Alternative Dental Insurance
PO BOX 1901
Sacramento, CA 95601

ADA CODE DESCRIPTION Usual Fee* You Pay Plan Discount Your Savings 
D4321Provisional splinting - extracoronal - by report $320.00 $204.00 36% $116.00
D4341Periodontal scaling & root planing - four or more teeth - per quadrant $250.00 $189.00 24% $61.00
D4342Periodontal scaling & root planing - one to three teeth - per quadrant $179.00 $100.00 44% $79.00
D4355Full mouth debridement $180.00 $85.00 53% $95.00
D4381Localized delivery of antimicrobial agents - per tooth - by report ARESTIN $160.00 $95.00 41% $65.00
D4910Periodontal maintenance procedures following active therapy $162.00 $98.00 40% $64.00
D5110Complete maxillary denture $1,942.00 $1,100.00 43% $842.00
D5120Complete mandibular denture $1,942.00 $1,100.00 43% $842.00
D5130Immediate maxillary denture $1,942.00 $1,100.00 43% $842.00
D5140Immediate mandibular denture $1,942.00 $1,100.00 43% $842.00
D5211Maxillary partial denture - resin base $1,942.00 $1,100.00 43% $842.00
D5212Mandibular partial denture - resin base $1,942.00 $1,100.00 43% $842.00
D5213Maxillary partial denture - cast metal framework with resin denture base $1,942.00 $1,100.00 43% $842.00
D5214Mandibular partial denture - cast metal framework with resin denture base $1,942.00 $1,100.00 43% $842.00
D5225Maxillary partial denture - flexible base (including any clasps, rests and teeth) $1,942.00 $1,100.00 43% $842.00
D5226Mandibular partial denture - flexible base (including any clasps, rests and teeth) $1,942.00 $1,100.00 43% $842.00
D5281Removable unilateral partial denture - one piece cast metal $1,942.00 $1,100.00 43% $842.00
D5410Adjust complete denture - maxillary $97.00 $65.00 33% $32.00
D5411Adjust complete denture - mandibular $97.00 $65.00 33% $32.00
D5421Adjust partial denture - maxillary $97.00 $65.00 33% $32.00
D5422Adjust partial denture - mandibular $97.00 $65.00 33% $32.00
D5510Repair broken complete denture base $375.00 $190.00 49% $185.00
D5520Replace missing or broken teeth - complete denture (each tooth) $375.00 $190.00 49% $185.00
D5610Repair resin denture base $375.00 $190.00 49% $185.00
D5620Repair cast framework $375.00 $190.00 49% $185.00
D5630Repair or replace broken clasp $375.00 $190.00 49% $185.00
D5640Replace broken teeth - per tooth $375.00 $190.00 49% $185.00
D5650Add tooth to existing partial denture $375.00 $190.00 49% $185.00
D5660Add clasp to existing partial denture $375.00 $190.00 49% $185.00
D5710Rebase complete denture - maxillary $723.00 $324.00 55% $399.00
D5711Rebase complete denture - mandibular $723.00 $324.00 55% $399.00
D5720Rebase partial denture - maxillary $723.00 $324.00 55% $399.00
D5721Rebase partial denture - mandibular $723.00 $324.00 55% $399.00
D5730Reline complete denture - maxillary - chairside $320.00 $160.00 50% $160.00
D5731Reline complete denture - mandibular - chairside $320.00 $160.00 50% $160.00
D5740Reline partial denture - maxillary - chairside $320.00 $160.00 50% $160.00
D5741Reline partial denture - mandibular - chairside $320.00 $160.00 50% $160.00
D5750Reline complete denture - maxillary - laboratory $544.00 $272.00 50% $272.00
D5751Reline complete denture - mandibular - laboratory $544.00 $272.00 50% $272.00
D5760Reline partial denture - maxillary - laboratory $544.00 $272.00 50% $272.00
D5761Reline partial denture - mandibular - laboratory $544.00 $272.00 50% $272.00
D5810Interim complete denture - maxillary STAYPLATE $926.00 $467.00 50% $459.00
