| Advantages | Wise Choice | Dental Insurance |
|---|---|---|
| No Paperwork Hassles | √ | X |
| No Deductible | √ | X |
| No Preauthorization of Treatment Required | √ | X |
| Immediate Activation | √ | X |
| No Annual Limits | √ | X |
| Discounts on Cosmetic Procedures | √ | X |
Wise Choice Dental Plan is an annual membership that will pay for itself during your first dental office visit with 100% coverage on diagnostics and preventive treatment. This unique plan is being offered exclusively by:
Jose J. Alvarez, DMD & Associates
We offer all phases of dentistry in a state-of-the-art facility with an unconditional dedication to quality dental care.
| Costs: | |
| Individual | $120/year |
| Individual and Spouse | $195/year |
| Family with up to Four Menbers | $280/year – Kids up to 21 years of age |
| Additional Child | $70/year |
NO CHARGE: Dental exam, X-rays (unlimited), Two Cleanings – Prophylaxis every 6 months per membership year, fluoride treatment for children, unlimited emergency consultations.
| Procedure | Standard Fee | With Plan |
|---|---|---|
| Diagnostic: | ||
| D0110 Initial Exam | $90 | No Charge |
| D0120 Periodic Oral Exam | $75 | No Charge |
| D0210 Intraoral Complete Series | $120 | No Charge |
| D0220 Intraoral Periapical 1st Film | $25 | No Charge |
| D0230 Intraoral Periapical Each Addl Film | $25 | No Charge |
| D0272 Bitewings Two Films | $45 | No Charge |
| D0274 Bitewings Four Films | $65 | No Charge |
| D0330 Panoramic Film | $120 | No Charge |
| Preventive: | ||
| D1110 Prophylaxis – Adult (One every 6mos.) | $85 | No Charge |
| Each Additional à | $65 | |
| D1120 Prophylaxis – Child (One every 6mos.) | $65 | No Charge |
| Each Additional à | $45 | |
| D1203 Fluoride – Child | $35 | No Charge |
| D1351 Sealant – Per Tooth | $60 | $40 |
| Restorative Basic: | ||
| D2330 Resin Anterior 1 Surface | $225 | $145 |
| D2331 Resin Anterior 2 Surface | $250 | $165 |
| D2332 Resin Anterior 3 Surface | $275 | $185 |
| D2335 Resin Anterior 4 + Surface | $350 | $205 |
| D2391/D2140 Resin Amalgam Posterior 1 Surface | $225 | $165 |
| D2392/D2150 Resin/Amalgam Posterior 2 Surface | $275 | $185 |
| D2393/D2160 Resin/Amalgam Posterior 3 Surface | $350 | $205 |
| D2394/D2161 Resin/Amalgam Posterior 4 Surface | $400 | $225 |
| D2920 Recement Crown | $75 | $56 |
| D2940 Sedative Filling | $85 | $51 |
| Restorative Major: | ||
| D2630 Inlay 3 Surface –Cerec | $1200 | $950 |
| D2642 Onlay 3 Surface –Cerec | $1400 | $950 |
| D2740 Single Crown – Porcelain/Ceramic | $275 | $185 |
| D2335 Resin Anterior 4 + Surface | $1500 | $1100 |
| D2920 Recement Crown | $75 | $56 |
| D2940 Sedative Filling | $85 | $51 |
| D2750 Single Crown – High Noble Metal | $1300 | $875 |
| D2752 Single Crown – Noble Metal | $1200 | $825 |
| D2751 Single Crown – Base Metal | $1100 | $775 |
| D2950 Core Build Up | $350 | $250 |
| D2954 Post Core Build Up | $375 | $260 |
| D2960 Veneer Chair Side – Resin | $500 | $350 |
| D2962 Veneer (lab processed) – Porcelain | $1300 | $950 |
| D6240 Pontic | $1500 | $950 |
| D6750 Crown – Porcelain Fused Metal (Retainer) | $1500 | $950 |
| D6920 Lingual Bar | $1200 | $950 |
| Endodontics: | ||
| D3110 Pulp Cap Direct | $250 | $175 |
| D3120 Pulp Cap In-Direct | N/C | N/C |
| D3220 Pulpotomy | $400 | $280 |
| D3310 Root Canal Anterior | $900 | $675 |
| D3320 Root Canal Bicuspid | $1200 | $875 |
| D3330 Root Canal Molar | $1400 | $995 |
| D3346 Re-Treat RCT Anterior | $950 | $712 |
| D3347 Re-Treat RCT Bicuspid | $1350 | $1000 |
| D3348 Re-Treat RCT Molar | $1450 | $1100 |
| Periodontal: | ||
| D4210 Gingivectomy – Per Quadrant | $950 | $600 |
| D4211 Gingivectomy – Per Tooth | $350 | $140 |
| D4249 Crown Lengthening – Per Tooth | $750 | $525 |
| D4260 Periodontal Oss. Surgery – Per Quadrant | $1200 | $900 |
| D4263 Bone Graft – Per Block/Site | $1900 | $1330 |
| D4263 Bone Graft – Socket Fill | $800 | $560 |
| D4273 Gingival Graft – Per Site | $1800 | $1000 |
| D4321 Splinting – Up to 4 Teeth | $1500 | $750 |
| D4341 Root Planning/Scaling – Per Quadrant | $250 | $150 |
| D4342 Root Planning/Scaling – 1-3 Teeth | $175 | $110 |
| D4355 Full Mouth Debridement | $120 | $65 |
| D4910 Periodontal Maintenance | $120 | $65 |
| Partials & Dentures: | ||
| D5110 Upper Denture | $1400 | $950 |
| D5120 Lower Denture | $1400 | $950 |
| D5130 Immediate Upper Denture | $1200 | $840 |
| D5140 Immediate Lower Denture | $1200 | $840 |
| D5213 Partial Upper Denture | $1400 | $950 |
| D5214 Partial Lower Denture | $1400 | $950 |
| D5730 Reline Upper Denture | $750 | $450 |
| D5731 Reline Lower Denture | $750 | $450 |
| Partials & Dentures: | ||
| D6010 Endosseous Implant | $1500 | $1200 |
| D6056 Implant Abutment – Titanium | $750 | $550 |
| D6057 Implant Abutment – Ceramic | $1050 | $735 |
| D6059 Implant Crown | $1500 | $995 |
| Oral Surgery: | ||
| D7140 Simple Extraction | $225 | $150 |
| D7210 Surgical Extraction | $500 | $250 |
| D7220 Impacted Wisdom – Soft Tissue | $450 | $300 |
| D7230 Partially Impacted Wisdom | $700 | $790 |
| D7240 Fully Impacted Wisdom | $700 | $490 |
| D7241 Fully Impacted w/Complications | $750 | $525 |
| D7310 Alveoloplasty | $500 | $350 |
| Miscellaneous: | ||
| D0460 Pulp Vitality Test | $75 | $52 |
| D0470 Diagnostic Cast | $75 | $52 |
| D0471 Diagnostic Photos | $120 | $87 |
| D9110 Palliative Treatment | $150 | $112 |
| D9940 Occlusal Guard | $500 | $350 |
| D9951 Occlusal Adjustment (One Visit) | $25 | $18 |
