My Fee Schedule - Affordable Family Health Services | Dental Plan

GET STARTED

Call Now : 1-866-519-7667 Or Join Us online

30 Days Money Back Guarantee
GET STARTED


Dental costs can vary by location and provider – but AFHSCO members typically enjoy a 25-60% discount off customary dental charges for your area.  Check your state’s “Fee Schedule” to review your potential savings.   

Green Fee Schedule

 

ADA Code Procedures Customary Fees Member's Fees
D0120 Periodic Oral Examination $54.00 $15.00
 
D0140 Limited Oral examination, problem focused $85.00 $15.00
 
D0150 Comprehensive Exam $93.00 $20.00
 
D0180 Perio Exam $115.00 $15.00
 
D0210 Intraoral- complete series( including bitewing) $139.00 $45.00
 
D0220 Interoral _ periapical first film $31.00 $10.00
 
D0230 Interoral - periapical each additional film $26.00 $8.00
 
D0240 Intraoral - occlusal film $42.00 $12.00
 
D0270 Bitewing Single Film $29.00 $8.00
 
D0272 Bitewing Two Film $47.00 $12.00
 
D0273 Bitewing- three films $59.00 $18.00
 
D0274 Bitewing Four Films $70.00 $24.00
 
D0330 Panoramic X-ray $82.00 $45.00
 
D0460 Pulp Vitality test $54.00 $38.00
 
D0470 Diagnostic casts

$150.00

$30.00
 
D1110 PROPHYLAXIS-ADULT $96.00 $40.00
 
D1120 PROPHYLAXIS-CHILD $71.00 $32.00
 
D1203 Fluoride Child $40.00 $10.00
 
D1204 Fluoride Adult $38.00 $15.00
 
D1330 Oral hygiene instruction $40.00 $10.00
 
D1351 Sealant -per tooth $58.00 $22.00
 
D1510 Space Maintainer - fixed unilateral type $368.00 $145.00
 
D1515 Space Maintainer - fixed bilateral type $595.00 $175.00
 
D2140 Amalgam Primary or Permanent 1 Surface $161.00 $60.00
 
D2150 Amalgam Primary or Permanent 2 Surface $199.00 $70.00
 
D2160 Amalgam Primary or Permanent 3 Surface $249.00 $80.00
 
D2161 Amalgam Primary or Permanent 4 Surface per tooth - 25% Discount
 
D2330 Resin 1 Surface (anterior) $195.00 $65.00
 
D2331 Resin 2 Surface (anterior) $232.00 $85.00
 
D2332 Resin 3 Surface (anterior) $283.00 $110.00
 
D2335 Resin 4 Surfaces or involving incisal angle (anterior) - 25% Discount
 
D2391 Resin-Based composite 1 surface (posterior) $205.00 $75.00
 
D2392 Resin-Based composite 2 Surface (posterior) $252.00 $95.00
 
D2393 Resin- Based composite 3 Surface (posterior) $315.00 $120.00
 
D2394 Resin -Based composite - Four or moresurfaces - posterior - 25% Discount
 
D2750 Porcelain Crown Fused To High Noble Metal $1,352.00 $600.00
 
D2751 Crown - porcelain fused to predominately base metal $1,188.00 $550.00
 
D2752 Porcelain Crown Fused To Noble Metal $1,295.00 $575.00
 
D2790 Crown - full cast high noble metal - 25% Discount
 
D2791 Crown - full cast predominantly base metal 3/4 cast metallic - 25% Discount
 
D2792 Crown - full cast noble metal - 25% Discount
 
D2910 Recement inlay $137.00 $40.00
 
D2920 Recement Crown $125.00 $40.00
 
D2930 Prefab. stainless steel crown, primary tooth - 25% Discount
 
D2940 Sedative filling $148.00 $40.00
 
D2950 Crown buld up, including any pins $308.00 $140.00
 
D2951 Pin Retention per tooth in addition to restoration - 25% Discount
 
D2952 Cast Post &Core in addition to crown - 25% Discount
 
D2953 Cast post as part of crown - 25% Discount
 
D2954 Prefabricated post & core in addition to crown $361.00 $160.00
 
D3110 Pulp Cap- direct (excluding final restoration) $89.00 $35.00
 
D3120 Pulp cap - indirect (excluding final restoration) $83.00 $35.00
 
D3220 Therapeutic pulpotomy (excluding final restoration) $226.00 $65.00
 
D3310 Root Canal anterior (excluding final restoration) $945.00 $350.00
 
D3320 Root Canal bicuspid (excluding final restoration) $614.00 $400.00
 
D3330 Root Canal molar (excluding final restoration - 25% Discount
 
D4240 Gingival flap procedure, including root planning per quadrant - 25% Discount
 