D5811Interim complete denture - mandibular STAYPLATE $926.00 $467.00 50% $459.00
D5820Interim partial denture - maxillary $926.00 $467.00 50% $459.00
D5821Interim partial denture - mandibular $726.00 $467.00 36% $259.00
D5850Tissue conditioning - maxillary $170.00 $85.00 50% $85.00
D5851Tissue conditioning - mandibular $170.00 $85.00 50% $85.00
D5860Overdenture - complete - by report $1,942.00 $1,100.00 43% $842.00
D5861Overdenture - partial - by report $1,942.00 $1,100.00 43% $842.00
D5862Precision attachment - by report $750.00 $375.00 50% $375.00
D5982Surgical stent - by report $886.00 $342.00 61% $544.00
D6010Surgical placement of implant body - endosteal implant $2,975.00 $1,500.00 50% $1,475.00
D6056Prefabricated abutment - includes placement $750.00 $420.00 44% $330.00
D6058Abutment supported crown - porcelain/ceramic $2,713.00 $1,400.00 48% $1,313.00
D6059Abutment supported crown - porcelain fused to high noble metal $2,690.00 $1,400.00 48% $1,290.00
D6060Abutment supported crown - porcelain fused to predominantly base metal $2,597.00 $1,400.00 46% $1,197.00
D6061Abutment supported crown - porcelain fused to noble metal $2,630.00 $1,400.00 47% $1,230.00
D6062Abutment supported crown - cast high noble metal $2,623.00 $1,400.00 47% $1,223.00
D6063Abutment supported crown - cast predominantly base metal $2,394.00 $1,400.00 42% $994.00
D6064Abutment supported crown - cast noble metal $2,477.00 $1,400.00 43% $1,077.00
D6065Implant supported crown - porcelain/ceramic $2,685.00 $1,400.00 48% $1,285.00
D6066Implant supported crown - porcelain fused to high noble metal or titanium $2,641.00 $1,400.00 47% $1,241.00
D6067Implant supported crown - high noble metal or titanium $2,592.00 $1,400.00 46% $1,192.00
D6068Abutment supported retainer for porcelain/ceramic FPD $2,713.00 $1,400.00 48% $1,313.00
D6069Abutment supported retainer for porcelain fused to metal FPD (high noble metal) $2,690.00 $1,400.00 48% $1,290.00
D6070Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) $2,597.00 $1,400.00 46% $1,197.00
D6071Abutment supported retainer for porcelain fused to metal FPD (noble metal) $2,630.00 $1,400.00 47% $1,230.00
D6072Abutment supported retainer for cast metal FPD (high noble metal) $2,664.00 $1,400.00 47% $1,264.00
D6073Abutment supported retainer for cast metal FPD (predominantly base metal) $2,506.00 $1,400.00 44% $1,106.00
D6074Abutment supported retainer for cast metal FPD (noble metal) $2,623.00 $1,400.00 47% $1,223.00
D6075Implant supported retainer for ceramic FPD $2,685.00 $1,400.00 48% $1,285.00
D6076Implant supported retainer for porcelain fused to metal FPD (high noble metal or titanium) $2,641.00 $1,400.00 47% $1,241.00
D6077Implant supported retainer for cast metal FPD (high noble metal or titanium) $2,592.00 $1,400.00 46% $1,192.00
D6078Implant/Abutment supported fixed denture for completely edentulous arch $1,650.00 $1,200.00 27% $450.00
D6079Implant/Abutment supported fixed denture for partially edentulous arch $1,650.00 $1,200.00 27% $450.00
D6092Recement implant/abutment supported crown $175.00 $75.00 57% $100.00
D6093Recement implant/abutment supported fixed partial denture $206.00 $84.00 59% $122.00
D6094Abutment supported crown - (titanium) $1,650.00 $950.00 42% $700.00
D6190Radiographic/surgical implant index - by report $344.00 $201.00 42% $143.00
D6194Abutment supported retainer crown for FPD - (titanium) $1,650.00 $895.00 46% $755.00
D6210Bridge pontic - cast high noble metal $1,650.00 $895.00 46% $755.00
