| Procedure Description | Usual Fee 1 | Discounted Fee (for Plan Members) 2 |
Member Savings | Savings Percentage |
| Routine 6 Month Check-Up | $57 | $21 | $36 | 63% |
| In Depth Check-Up | $99 | $31 | $68 | 69% |
| Full Mouth X-Rays | $144 | $60 | $84 | 58% |
| Four Bitewing X-Rays | $70 | $27 | $43 | 61% |
| Panoramic Film | $122 | $47 | $75 | 61% |
| Adult Teeth Cleaning | $102 | $47 | $55 | 54% |
| Child Teeth Cleaning | $75 | $32 | $43 | 57% |
| Protective Sealant / Tooth | $61 | $27 | $34 | 56% |
| 1 Surface White Filling for U or L Front Tooth | $175 | $61 | $114 | 65% |
| Single Crown - Porcelain on High Noble Metal | $1,227 | $546 | $681 | 56% |
| Single Crown - Porcelain on Noble Metal | $1,162 | $501 | $661 | 57% |
| Core Build-Up With Pins | $296 | $91 | $205 | 69% |
| Root Canal Treatment - Front Tooth | $826 | $316 | $510 | 62% |
| Root Canal Treatment - Bicuspid | $967 | $369 | $598 | 62% |
| Root Canal Treatment - Molar | $1,170 | $498 | $672 | 57% |
| Perio Scaling and Root Planing (Per Quadrant) | $271 | $101 | $170 | 63% |
| Full Upper Denture | $1,855 | $716 | $1,139 | 61% |
| Tooth Replacement Part of Permanent Bridge | $1,197 | $515 | $682 | 57% |
| Single Tooth Removal - Simple Extraction | $197 | $56 | $141 | 72% |
The sample table above is a small selection of common procedures discounted by CIGNAPlus Savings. The procedures discounted under CIGNAPlus Savings offer similar savings to the sample above.
1 Source: DentalPlans.com (DP.C) 2010 Survey of Sample Average National Dental Fees (updated March 2011). Fees may vary slightly by region.
2Discounted fees are listed for visits to a participating general dentist. Any procedure not listed on the complete fee schedule will be discounted 20% off the provider's normal fee. Members will be charged the provider's CIGNAPlus Savings contracted fees. Charges may vary from the sample fee schedule above. Consult with your provider prior to beginning any treatment.
This plan is based geographically by ZIP code in terms of provider participation and location. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code.