D4260 Osseous surgery (including flap entry & closure - per quadrant - 25% Discount
 
D4270 Pedicle soft tissue graft procedure - 25% Discount
 
D4271 Free soft tissue graft procedure - 25% Discount
 
D4341 Periodontal scaling & root planning (per quad) $272.00 $100.00
 
D4355 Full Mouth Debridement $199.00 $60.00
 
D4381 Arestin Per Tooth $95.00 $50.00
 
D4910 Periodontal Maintenance procedures following active therapy $146.00 $60.00
 
D5110 Complete Denture, Upper $1,430.00 $750.00
 
D5120 Complete Denture, Lower $1,133.00 $750.00
 
D5130 Immediate Denture, Upper - 25% Discount
 
D5140 Immediate Lower Denture - 25% Discount
 
D5140 Immediate Denture, Lower - 25% Discount
 
D5211 Upper partial - acrylic base (including any conventional clasps & rests) $1,133.00 $650.00
 
D5212 Lower Partial- acrylic base (including any convential clasps & rests) $1,200.00 $650.00
 
D5213 Upper Partial-predominately base cast base with acrylic saddles (influding any conventional clasps & rests) $1,659.00 $800.00
 
D5214 Lower partial - predominantly base cast base with acrylic saddles ( including any conventional clasps & rests) $1,733.00 $800.00
 
D5410 Adjust complete denture -upper $70.00 $40.00
 
D5411 Adjust complete denture- lower $47.00 $40.00
 
D5421 Adjust partial denture -upper $100.00 $40.00
 
D5422 Adjust partial denture - lower $100.00 $40.00
 
D5520 Replace missing or broken teeth complete denture (each tooth) - 25% Discount
 
