are here for you.

Below are some highlights of the benefits you receive with our plan. For a complete listing of all services click on the Plan Benefits button or call us and we can mail a brochure to you.

460 Plan Benefits   

ADA CODE


Member Pays

Diagnostic



D0100-D0999

Office Visit

$5.00

Clinical Oral Evaluations

No Charge

D0120

Periodic Oral Examination

No Charge

D0140

Limited Oral Exam/Problem Focused

No Charge

D0150

Comprehensive Exam

No Charge

D0170

Re-Evaluation, Limited, Problem Focused

No Charge

D0180

Comprehensive Periodontal Evaluation

$15.00

Radiographs/Diagnostic Imaging


D0210

Intraoral, Complete Series w/ Bitewings

No Charge

D0220

Intraoral, Periapical, First Film

No Charge

D0230

Intraoral, Periapical, Each Additional Film

No Charge

D0240

Intraoral, Occlusal Film

No Charge

D0270

Bitewings, Single Film

No Charge

D0272

Bitewings, Two Films

No Charge

D0274

Bitewings, Four Films

No Charge

D0330

Panoramic Film .

No Charge

D0350

Oral/Facial Image, Non-Orthodontic

No Charge

Tests And Laboratory Examinations


D0460

Pulp Vitality Tests

No Charge

D0470

Diagnostic Casts, Non-Orthodontic

$10.00

Dental Prophylaxis, Coronal Scaling & Polish


D1110

Prophylaxis, Adult

No Charge

D1120

Prophylaxis, Child

No Charge

Other Preventive Services


D1310

Nutritional Counseling for Dental Disease

No Charge

D1320

Tobacco Counseling

No Charge

D1330

Oral Hygiene Instruction

No Charge

D1351

Sealant, Per Tooth, Under Age 14 Only

$20.00
















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