A Dental
Plan Designed With Cost In Mind
DDP members save 30% on all Basic and Major dental work as well as a 10% discount on services provided by a specialist.
Please see DDP Discounted Fee Schedule below:
DUPAGE DENTAL PLAN
GENERAL
Services FREE with Membership – NO EXTRA CHARGE
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D0150 | COMPREHENSIVE ORAL EVALUATION 1/YEAR | 109 | free | 100% |
D0120 | PERIODIC ORAL EVALUATION 1/YEAR | 69 | free | 100% |
D1110 | PROPHYLAXIS CLEANING ADULT 2/YEAR | 121 | free | 100% |
D1120 | PROPHYLAXIS CLEANING CHILD 2/YEAR | 88 | free | 100% |
D0210 | FULL SERIES XRAYS | 168 | free | 100% |
Preventative
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D0140 | LIMITED ORAL EVALUATION | 97 | 68 | 30% |
D0220 | INTRAORAL PERIAPICAL FIRST FILM | 36 | 25 | 30% |
D0230 | INTRAORAL PERIAPICAL EACH ADDITIONAL | 30 | 21 | 30% |
D0270 | BITEWING SINGLE FILM | 37 | 26 | 30% |
D0272 | BITEWING TWO FILMS | 56 | 39 | 30% |
D0274 | BITEWING FOUR FILMS | 81 | 57 | 30% |
D0330 | PANORAMIC XRAY | 142 | 99 | 30% |
D1351 | SEALANT PER TOOTH | 68 | 48 | 30% |
D1510 | SPACE MAINTAINER FIXED UNILATERAL | 382 | 267 | 30% |
D1515 | SPACE MAINTAINER FIXED BILATERAL | 550 | 385 | 30% |
D1525 | SPACE MAINTAINER REMOVAL BILATERAL | 438 | 419 | 30% |
Composite (White Fillings) Anterior
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D2330 | RESIN ONE SURFACE, ANTERIOR | 203 | 142 | 30% |
D2331 | RESIN TWO SURFACE, ANTERIOR | 250 | 175 | 30% |
D2332 | RESIN THREE SURFACE, ANTERIOR | 301 | 211 | 30% |
D2335 | RESIN FOUR OR MORE SURFACES, ANTERIOR | 370 | 259 | 30% |
Composite (White Fillings) Posterior
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D2391 | RESIN ONE SURFACE, POSTERIOR | 221 | 155 | 30% |
D2392 | RESIN TWO SURFACE, POSTERIOR | 282 | 197 | 30% |
D2393 | RESIN THREE SURFACE, POSTERIOR | 345 | 242 | 30% |
D2394 | RESIN FOUR OR MORE SURFACES, POSTERIOR | 405 | 284 | 30% |
Crown Services
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D2740 | CROWN PORCELAIN/CERAMIC SUBSTRATE | 1470 | 1029 | 30% |
D2750 | CROWN PORCELAIN WITH HIGH NOBEL METAL | 1454 | 1018 | 30% |
D2752 | CROWN PORCELAIN FUSED TO NOBEL METAL | 1329 | 930 | 30% |
D2930 | PREFAB STAINLESS STEEL CROWN-PRIMARY | 319 | 223 | 30% |
D2931 | PREFAB STAINLESS STEEL CROWN-PERMANENT | 364 | 255 | 30% |
D2940 | SEDATIVE FILLING | 147 | 103 | 30% |
D2951 | PIN RENTENTION-PER TOOT | 90 | 63 | 30% |
D2952 | POST AND CORE IN ADDITION TO CROWN | 522 | 3654 | 30% |
D2954 | PREFABRICATED POST AND CORE | 427 | 299 | 30% |
D297- | TEMPORARY CROWN | 389 | 272 | 30% |