D5650 Add tooth to existing partial denture - 25% Discount
 
D5660 Add clasp to existing partial denture - 25% Discount
 
D5710 Rebase complete upper denture $540.00 $250.00
 
D5711 Rebase complete lower denture $350.00 $250.00
 
D5720 Rebase upper partial denture $540.00 $250.00
 
D5721 Rebase lower partial denture $540.00 $250.00
 
D5730 Reline complete upper dentures (chairside) - 25% Discount
 
D5731 Reline complete lower dentures (chairside) - 25% Discount
 
D5740 Reline upper partial dentures (chairside) - 25% Discount
 
D5741 Reline lower partial dentures (chairside) - 25% Discount
 
D5750 (Laboratory) Reline complete upper dentures - 25% Discount
 
D5751 Reline complete lower dentures (laboratory) - 25% Discount
 
D5760 Reline upper partial dentures (laboratory) - $25% Discoount
 
D5761 Reline lower partial dentures (laboratory) - 25% Discount
 
D6210 Pontic - cast high noble metal $1,158.00 $600.00
 
D6211 Pontic - cast predominantly base metal $1,136.00 $550.00
 
D6212 Pontic - cast noble metal $1,182.00 $550.00
 
D6240 Pontic - porcelain fused to high noble metal $1,275.00 $600.00
 
D6241 Pontic - porcelain fused to predominately base metal $1,150.00 $550.00
 
D6242 Pontic - porcelain fused to noble metal $1,198.00 $550.00
 
D6520 Inlay - metallic - 2 surfaces - 25% Discount
 
D6545 Cast metal retainer for resin bonded fixed prosthesis - 25% Discount
 
D6750 Crown - porcelain fused to high noble metal $1,295.00 $600.00
 
D6751 Crown - porcelain fused to predominantly base metal $1,234.00 $550.00
 
D6752 Crown - porcelain fused to noble metal $1,195.00 $550.00
 
D6780 Crown - 3/4 cast high noble metal - 25% Discount
 
D6790 Crown - full cast high noble metal - 25% Discount
 
D6791 Crown - full cast predominantly base metal - 25% Discount
 
D6792 Crown - full cast noble metal - 25% Discount
 
D6930 Recement bridge $175.00 $60.00
 
D6940 Stress breaker - 25% Discount
 
D6950 Precision attachment - 25% Discount
 
D6970 Cast post & core in addition to bridge retainer - 25% Discount
 
D6972 Prefabricated post & core in addition to bridge retainer - 25% Discount
 
D7140 Single tooth $180.00 $60.00
 
D7210 Surgical removal of erupted toooth requiring elevation of mucopriosteal flap & removal of bone & or section of tooth $315.00 $130.00
 
D7220 Removal of Impacted Tooth (soft tissue) $385.00 $150.00
 
D7230 Removal of Impacted Tooth (partially bony) $485.00 $180.00
 
D7240 Removal of Impacted Tooth (completely bony) - 25% Discount
 
D9630 Medicinal Irrigation (per quad) $20.00 $10.00
 
 

 

 

Orange Fee Schedule

 

ADA Code Procedures Customary Fees Member's Fees
D0120 Periodic Oral Examination $30.00 $15.00
 
D0140 Limited Oral Examination, Problem Focused $49.00 $25.00
 
D0150 Comprehensive Oral Examination $45.00 $25.00
 
D0180 Perio Exam $40.00 $15.00
 
D0210 Intraoral - Complete Series (including bitewing) $97.00 $45.00
 
D0220 Interoral - Periapical - first film $18.00 $10.00
 
D0230 Interoral - Periapical - each additional film $12.00 $8.00
 
D0240 Intraoral - Occlusal film $30.00 $12.00
 
D0270 Bitewing - Single film $15.00 $8.00
 
D0272 Bitewing - Two films $28.00 $12.00
 
D0273 Bitewing - Three films $38.00 $18.00
 
D0274 Bitewing - Four films $44.00 $24.00
 
D0330 Panoramic Film $82.00 $45.00
 
D0460 Pulp Vitality Test $54.00 $38.00
 
D0470 Diagnostic Casts $72.00 $30.00
 
D1110 Prophylaxis - adult $69.00 $38.00
 
D1120 Prophylaxis - child $60.00 $28.00
 
D1203 Fluoride child $28.00 $10.00
 
D1204 Fluoride Adult $32.00 $15.00
 
D1330 Oral Hygiene Instruction $25.00 $10.00
 
D1351 Sealant - per tooth $34.00 $22.00
 
D1510 Space Maintainer - fixed unilateral type $231.00 $145.00
 
D1515 Space Maintainer - fixed bilateral type $305.00 $175.00
 
D2140 Amalgam - 1 Surface, Primary or Permanent $97.00 $60.00
 
D2150 Amalgam - 2 Surfaces, Primary or Permanent $113.00 $70.00
 
D2160 Amalgam - 3 Surfaces, Primary or Permanent $136.00 $80.00
 
D2161 Amalgam - 4 Or More Surfaces, Primary or Permanent $170.00 25% Discount
 
D2330 Resin - 1 Surface Anterior $136.00 $65.00
 
D2331 Resin - 2 Surfaces Anterior $155.00 $85.00
 
D2332 Resin - 3 Surfaces Anterior $173.00 $110.00
 
D2335 Resin - 4 Surfaces or Involving Incisal Angel $268.00 25% Discount
 
D2391 resin - based composite - 1 surface posterior $147.00 $75.00
 
D2392 Resin - Based Composite - 2 surfaces posterior $173.00 $95.00
 
D2393 Resin - Based Composite - 3 surfaces posterior $201.00 $120.00
 
D2394 Resin - Based Composite - 4 or more surfaces posterior $210.00 25% Discount
 
