|Procedure||Average Cost*||Average Cost with Aetna Dental Access*||Member Savings|
|Periodic Oral Exam||$61||$32||$29|
|Comprehensive Oral Exam||$96||$45||$51|
|X-Ray, Intraoral–Complete Series Including Bitewing||$150||$80||$70|
|X-Ray, Bitewings– Four Films||$71||$38||$33|
|X-Ray Panoramic Film||$127||$67||$60|
|Sealant Per Tooth||$67||$32||$35|
|Filling– 1 Surface Resin(White) Filling, Front (Anterior) Tooth||$182||$94||$88|
|Crown– Porcelain Fused to High Noble Metal (i.e. gold)||$1,176||$799||$377|
|Restorative Crown– Porcelain Fused to Noble Metal||$1,144||$747||$397|
|Root Canal Front Tooth (Anterior) Excluding Final Restoration||$814||$480||$334|
|Root Canal Premolar Tooth (Bicuspid) Excluding Final Restoration||$906||$582||$324|
|Root Canal Molar Excluding Final Restoration||$1,120||$784||$336|
|Scaling/Root Planing Four or More Contiguous Teeth||$250||$152||$98|
|Complete Upper Denture (Maxillary)||$1,310||$937||$373|
|Extraction of Erupted Tooth or Exposed Root – Includes Local Anesthesia and Suturing If Needed||$198||$90||$108|
|Comprehensive Orthodontic Treatment Child||$5,605||$3,550||$2055|
*Actual costs and savings may vary by provider, service and geographic location. We use the average of negotiated fees from participating providers to determine the average costs, as shown on the chart. The select regional average cost represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the cost of care tool as of August, 2014.
Q. How does the dental plan work? A. Participating dental providers are listed in the membership fulfillment kit; members may also call the toll-free number located on the back of the membership card Monday through Friday, 7 a.m. to 7 p.m. and Saturday, 8 a.m. to 5 p.m. Central Time. When calling to schedule an appointment the member should identify him/herself as a member of the Aetna Dental Access® program. To receive the discount the member must present the membership card and pay the total discounted bill at the time of service.
Q. Is there a limit to the number of times the card can be used? A. No. Members and their families may take advantage of the savings any time throughout the year. Members may also change dentists within the network whenever they choose.
Q. May this discount be combined with dental insurance? A. In some cases, members may use both. If your insurance company allows you to submit claims after service, simply visit a participating dental provider, pay the discounted bill and submit the bill and claim to the insurance company. The net out-of-pocket cost will be lower because the insurance company would reimburse the member the percentage of the reduced bill as defined in their insured plan. If your insurance company does not allow the policyholder to submit claims, the discount dental can only be used for services not paid for by the insurance such as cosmetic dentistry or services after your annual maximum has been met.
Q. Is there someone that can answer questions about the card and services offered? A. Yes. Simply call the toll-free number located on the back of the membership card Monday through Friday, between 7 a.m. and 7 p.m. Central and Saturday between 8 a.m. and 5 p.m. Central. A member services representative is standing by to answer any questions.
Q. What if a member’s dentist is not a participating provider? A. Simply call the toll-free number on the membership card and give the member services representative the doctor’s name, address, phone number and specialty. We then contact the doctor about becoming a provider.