Dental HMO Plan

Sample Co-Pays Detailed Oral exam = No cost X-Rays = No cost Office Visit = $5.00 Teeth Cleaning = $5.00 (One teeth cleaning every 6 months) Fillings = $8.00 (Amalgam one surface) Tooth Extraction = $10.00 Root canals = $165 to $365 Crowns = $185 to $395 Complete Denture (Maxillary) = $365 Braces = Child $1, / Adult $2, Full List of Description of Benefits and Co-Pays at

State by State Availability State(s)IndividualFamily CA,FL,PA,NJ,NY,MD$39.95 a month/$60 one-time App Fee$89.95 a month/$100 App Fee Texas$39.95 a month/$60 one-time App Fee$89.95 a month/$60 App Fee AZ,KY,NM*,OH,TN$49.95 a month/$60 one-time App Fee$89.95 a month/$100 App Fee Georgia$59.95 a month/$60 one-time App Fee$ a month/$60 App Fee Nevada$59.95 a month/$60 one-time App Fee$ a month/$100 App Fee Washington State*$69.95 a month/$60 one-time App Fee$ a month/$100 App Fee Hawaii*$69.95 a month/$60 one-time App Fee$ a month/$100 App Fee Virginia*$79.95 a month/$60 one-time App Fee$ a month/$100 App Fee Health and life Insurance License required in MD, NV, UT, OR, and SD NY and MD Dental HMO Plans on All other States on * These States will open on Feb 1 st.