D2750 Crown - Porcelain fused to high nobel metal $993.00 $550.00
 
D2751 Crown - Porcelain fused to base metal $880.00 $500.00
 
D2752 Crown - Porcelain fused to noble metal $855.00 $500.00
 
D2790 Crown - Full cast high noble metal $800.00 25% Discount
 
D2791 Crown - Full cast base metal 3/4 cast metallic $705.00 25% Discount
 
D2792 Crown - Full cast noble metal $950.00 25% Discount
 
D2810 Crown - 3/4 cast metallic $750.00 $400.00
 
D2910 Recement Inlay $65.00 $40.00
 
D2920 Recement Crown $97.00 $40.00
 
D2930 Prefabricated stainless steel crown, primary tooth $200.00 25% Discount
 
D2940 Sedative Filing $80.00 $40.00
 
D2950 Crown build-up including any pins $228.00 $140.00
 
D2951 Pin retention per tooth in addition to restoration $70.00 25% Discount
 
D2952 Cast post and core in addition to crown $243.00 25% Discount
 
D2953 Cast post as part of crown $115.00 25% Discount
 
D2954 Prefabricated post and core in addition to crown $205.00 $160.00
 
D3110 Pulp Cap - direct (excluding final restoration) $50.00 $35.00
 
D3120 Pulp Cap - indirect (excluding final restoration) $50.00 $35.00
 
D3220 Therapeutic pulpotomy (excluding final restoration) $118.00 $65.00
 
D3310 Root Canal anterior $496.00 $350.00
 
D3320 Root Canal bicuspid $614.00 $400.00
 
D3330 Root Canal molar $850.00 25% Discount
 
D4240 Gingival flap procedure $476.00 25% Discount
 
D4260 Osseous surgery $768.00 25% Discount
 
D4270 Pedicle soft tissue graft procedure $532.00 25% Discount
 
D4271 Free soft tissue graft procedure $547.00 25% Discount
 
D4341 Periodontal scaling & root planning $185.00 $100.00
 
D4355 Full mouth debridement $135.00 $60.00
 
D4910 Periodontal maintenance $110.00 $70.00
 
D5110 Complete Upper Denture $1000.00 $700.00
 
D5120 Complete Lower Denture $1000.00 $700.00
 
D5130 Immediate Upper Denture $1050.00 25% Discount
 
D5140 Immediate Lower Denture $1050.00 25%Discount
 
D5211 Upper partial - acrylic base $850.00 $625.00
 
D5212 Lower partial - acrylic base $950.00 $625.00
 
D5213 Upper partial $1200.00 $750.00
 
D5214 Lower partial $1200.00 $750.00
 
D5410 Adjust complete denture - upper $35.00 $40.00
 
D5411 Adjust complete denture - lower $55.00 $40.00
 
D5421 Adjust partial denture - upper $55.00 $40.00
 
D5422 Adjust partial denture - lower $55.00 $40.00
 
D5520 Replace missing or broken teeth complete denture $80.00 25% Discount
 
D5650 Add tooth to existing partial denture $98.00 25% Discount
 
D5660 Add clasp to existing partial denture $98.00 25% Discount
 
D5710 Rebase complete upper denture $350.00 $250.00
 
D5711 Rebase complete lower denture $350.00 $250.00
 
D5720 Rebase upper partial denture $200.00 $250.00
 
D5721 Rebase lower partial denture $200.00 $250.00
 
D5730 Reline complete upper dentures (chairside) $200.00 25% Discount
 
D5731 Reline complete lower dentures (chairside) $200.00 25% Discount
 
D5740 Reline upper partial dentures (chairside) $183.00 25% Discount
 
D5741 Reline lower partial dentures (chairside) $183.00 25% Discount
 
D5750 Reline complete upper dentures (laboratory) $215.00 25% Discount
 
D5751 Reline complete lower dentures (laboratory) $267.00 25% Discount
 
D5760 Reline upper partial dentures (laboratory) $263.00 25% Discount
 
D5761 Reline lower partial dentures (laboratory) $263.00 25% Discount
 
D6210 Pontic - cast high noble metal $650.00 $25% DISCOUNT
 
D6211 Pontic - cast predominantly base metal $700.00 25% Discount
 
D6212 Pontic - cast noble metal $700.00 25% Discount
 
D6240 Pontic - porcelain fused to high noble metal $780.00 25% Discount
 
