Perfect Teeth Dental Plan | www.perfectteeth.com

Procedure Description                        Regular Fee Member Cost Savings
Diagnostic & Preventive
Exam $78 $0 100%
Complete X-rays $152 $0 100%
Preventive Cleaning - Adult
(Limited to two cleanings per year)
$90 $49 46%
Preventive Cleaning - Child 
(Limited to two cleanings per year)
$80 $29* 64%
Fluoride Varnish $35 $25 28%
Fillings - Tooth Colored
Front Tooth - 1 Surface $123 $85 31%
Front Tooth - 2 Surfaces $163 $105 36%
Front Tooth - 3 Surfaces $199 $110 45%
Back Tooth - 1 Surface $143 $100 30%
Back Tooth - 2 Surfaces  $263 $125 52%
Back Tooth - 3 Surfaces $333 $145 56%
Crowns
Ceramic $1,408 $850 40%
Porcelain to Fused High Noble $1,314 $780 41%
Porcelain Fused to Base Metal $1,055 $495 53%
Build- up $331 $135 59%
Basic Implant Bundle (EXT/Implant/Cust Abut/PFM) $5,000 $3,495* 30%
Periodontics
Root Planing & Scaling - full quad $319 $139 56%
Root Planing & Scaling-1-3 teeth $175 $89 49%
Perio Maintenance $162 $79 51%
Oral Irrigation- per quad $15 $10 33%
Endodontics
Root Canal - Front $828 $449* 46%
Root Canal - Bicuspid $994 $499* 50%
Root Canal - Molar $1,323 $860* 24%
Dentures
Complete Upper $1,133 $825 27%
Complete Lower $1,133 $825 27%
Oral Surgery
Extraction - Simple $156 $115* 26%
Extraction - Surgical $232 $175* 25%

*Regular fee is based on 2017 Colorado fees which vary slightly by state. Additional fees may apply depending on the services you need. With the exception of orthodontics, all fees listed above are for treatments performed by a general dentist. Fees for treatments provided by a specialist will vary. Dental fees are subject to change without notice. The PTDP may not be combined with other insurance or discount plan; non-covered benefits are excepted. Click here for more detailed fees.

Additional fees may apply depending on the services you need. Dental fees are subject to change without notice. The PERFECT TEETH™ Dental Plan may not be used in conjunction with other insurance or discount plan.

This fee schedule is void if services are rendered by a specialist.