D6211Bridge pontic - cast predominantly base metal $1,650.00 $895.00 46% $755.00
D6212Bridge pontic - cast noble metal $1,650.00 $895.00 46% $755.00
D6214Bridge pontic - titanium $1,650.00 $895.00 46% $755.00
D6240Bridge pontic - porcelain fused to high noble metal $1,650.00 $895.00 46% $755.00
D6241Bridge pontic - porcelain fused to predominantly base metal $1,650.00 $895.00 46% $755.00
D6242Bridge pontic - porcelain fused to noble metal $1,650.00 $895.00 46% $755.00
D6245Bridge pontic - porcelain/ceramic $1,650.00 $895.00 46% $755.00
D6250Bridge pontic - resin with high noble metal $1,650.00 $895.00 46% $755.00
D6251Bridge pontic - resin with predominantly base metal $1,650.00 $895.00 46% $755.00
D6252Bridge pontic - resin with noble metal $1,650.00 $895.00 46% $755.00
D6253Provisional pontic $445.00 $250.00 44% $195.00
D6751Bridge Pontic - (PFM) Base Metal $1,650.00 $895.00 46% $755.00
D6930Recement fixed partial denture $298.00 $149.00 50% $149.00
D6940Stress breaker - by report $417.00 $162.00 61% $255.00
D6950Precision attachment - by report $890.00 $445.00 50% $445.00
D6970Post and core in addition to fixed partial denture retainer, indirectly fabricated $386.00 $205.00 47% $181.00
D6972Prefabricated post & core in addition to FPD retainer $314.00 $156.00 50% $158.00
D6973Core build up for retainer - including any pins $293.00 $154.00 47% $139.00
D7111Extraction - coronal remnants - deciduous tooth $140.00 $89.00 36% $51.00
D7140Extraction - erupted tooth or exposed root (elevation and/or forceps removal) $186.00 $106.00 43% $80.00
D7210Surgical removal of erupted tooth $349.00 $155.00 56% $194.00
D7220Removal of impacted tooth - soft tissue $420.00 $255.00 39% $165.00
D7230Removal of impacted tooth - partially bony $549.00 $375.00 32% $174.00
D7240Removal of impacted tooth - completely bony $587.00 $383.00 35% $204.00
D7241Removal of impacted tooth - completely bony - with unusual surgical complications - by report $737.00 $499.00 32% $238.00
D7250Surgical removal of residual tooth roots - cutting procedure $317.00 $222.00 30% $95.00
D7260Oroantral fistula closure $2,638.00 $863.00 67% $1,775.00
D7261Primary closure of a sinus perforation $1,853.00 $858.00 54% $995.00
D7270Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth - by report $836.00 $412.00 51% $424.00
D7310Alveoloplasty in conjunction with extractions – four or more teeth or tooth spaces, per quadrant $349.00 $203.00 42% $146.00
D7311Alveoloplasty - in conjunction with extractions - one to three teeth or tooth spaces, per quadrant $272.00 $102.00 63% $170.00
D7320Alveoloplasty not in conjunction with extractions –four or more teeth or tooth spaces, per quadrant $504.00 $278.00 45% $226.00
D7321Alveoloplasty - not in conjunction with extractions - one to three teeth or tooth spaces, per quadrant $427.00 $139.00 67% $288.00
D7340Vestibuloplasty - ridge extension - secondary epithelialization $2,793.00 $1,259.00 55% $1,534.00
D7350Vestibuloplasty - ridge extension $8,728.00 $3,976.00 54% $4,752.00
D7471Removal of lateral exostosis (maxilla or mandible) $1,153.00 $490.00 58% $663.00
D7472Removal of torus palatinus $1,370.00 $456.00 67% $914.00
D7473Removal of torus mandibularis $1,293.00 $458.00 65% $835.00
D7485Surgical reduction of osseous tuberosity $1,153.00 $304.00 74% $849.00
D7510Incision and drainage of abscess - intraoral soft tissue $334.00 $121.00 64% $213.00
D7530Removal of a foreign body from mucosa, skin, or subcutaneous alveolar tissue $573.00 $103.00 82% $470.00