D6241 Pontic - porcelain fused to predominantly base metal $931.00 25% Discount
 
D6242 Pontic - porcelain fused to noble metal $931.00 25% Discount
 
D6520 Inlay - metallic - 2 surfaces $931.00 25% Discount
 
D6530 Inlay - metallic - 3 or more surfaces $951.00 25% Discount
 
D6545 Cast metal retainer for resin bonded fixed prosthesis $520.00 25% Discount
 
D6750 Crown - porcelain fused to high noble metal $780.00 25% Discount
 
D6751 Crown - porcelain fused to predominantly base metal $725.00 25% Discount
 
D6752 Crown - porcelain fused to noble metal $725.00 25% Discount
 
D6780 Crown - 3/4 cast high noble metal $681.00 25% Discount
 
D6790 Crown - full cast high noble metal $711.00 25% Discount
 
D6791 Crown - full cast predominantly base metal $711.00 25% Discount
 
D6792 Crown - full cast noble metal $711.00 25% Discount
 
D6930 Recement bridge $95.00 $50.00
 
D6940 Stress breaker $235.00 25% Discount
 
D6950 Precision attachment $350.00 25% Discount
 
D6970 Cast post & core in addition to bridge retainer $298.00 25% Discount
 
D6971 Cast post as part of bridge retainer $203.00 25% Discount
 
D6972 prefabricated post & core in addition to bridge retainer $175.00 25% Discount
 
D7140 Single Tooth $95.00 $60.00
 
D7210 Surgical removal of erupted tooth $190.00 $130.00
 
D7220 Removal of Impacted Tooth (soft tissue) $260.00 $150.00
 
D7230 Removal of Impacted Tooth (partially bony) $250.00 $180.00
 
D7240 Removal of Impacted Tooth (completely) $300.00 25% Discount
 
D9630 Medicinal Irrigation (per quad) $20.00 $10.00

 

Blue Fee Schedule

 

ADA Code Procedures Customary Fees Member's Fees
D0120 Periodic Oral Examination $30.00 $12.00
 
D0140 Limited Oral Examination, Problem Focused $49.00 $25.00
 
D0150 Comprehensive Oral Examination $45.00 $30.00
 
D0180 Perio Exam $40.00 $15.00
 
D0210 Intraoral - Complete Series (including bitewing) $97.00 $48.00
 
D0220 Interoral - Periapical - First Film $16.00 $14.00
 
D0230 Interoral - Periapical - Each Additional Film $12.00 $10.00
 
D0240 Intraoral - Occlusal film $20.00 $14.00
 
D0270 Bitewing - Single film $15.00 $10.00
 
D0272 Bitewing - Two films $28.00 $18.00
 
D0273 Bitewing - Three films $38.00 $22.00
 
D0274 Bitewing - Four films $44.00 $30.00
 
D0330 Panoramic Film $82.00 $48.00
 
D0460 Pulp Vitality Test $54.00 $38.00
 
D0470 Diagnostic Casts $72.00 $30.00
 
D1110 Prophylaxis - adult $69.00 $45.00
 
D1120 Prophylaxis - child $60.00 $38.00
 
D1203 Flouoride Child $28.00 $15.00
 
D1204 Fluoride Adult $32.00 $15.00
 
D1330 Oral Hygiene Instruction $25.00 $10.00
 
D1351 Sealant - per tooth $34.00 $22.00
 
D1510 Space Maintainer - Fixed Unilateral Type $231.00 $145.00
 
D1515 Space Maintainer - Fixed Bilateral Type $305.00 $175.00
 
D2140 Amalgam - 1 Surface, Primary or Permanent $97.00 $60.00
 
D2150 Amalgam - 2 Surfaces, Primary or Permanent $113.00 $70.00
 
D2160 Amalgam - 3 Surfaces, Primary or Permanent $136.00 $80.00
 
D2161 Amalgam - 4 Or More Surfaces, Primary or Permanent $170.00 $120.00
 
D2330 Resin 1 Surface, Anterior $136.00 $65.00
 
D2331 Resin 2 Surfaces, Anterior $155.00 $85.00
 
D2332 Resin 3 Surfaces, Anterior $173.00 $110.00
 
D2335 Resin 4 Surfaces or Involving Incisal Angel Anterior $268.00 $160.00
 
D2391 Resin - Based Composite 1 Surface Posterior $147.00 $75.00
 
D2392 Resin - Based Composite - 2 Surfaces - Posterior $173.00 $95.00
 
D2393 Resin - Based Composite - 3 Surfaces Posterior $201.00 $120.00
 
D2394 Resin - Based Composite - 4 Surfaces or More Surfaces Posterior $210.00 $180.00
 