Periodontal Treatment
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D4210 | GINGIVECTOMY | 820 | 574 | 30% |
D4249 | CROWN LENGTHENING | 1107 | 775 | 30% |
D4341 | SCALING & ROOT PLANING 4+ TEETH PER QUAD | 314 | 220 | 30% |
D4342 | SCALING & ROOT PLANING 1-3 TEETH PER QUAD | 222 | 155 | 30% |
D4346 | SCALING WITH INFLAMMATION | 205 | 144 | 30% |
D4355 | FULL MOUTH DEBRIDEMENT | 214 | 150 | 30% |
D4910 | PERIODONTAL MAINTENANCE PROCEDURE | 178 | 125 | 30% |
Extractions
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D7140 | EXTRACTION ERUPTED TOOTH | 221 | 249 | 30% |
D7210 | SURGICAL REMOVAL OF ERUPTED TOOTH | 355 | 249 | 30% |
D7230 | REMOVAL OF IMPACTED TOOTH PARTIAL BONY | 524 | 367 | 30% |
D7240 | REMOVAL OF IMPACTED TOOTH COMPLETEY BONY | 629 | 440 | 30% |
D7250 | SURGICAL REMOVAL OF TOOTH ROOTS | 375 | 263 | 30% |
D9940 | ENAMELPLASTY/MICROABRASION | 184 | 129 | 30% |
PEDIATRIC DENTISTRY Ages 0-13*
Services FREE with Membership – NO EXTRA CHARGE
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D0150 | COMPREHENSIVE ORAL EVALUATION | 87 | FREE | 100% |
D0120 | PERIODIC ORAL EVALUATION | 49 | FREE | 100% |
D1120 | PROPHYLAXIS CLEANING CHILD 2/YEAR | 67 | FREE | 100% |
D2010 | FULL SERIES XRAYS | 123 | FREE | 100% |
Preventative
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D0140 | LIMITED ORAL EVALUATION | 75 | 68 | 10% |
D0220 | INTRAORAL PERIAPICAL FIRST FIL | 28 | 25 | 10% |
D0230 | INTRAORAL PERIAPICAL EAC | 24 | 22 | 10% |
D0270 | BITEWING SINGLE FILM | 28 | 25 | 10% |
D0272 | BITEWING TWO FILMS | 43 | 39 | 10% |
D0274 | BITEWING FOUR FILMS | 70 | 63 | 10% |
D0330 | PANORAMIC XRAY | 104 | 94 | 10% |
D1351 | SEALANT PER TOOTH | 59 | 53 | 10% |
D1510 | SPACE MAINTAINER FIXED | 336 | 302 | 10% |
D1515 | SPACE MAINTAINER FIXE | 479 | 431 | 10% |
D1525 | SPACE MAINTAINER REMOVAL | 509 | 458 | 10% |
Composite (White Fillings) Anterior
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D2330 | RESIN ONE SURFACE, ANTERIOR | 175 | 158 | 10% |
D2331 | RESIN TWO SURFACE, ANTERIOR | 214 | 193 | 10% |
D2332 | RESIN THREE SURFACE, ANTERIOR | 259 | 233 | 10% |
D2335 | RESIN FOUR OR MORE SURFACES, ANTERIOR | 319 | 287 | 10% |
Composite (White Fillings) Posterior
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D2391 | RESIN ONE SURFACE, POSTERIOR | 189 | 170 | 10% |
D2392 | RESIN TWO SURFACE, POSTERIOR | 241 | 217 | 10% |
D2393 | RESIN THREE SURFACE, POSTERIOR | 295 | 266 | 10% |
D2394 | RESIN FOUR OR MORE SURFACES, POSTERIOR | 346 | 311 | 10% |
* – Pediatric patient age subject to Doctor’s discretion.