D7880Occlusal orthotic device (TMJ treatment appliance) - by report $857.00 $756.00 12% $101.00
D7910Suture of recent small wounds up to 5 cm $509.00 $98.00 81% $411.00
D7911Complicated suture - up to 5 cm $1,271.00 $97.00 92% $1,174.00
D7912Complicated suture - greater than 5 cm $2,287.00 $109.00 95% $2,178.00
D7953Bone replacement graft for ridge preservation - per site $895.00 $450.00 50% $445.00
D7960Frenulectomy (frenectomy or frenotomy) - separate procedure $441.00 $230.00 48% $211.00
D7970Excision of hyperplastic tissue - per arch $683.00 $272.00 60% $411.00
D7971Excision of pericoronal gingiva $241.00 $102.00 58% $139.00
D7972Surgical reduction of fibrous tuberosity $969.00 $431.00 56% $538.00
D8010Limited Orthodontic treatment of the primary dentition $5,500.00 $2,500.00 55% $3,000.00
D8020Limited Orthodontic treatment of the transitional dentition $5,500.00 $2,500.00 55% $3,000.00
D8030Limited Orthodontic treatment of the adolescent dentition $5,500.00 $3,200.00 42% $2,300.00
D8040Limited Orthodontic treatment of the adult dentition $5,500.00 $3,200.00 42% $2,300.00
D8070Comprehensive orthodontic treatment of the transitional dentition $5,500.00 $3,800.00 31% $1,700.00
D8080Comprehensive orthodontic treatment of the adolescent dentition $5,500.00 $3,800.00 31% $1,700.00
D8090Comprehensive orthodontic treatment of the adult dentition $5,500.00 $3,800.00 31% $1,700.00
D8210Remoable appliance Therapy (RETAINER) $650.00 $420.00 35% $230.00
D8220Fixed appliance therapy (FIXED RETAINER) $650.00 $420.00 35% $230.00
D8660Pre-Orthodontic Treatment Visit $- $- #DIV/0! $-
D8670Periodic Orthodontic Treatment Visit (As Part of Contract) $- $- #DIV/0! $-
D8680Orthodontic Retention (Removal of appliances, Construction & Placement of Retainer(s)) $849.00 $450.00 47% $399.00
D8999Unspecificed Orthodontic Procedure (BY Report) (Invisalign) $5,500.00 $4,000.00 27% $1,500.00
D8999Unspecificed Orthodontic Procedure (BY Report) (Six Month Smiles) $4,200.00 $3,800.00 10% $400.00
D9110Palliative emergency treatment of dental pain - minor procedure - by report $138.00 $57.00 59% $81.00
D9248Non-intravenous conscious sedation $450.00 $219.00 51% $231.00
D9420Hospital call $532.00 $222.00 58% $310.00
D9430Office visit - for observation during office hours, no other services performed $90.00 $36.00 60% $54.00
D9440Office visit - after regularly scheduled office hours $180.00 $62.00 66% $118.00
D9610Therapeutic parenteral drug, single administration $25.00 $25.00 0% $-
D9612Therapeutic parenteral drugs, two or more administrations, different medications $46.00 $46.00 0% $-
D9910Application of desensitizing medicament, per visit $63.00 $25.00 60% $38.00
D9920Behavior management - by report $49.00 $49.00 0% $-
D9940Occlusal guard - by report $549.00 $350.00 36% $199.00
D9942Repair and/or reline of occlusal guard. Provide placement date of nightguard $250.00 $125.00 50% $125.00
D9950Occlusion analysis - mounted case - by report $377.00 $237.00 37% $140.00
D9951Limited occlusal adjustment - per visit $176.00 $77.00 56% $99.00
D9952Complete occlusal adjustment - by report $988.00 $246.00 75% $742.00
D9972External bleaching - per arch $436.00 $182.00 58% $254.00
D9974Internal bleaching - per tooth $372.00 $152.00 59% $220.00
* Usual is the average amount charged by neiborhood dentists, actual cost may vary        
** A $5 copay will be added to every office visit. Fees may change without any notification and may slighltly vary from a provider to another based on the location