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%

55 S. Main Street, Suite 231-217 Naperville, IL 60540

Copyright by Innovative Dental Partners 2017. All rights reserved.

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