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Thank you for choosing "TDA" !


 

Annual Premiums (You only pay once a Year!!)

Member (Single)

$48.00

Member & one dependent

$72.00

Member & dependents

$96.00

 

Cost per dental procedure of what you pay!


 

Member Services

Member Co-Payment

Diagnostic & Preventative

Office Visit

$0.00

Oral Exam

$10.00

Fluoride (to age 14)

$0.00

Prophylaxis (cleaning -- adult & child)

$25.00

Single Periodical x-ray

$10.00

Each additional Periodical

$8.00

Bitewing x-ray (1, 2, & 4 films)

$15.00

Intraoral x-ray (incl. Bitewings)

$52.00

Panoramic x-ray

$40.00

Sealant (per tooth)

$15.00

Restorative Dentistry (Filling-Cavities)

Amalgam Restorations - Primary

One Surface

$40.00

Two Surfaces

$50.00

Three Surfaces

$60.00

Four Surfaces

$70.00

Amalgam Restorations - Permanent

One Surface

$45.00

Two Surfaces

$55.00

Three Surfaces

$65.00

Four Surfaces

$80.00

Composite Restorations - Anterior

One Surface

$55.00

Two Surfaces

$70.00

Three Surfaces

$85.00

Four Surfaces

$100.00

Composite Restorations - Posterior

One Surface

$60.00

Two Surfaces

$85.00

Three Surfaces

$105.00

Crown and Bridges

Porcelain Crown/Porcelain with Metal Crown

$455.00

Stainless Steel Crown (permanent or primary)

$95.00

Full Crown

$435.00

Acrylic with Metal Crown

$425.00

Cast Pontic

$405.00

Porcelain with Metal Pontic

$395.00

Acrylic Pontic

$390.00

Recement Crown

$35.00

Crown Buildup (including pins)

$90.00

Crown Post & Core

$140.00

Periodontics**

Gingivectomy or Gingiovplasty per Quad

$205.00

Gingival Curettage per Quad

$75.00

Gingival Flap Procedure (including root planning)

$240.00

Osseious Surgery per Quad (incl. flap entry and closure)

$390.00

Periodontal Scaling and Root Planning per Quad

$95.00

Full Mouth Debridement

$65.00

Periodontal Maintenance Following Active Therapy

$60.00

Oral Surgery**

Extraction (Simple)

$50.00

Extraction (Surgical)

$85.00

Soft Tissue Impaction

$105.00

Partial Bony Impaction

$140.00

Full Bony Impaction

$205.00

Root Removal (Exposed Roots)

$60.00

Surgical Exposure of Impacted Tooth

$195.00

Endodontics (Root Canal Therapy)**

Pulp Capping (Direct/Indirect)

$25.00

Therapeutic Pulpotomy

$60.00

Root Canal Anterior

$260.00

Root Canal Bicuspid

$315.00

Root Canal Molar

$405.00

Prosthetics (Dentures)

Complete Upper/Lower Denture

$525.00

Immediate Upper/Lower Denture

$570.00

Partial Resin Upper/Lower

$470.00

Partial Cast Metal Base Upper/Lower

$575.00

Removable Unilateral Partial Denture

$340.00

Denture Adjustment

$30.00

Repair Broken Complete Denture Base

$60.00

Replace Missing or Broken Teeth

$50.00

Add Tooth to Existing Partial Denture

$75.00

Add Clasp to Existing Partial Denture

$90.00

Rebase

$215.00

Reline Dentrue (Chairside)

$120.00

Reline Denture (Lab)

$160.00

Tissue Reconditioning per Denture

$50.00

Other Services

Emergency Palliative Treatment

$35.00

Local Anesthetic

$10.00

Analgesia/Nitrous Oxide

$20.00

Office Visit (After Regular Hours)

$45.00

Missed/Cancelled Appt. (without 24 hr notice)

$30.00

Orthodontics (Braces)

Comprehensive Orthodontic Treatment (24 months)

 

Under age 19

$2,300.00

Age 19 & Over

$2,500.00

Screening Exam

No Charge

Initial Workup & x-rays

$200.00

Final Workup & x-rays

$200.00

Lost or Broken Metal Bands

$10.00

Interceptive Per-Ortho Guidance (per Visit)

$15.00

Lost or Broken Head Gear

$25.00

Lost or Irreparable Retainer

$75.00

Partial Treatment/Functional Ortho Treatment

25% discount


HOW DO I ENROLL?

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Download the Individual or Family Enrollment Application

  

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Attach a check for the annual premium

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Mail your original completed application to our office.
Your Annual Membership Fee includes a non-refundable $10.00 enrollment and processing fee.

Utah Health Phone CallPlease feel free to call us with any questions you may have. 

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