|Procedure||ADA Code||Fee*||With Aetna**||You Save||%|
|Routine 6 Month Check-up||ADA Code: D0120||Usual Fee*: $73.50||With Aetna**: $24.75||You Save: $48.75||Saving Percentage: 66%|
|Full Mouth X-Rays||ADA Code: D0210||Usual Fee*: $171.50||With Aetna**: $66.50||You Save: $105.00||Saving Percentage: 61%|
|Adult Teeth Cleaning||ADA Code: D1110||Usual Fee*: $125.00||With Aetna**: $53.00||You Save: $72.00||Saving Percentage: 58%|
|Child Teeth Cleaning||ADA Code: D1120||Usual Fee*: $91.00||With Aetna**: $37.50||You Save: $53.50||Saving Percentage: 59%|
|Perio Scaling and Root Planing (Per Quadrant)||ADA Code: D4341||Usual Fee*: $289.75||With Aetna**: $137.75||You Save: $152.00||Saving Percentage: 52%|
|1 Surface Silver Filling for Primary or Permanent Tooth||ADA Code: D2140||Usual Fee*: $198.75||With Aetna**: Call||You Save: Call||Saving Percentage: Call|
|1 Surface White Filling for U or L Front Tooth||ADA Code: D2330||Usual Fee*: $222.75||With Aetna**: $83.50||You Save: $139.25||Saving Percentage: 63%|
|Root Canal Treatment – Front Tooth||ADA Code: D3310||Usual Fee*: $1,060.75||With Aetna**: $392.25||You Save: $668.50||Saving Percentage: 63%|
|Root Canal Treatment – Bicuspid||ADA Code: D3320||Usual Fee*: $1,169.25||With Aetna**: $463.75||You Save: $705.50||Saving Percentage: 60%|
|Root Canal Treatment – Molar||ADA Code: D3330||Usual Fee*: $1,490.50||With Aetna**: $652.50||You Save: $838.00||Saving Percentage: 56%|
|Full Upper Denture||ADA Code: D5110||Usual Fee*: $1,932.50||With Aetna**: $879.00||You Save: $1,053.50||Saving Percentage: 55%|
|Single Tooth Extraction||ADA Code: D7140||Usual Fee*: $267.00||With Aetna**: $74.25||You Save: $193.25||Saving Percentage: 72%|
|Wisdom Tooth Extraction (Impacted Tooth, Soft Tissue)||ADA Code: D7220||Usual Fee*: $443.00||With Aetna**: Call||You Save: Call||Saving Percentage: Call|
Discounted fees are listed for visits to a participating general dentist. Actual costs and savings may vary by provider, service and geographic location. The discounted fee represents the average cost of the negotiated fees for Tampa, Dallas, Chicago and New York City. Individual dentist fee schedules may differ. In order to determine the specific rates for a dental provider, you should contact the dental provider directly.
Savings on vision care is also included in the Aetna Vital Dental Savings’. Click on the tab below for an explanation of added savings for vision care.
Included in your Aetna Vital Dental Savings’ is a vision savings plan by Aetna Vision powered by EyeMed. Aetna Vision provides a simple way to reduce eye care costs by taking advantage of savings.
Aetna Vision – eye exams, lenses, frames and more
The Aetna Vision network gives you access to 65,000+ eye care professionals nationwide.
This includes major retailers such as:
JCPenney Optical, Vision Source, Pearle Vision Centers, Sears Optical, Target Optical, Visionworks, and more.
|Description||Cost Without Aetna Vision2||Discount Savings1|
|Contact Lens Exam||$120||$105||12%|
|Lenses – Single Vision||$270||$289||30%|