D2750 Crown - Porcelain Fused To High Nobel Metal $993.00 $600.00
 
D2751 Crown - Porcelain Fused To Predominately Base Metal $880.00 $550.00
 
D2752 Crown - Porcelain Fused To Noble Metal $855.00 $575.00
 
D2790 Crown - Full Cast High Noble Metal $800.00 25% Discount
 
D2791 Crown-Full Cast Predominantly Base Metal 3/4 Cast Metallic $705.00 25% Discount
 
D2791 Crown - Full Cast Predominantly Base Metal 3/4 $705.00 25% Discount
 
D2792 Crown - Full Cast Noble Metal $950.00 25% Discount
 
D2810 Crown - 3/4 Cast Metallic $750.00 $450.00
 
D2910 Recement Inlay $65.00 $40.00
 
D2920 Recement Crown $97.00 $40.00
 
D2930 Prefabricated Stainless Steel Crown, Primary Tooth $200.00 25% Discount
 
D2940 Sedative Filing $80.00 $40.00
 
D2950 Crown Build Up, Including Any Pins $228.00 $150.00
 
D2951 Pin Retention Per Tooth In Addition To Restoration $70.00 25% Discount
 
D2952 Cast Post And Core In Addition To Crown $243.00 25% Discount
 
D2953 Cast Post As Part Of Crown $115.00 25% Discount
 
D2954 Prefabricated Post And Core In Addition To Crown $205.00 25% Discount
 
D3110 Pulp Cap - Direct (Excluding Final Restoration) $50.00 $35.00
 
D3120 Pulp Cap - Indirect (Excluding Final Restoration) $50.00 $35.00
 
D3220 Therapeutic Pulpotomy (Excluding Final Restoration) $118.00 $65.00
 
D3310 Root Canal Anterior (Excluding Final Restoration) $496.00 $400.00
 
D3320 Root Canal Bicuspid (Excluding Final Restoration) $614.00 $450.00
 
D3330 Root Canal Molar (Excluding Final Restoration) $850.00 25% Discount
 
D4240 Gingival Flap Procedure, Including Root Planning Per Quadrant $476.00 25% Discount
 
D4260 Osseous Surgery (Including Flap Entry & Closure - Per Quadrant) $768.00 25% Discount
 
D4270 Pedicle Soft Tissue Graft Procedure $532.00 25% Discount
 
D4271 Free Soft Tissue Graft Procedure $547.00 25% Discount
 
D4341 Periodontal Scaling & Root Planning - Per Quadrant $185.00 $100.00
 
D4355 Full Mouth Debridement $135.00 $60.00
 
D4910 Periodontal Maintenance Procedures Following Active Therapy $110.00 $75.00
 
D5110 Complete Denture Upper $1000.00 $750.00
 
D5120 Complete Denture Lower $1000.00 $750.00
 
D5130 Immediate Denture Upper $1050.00 25% Discount
 
D5140 Immediate Denture Lower $1050.00 25% Discount
 
D5211 Upper Partial - Acrylic Base (Including Any Conventional Clasps & Rests) $850.00 $600.00
 
D5212 Lower Partial - Acrylic Base (Including Any Convential Clasps & Rests) $950.00 25% Discount
 
D5213 Upper Partial - Predominately Base Cast Base With Acrylic Saddles (Including Any Conventional Clasps & Rests) $1200.00 $800.00
 
D5214 Lower Partial - Predominantly Base Cast Base With Acrylic Saddles (Including Any Conventional Clasps & Rests) $1200.00 $800.00
 