IMPLANT & COSMETIC DENTISTRY
Prosthodontics & Fixed Bridges
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D5110 | COMPLETE DENTURE MAXILLARY | 2355 | 2120 | 10% |
D5120 | COMPLETE DENTURE MANDIBULAR | 2259 | 2033 | 10% |
D5130 | IMMEDIATE DENTURE MAXILLARY | 2443 | 2199 | 10% |
D5140 | IMMEDIATE DENTURE MANDIBULAR | 2437 | 2193 | 10% |
D5211 | UPPER PARTIAL – RESIN BASE | 1709 | 1538 | 10% |
D5212 | LOWER PARTIAL – RESIN BASE | 1740 | 1566 | 10% |
D5213 | UPPER PARTIAL – CAST METAL | 2427 | 2184 | 10% |
D5214 | LOWER PARTIAL – RESIN BASE | 2398 | 2158 | 10% |
D5410 | ADJUST COMPLETE DENTURE UPPER | 124 | 112 | 10% |
D5411 | ADJUST COMPLETE DENTURE LOWER | 121 | 109 | 10% |
D5510 | REPAIR BROKEN COMPLETE DENTURE | 295 | 266 | 10% |
D5520 | REPLACE MISSING/BROKEN TEETH ON DENTURE | 242 | 218 | 10% |
D5630 | REPAIR OR REPLACE BROKEN CLASP | 338 | 304 | 10% |
D5650 | ADD TOOTH TO PARTIAL DENTURE | 306 | 275 | 10% |
D5660 | ADD CLASP TO PARTIAL DENTURE | 354 | 319 | 10% |
D5730 | RELINE DENTURE SOFT CHAIRSIDE UPPER | 504 | 454 | 10% |
D5731 | RELINE DENTURE SOFT CHAIRSIDE LOWER | 482 | 434 | 10% |
D5750 | RELINE DENTURE LAB UPPER | 621 | 559 | 10% |
D5751 | RELINE DENTURE LAB LOWER | 632 | 569 | 10% |
D5820 | INTERIM PARTIAL FLIPPER UPPER | 928 | 835 | 10% |
D5821 | INTERIM PARTIAL FLIPPER LOWER | 965 | 869 | 10% |
D6240 | PONTIC PORCELAIN FUSED TO HIGH NOBLE | 1619 | 1457 | 10% |
D6245 | PONTIC PORCELAIN/CERAMIC | 1627 | 1464 | 10% |
D6740 | CROWN PORCELAIN/CERAMIC | 1638 | 1474 | 10% |
D6750 | CROWN PORCELAIN FUSED TO HIGH NOBLE | 1636 | 1472 | 10% |
Implant Services
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D6010 | SURGICAL IMPLANT | 2854 | 2569 | 10% |
D6056 | PREFABRICATED ABUTMENT | 1177 | 1059 | 10% |
D6057 | CUSTOM ABUTMENT | 1331 | 1198 | 10% |
D6058 | IMPLANT CROWN PORCELAIN/CERAMIC | 2058 | 1852 | 10% |
D6059 | IMPLANT CROWN PORCELAIN FUSED TO METAL | 2107 | 1896 | 10% |
D4263 | BONE GRAFT | 977 | 879 | 10% |
D4266 | GUIDED TISSUE REGEN-RESORB | 1024 | 922 | 10% |
WP9970 | ENAMELPLASTY/MICROABRASION | 241 | 217 | 10% |
ENODODONTICS
Endodontics Root Canal Procedures
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
D3310 | ANTERIOR ROOT CANAL (EXCLUDING FINAL RESTORATION) | 889 | 800 | 10% |
D3320 | BICUSPID ROOT CANAL (EXCLUDING FINAL RESTORATION) | 1000 | 900 | 10% |
D3330 | MOLAR ROOT CANAL (EXCLUDING FIANL RESTORATION) | 1111 | 1000 | 10% |
D3332 | INCOMPLETE ENDO | 333 | 300 | 10% |
D3347 | RETREAT- BICUSPID | 1111 | 1000 | 10% |
D3346 | RETREAT- ANTERIOR | 1000 | 900 | 10% |
D3348 | RETREAT- MOLAR | 1233 | 1110 | 10% |
ORAL SURGERY
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
WP7111 | EXT OF CORONAL REMNTS | 156 | 140 | 10% |
WP7140 | EXT ERUPTED TOOTH | 221 | 199 | 10% |
WP7210 | EXT SURGICAL ERUPTED TH | 355 | 320 | 10% |
WP7220 | EXT IMPACTED SOFT TISSUE | 410 | 269 | 10% |
WP7230 | EXT IMPACTED PARTIAL BONY | 524 | 472 | 10% |
WP7240 | EXT IMPACTED COMPLETE BONY | 629 | 566 | 10% |
WP7241 | REMOVE IMPACT COM BONY | 731 | 658 | 10% |
WP7250 | SURGICAL REMOVAL OF TOOTH ROOTS | 375 | 338 | 10% |
WP7280 | SURGICAL ACCESS UNERUPTED | 572 | 515 | 10% |
WP7282 | MOBILIZ ERUPTED MALPOS/TH | 536 | 482 | 10% |
WP7283 | EXPOSURE W/ BRACKET | 548 | 493 | 10% |
ORTHODONTICS
Office Fee | CoPay | Your Savings | ||
---|---|---|---|---|
ADOL METAL BRACES | 5350 | 4815 | 10% | |
INVISALIGN ADULT | 5650 | 5085 | 10% | |
INVISALIGN TEEN | 5650 | 5085 | 10% |