To best understand how plans work (important when comparing), we recommend reading about Dental HMO/PPOs on
Unraveling the Mysteries.
If you have any questions, call us at 800-809-3494.
| Procedure Explanation: |
Doctor’s Usual Fee |
Your Cost with Savon |
Your Cost with Dental DPO |
Dental DPO waiting periods & Limits
(Here’s where we got our information) |
| Office Visit - Comprehensive Exam |
$70.00 |
No Charge |
$14.00
$7.00
N/C
|
During year 1 - 2 per year
During year 2
After 2 year
|
| X-Rays - Full Mouth |
$120.00 |
$60.00 |
$23.00
$11.00
N/C
|
During year 1 - 1 per 3 years
During year 2
After 2 years
|
| Cleaning - Adult |
$106.00 |
$53.00 |
$20.00
$10.00
N/C
|
During year 1 -2 per year
During year 2
After 2 years
|
| Cleaning - Child |
$82.00 |
$41.00 |
$15.00
$8.00
N/C
|
During year 1 -2 per year
During year 2
After 2 years
|
| Topical Fluoride (in addition to cleaning) |
$38.00 |
$19.00 |
$8.00
$4.00
N/C
|
During year 1 - Child Only
During year 2
After 2 years
|
| Sealants -- (Fee is per tooth) |
$52.00 |
$26.00 |
$10.00
$5.00
N/C
|
During year 1 - Child Only
During year 2
After year 2
|
| Filling - White 1 Surface |
$174.00 |
$87.00 |
$168.00
$67.00
$50.00
$34.00
|
During 6 month waiting period
After 6 months
During year 2
After 2 years
|
| Crown - Porcelain Fused to High Noble Metal |
$1,170.00 |
$585.00 |
$1,100.00
$660.00
$550.00
|
During 12 month waiting period
During year 2
After 2 years
|
| Root Canal - Anterior |
$762.00 |
$381.00 |
$662.00
$409.00
$341.00
|
682
During year 2
After 2 years
|
| Periodontal Scaling and Root Planning - Per Quadrant |
$292.00 |
$146.00 |
$282.00
$169.00
$141.00
|
During 12 month waiting period
During year 2
After 2 years
|
| Complete Denture Upper or Lower |
$1,398.00 |
$699.00 |
$1,316.00
$790.00
$658.00
|
During 12 month waiting period
During year 2
After 2 years
|
| Fixed Bridge 3 unit Porcelain to high noble metal (3 unit bridge requires 2 crowns and 1 pontic) |
$3,422.00 |
$1,711.00 |
$3,300.00
$1,980.00
$1,650.00
|
During 12 month waiting period
During year 2
After 2 years
|
| Simple Extraction |
$180.00 |
$90.00 |
$168.00
$101.00
$84.00
|
During 12 month waiting period
During year 2
After 2 years
|
| Surgical Removal of Erupted Tooth |
$274.00 |
$137.00 |
$264.00
$158.00
$132.00
|
During 12 month waiting period
During year 2
After 2 years
|
| Braces - Child |
$7,144.00 |
$3,572.00 |
$6,720.00
$4,032.00
$3,360.00
|
During 12 month waiting period
During year 2 - $400 year max
After 2 years - $1500.00 Lifetime Benefit
|
| Teeth Whitening |
$240.00 |
$120.00 |
$350.00
|
Not Covered Under This Plan
|
The fees shown above are based on zone. Fee schedules may vary by zone. This sample is for comparison only.
Refer to the Savon Fee Schedule for actual fees in your area.
Although we have carefully researched the company that we are comparing, Savon assumes no responsibility for the accuracy of their fees.
Savon assumes no responsibility nor do we guarantee that this plan is still available.
The fee schedule is in effect only in geographical areas where Network Preferred Providers are available.
To every extent possible, all comparison fees are from zip code 85029. Fees will be different depending on the region.
These comparisons were updated in September of 2016