D5410 Adjust Complete Denture - Upper $35.00 $40.00
 
D5411 Adjust Complete Denture - Lower $55.00 $40.00
 
D5421 Adjust Partial Denture - Upper $55.00 $40.00
 
D5422 Adjust Partial Denture - Lower $55.00 $40.00
 
D5520 Replace Missing Or Broken Teeth Complete Denture (Each Tooth) $80.00 25% Discount
 
D5650 Add Tooth To Existing Partial Denture $98.00 25% Discount
 
D5660 Add Clasp To Existing Partial Denture $98.00 25% Discount
 
D5710 Rebase Complete Upper Denture $350.00 $275.00
 
D5711 Rebase Complete Lower Denture $350.00 $275.00
 
D5720 Rebase Upper Partial Denture $200.00 $250.00
 
D5721 Rebase Lower Partial Denture $200.00 $250.00
 
D5730 Reline Complete Upper Dentures (Chairside) $200.00 25% Discount
 
D5731 Reline Complete Lower Dentures (Chairside) $200.00 25% Discount
 
D5740 Reline Upper Partial Dentures (Chairside) $183.00 25% Discount
 
D5741 Reline Lower Partial Dentures (Chairside) $183.00 25% Discount
 
D5750 Reline Complete Upper Dentures (Laboratory) $215.00 25% Discount
 
D5751 Reline Complete Lower Dentures (Laboratory) $267.00 25% Discount
 
D5760 Reline Upper Partial Dentures (Laboratory) $263.00 25% Discount
 
D5761 Reline Lower Partial Dentures (Laboratory) $263.00 25% Discount
 
D6210 Pontic - Cast High Noble Metal $650.00 25% Discount
 
D6211 Pontic - Cast Predominantly Base Metal $700.00 25% Discount
 
D6212 Pontic - Cast Noble Metal $700.00 25% Discount
 
D6240 Pontic - Porcelain Fused To High Noble Metal $780.00 25% Discount
 
D6241 Pontic - Porcelain Fused To Predominantly Base Metal $931.00 25% Discount
 
D6242 Pontic - Porcelain Fused To Noble Metal $931.00 25% Discount
 
D6520 Inlay - Metallic - 2 Surfaces $931.00 25% Discount
 
D6530 Inlay - metallic - 3 Surfaces Or More $951.00 25% Discount
 
D6545 Cast Metal Retainer For Resin Bonded Fixed Prosthesis $520.00 25% Discount
 
D6750 Crown - Porcelain Fused To High Noble Metal $780.00 25% Discount
 
D6751 Crown - Porcelain Fused To Predominantly Base Metal $725.00 25% Discount
 
D6752 Crown - Porcelain Fused To Noble Metal $725.00 25% Discount
 
D6780 Crown - 3/4 Cast High Noble Metal $681.00 25% Discount
 
D6790 Crown - Full Cast High Noble Metal $711.00 25% Discount
 
D6791 Crown - Full Cast Predominantly Base Metal $711.00 25% Discount
 
D6792 Crown - Full Cast Noble Metal $711.00 25% Discount
 
D6930 Recement Bridge $95.00 $60.00
 
D6940 Stress Breaker $235.00 25% Discount
 
D6950 Precision Attachment $350.00 25% Discount
 
D6970 Cast Post & Core In Addition To Bridge Retainer $298.00 25% Discount
 
D6971 Cast Post As Part Of Bridge Retainer $203.00 25% Discount
 
D6972 Prefabricated Post & Core In Addition To Bridge Retainer $175.00 25% Discount
 
D7140 Single Tooth $95.00 $60.00
 
D7210 Surgical removal of erupted tooth requiring elevation ofmucopriosteal flap & removal of bone & or section of tooth $190.00 $130.00
 
D7220 Removal of Impacted Tooth (soft tissue) $260.00 $150.00
 
D7230 Removal of Impacted Tooth (partially bony) $250.00 $200.00
 
D7240 Removal of Impacted Tooth (completely) $300.00 25% Discount


 

AFHSCO is not a health insurance policy. It provides discounts on designated services and products from participating health care providers. The plan member is obligated to pay the provider directly at time of service. Affordable Health Care Services Company is the licensed administrator of this plan.  AFHSCO cannot guarantee the quality of the services or products offered by individual providers.   Please contact us at 1-877-333-6120 with any questions.