Savings Summary

Making Dentistry Affordable for Everyone is What We Do

Epic Dental Plan provides transparent pricing so plan members know exactly what to expect when it comes to their dental care needs. Plan members receive member-only 20-50% SAVINGS on all dental procedures including preventive, basic, major, cosmetic, and even orthodontics!

Epic Dental Plan keeps it simple and features no waiting periods, exclusions or maximums.

Diagnostic And Preventive
Code Description Retail Fee* Member Pays Member Savings*
D0120 Periodic Exam $48.00 $24.00 50%
D0140 Limited Exam – Problem Focused $50.00 $25.00 50%
D0150 Comprehensive Exam $50.00 $25.00 50%
D0210 X-rays - Complete Series $100.00 $50.00 50%
D0220 Intraoral X-Ray (First Film) $25.00 $13.00 50%
D0274 Bitewings – Four Films $50.00 $25.00 50%
D0330 Panoramic Film $143.00 $72.00 50%
D1110 Adult Cleaning - Age 14+ $75.00 $38.00 50%
D1120 Child Cleaning - Under Age 14 $50.00 $25.00 50%
D1208 Fluoride $42.00 $21.00 50%
D1351 Sealant – Per Tooth $72.00 $36.00 50%
Restorative - Amalgam Fillings
Code Description Retail Fee* Member Pays Member Savings*
D2140 One Surface $118.00 $89.00 25%
D2150 Two Surfaces $159.00 $119.00 25%
D2160 Three Surfaces $169.00 $127.00 25%
Restorative - Composite Fillings (Resin Based)
Code Description Retail Fee* Member Pays Member Savings*
D2330 One Surface, Anterior $159.00 $119.00 25%
D2331 Two Surfaces, Anterior $198.00 $149.00 25%
D2332 Three Surfaces, Anterior $242.00 $182.00 25%
D2335 Four+ Surfaces, Anterior $306.00 $230.00 25%
D2391 One Surface, Posterior $171.00 $128.00 25%
D2392 Two Surfaces, Posterior $247.00 $185.00 25%
D2393 Three Surfaces, Posterior $297.00 $223.00 25%
Crowns
Code Description Retail Fee* Member Pays Member Savings*
D2740 Crown - Porcelain/Ceramic $1,482.00 $1,112.00 25%
D2750 Crown – Porcelain/High Noble Metal $1,433.00 $1,075.00 25%
D2751 Crown – Porcelain/Base Metal $1,231.00 $923.00 25%
D2752 Crown – Porcelain/Noble Metal $1,335.00 $1,001.00 25%
D2950 Core Build-Up, Including Pins $373.00 $280.00 25%
D2952 Post And Core In Addition To Crown, Indirectly Fabricated $472.00 $354.00 25%
Root Canals
Code Description Retail Fee* Member Pays Member Savings*
D3310 Anterior Root Canal (Excluding Final Restoration) $794.00 $596.00 25%
D3320 Bicuspid Root Canal (Excluding Final Restoration) $1,007.00 $755.00 25%
D3330 Molar Root Canal (Exclusing Final Restoration) $1,251.00 $938.00 25%
Periodontics
Code Description Retail Fee* Member Pays Member Savings*
D4341 Scaling/Root Planing - 4+ Teeth Per Quad $262.00 $197.00 25%
D4342 Scaling/Root Planing - 1-3 Teeth Per Quad $154.00 $116.00 25%
D4381 Arestin $68.00 $51.00 25%
D4910 Periodontal Maintenance $156.00 $117.00 25%
Dentures
Code Description Retail Fee* Member Pays Member Savings*
D5110 Complete Denture – Upper $1,504.00 $1,128.00 25%
D5120 Complete Denture – Lower $1,453.00 $1,090.00 25%
D5510 Repair Broken Denture Base $196.00 $147.00 25%
D5730 Reline Upper Denture (Chairside) $333.00 $250.00 25%
D5731 Reline complete mandibular denture (chariside) $333.00 $250.00 25%
D5740 Reline maxillary partial denture (chairside) $333.00 $250.00 25%
D5741 Reline mandibular partial denture (Chairside) $333.00 $250.00 25%
D5750 Reline Upper Denture (Laboratory) $451.00 $338.00 25%
D5751 Reline Lower Denture (Laboratory) $451.00 $338.00 25%
Bridges
Code Description Retail Fee* Member Pays Member Savings*
D6010 Surg Place Implant - Endosteal $2,458.00 $1,844.00 25%
D6057 Cust Abutment -Incl Placement $896.00 $672.00 25%
D6058 Implant - Porcelain $1,566.00 $1,175.00 25%
D6060 Abtmt Supp Porc Fused - Base Metal $1,409.00 $1,057.00 25%
D6750 Crown – Porcelain/High Noble Metal $1,281.00 $961.00 25%
D6751 Crown – Porcelain/Base Metal $1,231.00 $923.00 25%
D6752 Crown – Porcelain/Noble Metal $1,292.00 $969.00 25%
Extractions
Code Description Retail Fee* Member Pays Member Savings*
D7140 Simple Extraction $159.00 $119.00 25%
To view your affiliated dental provider's complete Member Savings Schedule, click on your location:
Massachusetts | New Hampshire | Texas

*Member Savings is the amount the member pays less their affiliated provider's Retail Fee. The Retail Fee refers to the normal rate charged to uninsured patients for services rendered by the provider.  Retail Fees and Member Savings can vary by affiliated provider. Plan savings and incentives are not available to patients whose dental care is covered by Medicaid.

Keep on Smilin' Assurance


Epic dental plan“Epic Dental Plan is great for our family. We've always paid out-of-pocket for dentistry, but now receive significant and transparent 20-50% member-only savings on all our dental care needs at our affiliated dental provider's office." - Reagan


Epic dental plan"Our employer offered dental insurance was expensive and lacked value.  We needed a dental plan that is affordable, easy-to-use, and has significant real dollar savings.  For only about $7.50/month, Epic Dental Plan saves us hundreds of dollars each time we visit our dentist!" - Charlie & Mallory