Dental Plan

When you join our dental savings plan, for a low yearly fee you are entitled to discounted services and preventive dental care with no out of pocket expense. Your enrollment will pay for itself immediately with:

Single Person

$250 per year

Couple

$350 per year

Each Dependent

$50 per year

Code Description The Hamptons Dental Plan Office Fee
D0120 PERIODIC ORAL EVALUATION $0 $55.00
D0140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED $0 $84.00
D0150 COMPREHENSIVE ORAL EVALUATION $0 $91.00
D0274 BITEWINGS-FOUR RADIOGRAPHIC IMAGES $0 $68.00
D1110 PROPHYLAXIS-ADULT $0 $95.00
D1120 PROPHYLAXIS-CHILD $0 $73.00
D1204 ADULT FLOURIDE $15 $20.00
D2330 RESIN-BASED COMPOSITE-ONE SURFACE $132.75 $177.00
D2331 RESIN-BASED COMPOSITE-TWO SURFACES $163.50 $218.00
D2332 RESIN-BASED COMPOSITE-THREE SURFACES $195.75 $261.00
D2335 RESIN-BASED COMPOSITE-FOUR SURFACES $244.50 $326.00
D2620 INLAY-PORCELAIN/CERAMIC $999 $1,140.00
D2643 ONLAY-PORCELAIN/CERAMIC $999 $1,240.00
D2740 CROWN-PORCELAIN/CERAMIC $999 $1,312.00
VENEERS $999 $1,312.00
D2950 CORE BUILDUP, INCLUDING ANY PINS WHEN REQUIRED $213.75 $285.00
D2954 PREFABRICATED POST AND CORE IN ADDITION TO CROWN $262.50 $350.00
D3110 PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION) $64.50 $86.00
D3320 ENDODONTIC THERAPY, PREMOLAR TOOTH $750 $993.00
D3330 ENDODONTIC THERAPY, MOLAR TOOTH $999 $1,304.00
D4211 GINGIVECTOMY OR GINGIVOPLAST (1-3 TEETH PER QUADRANT) $237 $316.00
D4341 PERIODONTAL SCALING AND ROOT PLANING FOUR OR MORE TEETH/QUAD $174.75 $263.00
D4355 FULL MOUTH DEEP CLEANING $699 $1,052.00
D4381 LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS $37.50 $50.00
D5110 COMPLETE DENTURE-MAXILLARY $1,199 $1,800.00
D5120 COMPLETE DENTURE-MANDIBULAR $1,199 $1,800.00
D5130 IMMEDIATE DENTURE-MAXILLARY $1,199 $1,850.00
D5213 MAXILLARY PARTIAL DENTURE $1,299 $1,873.00
D5214 MANDIBULAR PARTIAL DENTURE $1,299 $1,928.00
D5520 REPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE $135 $180.00
D5610 REPAIR RESIN DENTURE BASE $174 $232.00
D5620 REPAIR CAST FRAMEWORK $243.75 $325.00
D5630 REPAIR OR REPLACE BROKEN CLASP $192 $256.00
D5730 RELINE COMPLETE MAXILLARY DENTURE $288.75 $385.00
D5731 RELINE COMPLETE MANDIBULAR DENTURE $288 $384.00
D6058 IMPLANT ABUTMENT $1,199 $1,581.00
D6065 IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN $1,299 $1,658.00
D6245 BRIDGE PONTIC/ABUTMENT CROWNS $999 $1,325.00
D7210 EXTRACTION, ERUPTED TOOTH $221.25 $295.00
D8030 LIMITED ORTHODONTIC TREATMENT-ADOLESCENT $2,999 $3,300.00
D8040 LIMITED ORTHODONTIC TREATMENT-ADULT $2,999 $3,300.00
D8090 COMPREHENSIVE ORTHODONTIC TREATMENT-ADULT $5,199 $5,700.00
D8210 REMOVABLE APPLIANCE THERAPY $262.50 $350.00
D8220 FIXED APPLIANCE THERAPY $262.50 $350.00
D9230 INHALATION NITROUS OXIDE/ANALYSIS, ANALGESIA $42 $73.00
D9940 OCCLUSAL GUARD $399 $643.00
D9951 OCCLUSAL ADJUSTMENT-LIMITED $89 $120.00
D9952 OCCLUSAL ADJUSTMENT-COMPLETE $187.50 $250.00
EZOOM ZOOM WHITENING $299 $350.00
WHITENING TAKE HOME WHITENING 1 FREE PER YEAR $250.00
NO SHOW NO SHOW/LATE CANCELLATION $50 $50.00

Dentists Proudly Serving
Carrollton


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Call Us Today at: (972) 371-0747

(972) 371-0747