Procedure | ADA Code | Usual Fee1 | With Plan2 | You Save | % Saved |
---|---|---|---|---|---|
Routine 6 month check-up | ADA Code: D0120 | Usual Fee1: $51.00 | With Plan2: $20 | You Save: $31 | Saving Percentage: 61% |
In depth check-up | ADA Code: D0150 | Usual Fee1: $86.00 | With Plan2: $29 | You Save: $57 | Saving Percentage: 66% |
Full mouth x-rays | ADA Code: D0210 | Usual Fee1: $143.00 | With Plan2: $57 | You Save: $86 | Saving Percentage: 60% |
Four bitewing x-rays | ADA Code: D0274 | Usual Fee1: $66.00 | With Plan2: $25 | You Save: $41 | Saving Percentage: 62% |
Panoramic film | ADA Code: D0330 | Usual Fee1: $115.00 | With Plan2: $44 | You Save: $71 | Saving Percentage: 62% |
Adult teeth cleaning | ADA Code: D1110 | Usual Fee1: $90.00 | With Plan2: $44 | You Save: $46 | Saving Percentage: 51% |
Child teeth cleaning | ADA Code: D1120 | Usual Fee1: $66.00 | With Plan2: $30 | You Save: $36 | Saving Percentage: 55% |
Protective sealant / tooth | ADA Code: D1351 | Usual Fee1: $56.00 | With Plan2: $25 | You Save: $31 | Saving Percentage: 55% |
1 surface silver filling for primary or permanent tooth | ADA Code: D2140 | Usual Fee1: $149.00 | With Plan2: $44 | You Save: $105 | Saving Percentage: 70% |
1 surface white filling for u or l front tooth | ADA Code: D2330 | Usual Fee1: $160.00 | With Plan2: $58 | You Save: $102 | Saving Percentage: 64% |
Single crown - porcelain on high noble metal | ADA Code: D2750 | Usual Fee1: $1139.00 | With Plan2: $563 | You Save: $576 | Saving Percentage: 51% |
Single crown - porcelain on noble metal | ADA Code: D2752 | Usual Fee1: $1029.00 | With Plan2: $517 | You Save: $512 | Saving Percentage: 50% |
Core build-up with pins | ADA Code: D2950 | Usual Fee1: $285.00 | With Plan2: $93 | You Save: $192 | Saving Percentage: 67% |
Labial veneer (resin laminate) - direct | ADA Code: D2960 | Usual Fee1: $650.00 | With Plan2: $221 | You Save: $429 | Saving Percentage: 66% |
Labial veneer (porcelain laminate) - indirect | ADA Code: D2962 | Usual Fee1: $1345.00 | With Plan2: $355 | You Save: $990 | Saving Percentage: 74% |
Root canal treatment - front tooth | ADA Code: D3310 | Usual Fee1: $789.00 | With Plan2: $298 | You Save: $491 | Saving Percentage: 62% |
Root canal treatment - bicuspid | ADA Code: D3320 | Usual Fee1: $937.00 | With Plan2: $348 | You Save: $589 | Saving Percentage: 63% |
Root canal treatment - molar | ADA Code: D3330 | Usual Fee1: $1195.00 | With Plan2: $513 | You Save: $682 | Saving Percentage: 57% |
Bone replacement graft - retained natural tooth - first site in quadrant | ADA Code: D4263 | Usual Fee1: $353.00 | With Plan2: $202 | You Save: $151 | Saving Percentage: 43% |
Perio scaling and root planing (per quadrant) | ADA Code: D4341 | Usual Fee1: $277.00 | With Plan2: $95 | You Save: $182 | Saving Percentage: 66% |
Regular cleaning following periodontic procedure | ADA Code: D4910 | Usual Fee1: $150.00 | With Plan2: $72 | You Save: $78 | Saving Percentage: 52% |
Full upper denture | ADA Code: D5110 | Usual Fee1: $1532.00 | With Plan2: $675 | You Save: $857 | Saving Percentage: 56% |
Full lower denture | ADA Code: D5120 | Usual Fee1: $1500.00 | With Plan2: $675 | You Save: $825 | Saving Percentage: 55% |
Add clasp to existing partial denture | ADA Code: D5660 | Usual Fee1: $261.00 | With Plan2: $96 | You Save: $165 | Saving Percentage: 63% |
Surgical placement of implant body: endosteal implant | ADA Code: D6010 | Usual Fee1: $2150.00 | With Plan2: $1,768 | You Save: $382 | Saving Percentage: 18% |
Abutment supported cast metal crown (predominantly base metal) | ADA Code: D6063 | Usual Fee1: $1259.00 | With Plan2: $555 | You Save: $704 | Saving Percentage: 56% |
Implant supported crown high noble alloys | ADA Code: D6067 | Usual Fee1: $1418.00 | With Plan2: $725 | You Save: $693 | Saving Percentage: 49% |
Tooth replacement part of permanent bridge | ADA Code: D6210 | Usual Fee1: $1098.00 | With Plan2: $530 | You Save: $568 | Saving Percentage: 52% |
Single tooth removal - simple extraction | ADA Code: D7140 | Usual Fee1: $174.00 | With Plan2: $53 | You Save: $121 | Saving Percentage: 70% |
Extraction - impacted wisdom tooth (soft tissue) | ADA Code: D7220 | Usual Fee1: $330.00 | With Plan2: $131 | You Save: $199 | Saving Percentage: 60% |
Extraction - impacted wisdom tooth (partial bony) | ADA Code: D7230 | Usual Fee1: $415.00 | With Plan2: $176 | You Save: $239 | Saving Percentage: 58% |
Comprehensive orthodontic treatment of the transitional dentition | ADA Code: D8070 | Usual Fee1: $5562.00 | With Plan2: 20% Off | You Save: $1112.40* | Saving Percentage: 20% |
Full orthodontic child treatment (braces) | ADA Code: D8080 | Usual Fee1: $5658.00 | With Plan2: 20% Off | You Save: $1131.60* | Saving Percentage: 20% |
Full orthodontic adult treatment (braces) | ADA Code: D8090 | Usual Fee1: $5936.00 | With Plan2: 20% Off | You Save: $1187.20* | Saving Percentage: 20% |
External bleaching – per arch – performed in office | ADA Code: D9972 | Usual Fee1: $225.00 | With Plan2: 20% Off | You Save: $45.00* | Saving Percentage: 20% |
External bleaching - per tooth | ADA Code: D9973 | Usual Fee1: $185.00 | With Plan2: $135 | You Save: $50 | Saving Percentage: 27% |
Internal bleaching - per tooth | ADA Code: D9974 | Usual Fee1: $286.00 | With Plan2: 20% Off | You Save: $57.20* | Saving Percentage: 20% |
1 The [“Usual Fee”] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. Actual fees charged by your provider may vary for a variety of reasons.
2 Discounted 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.
* Savings will be 20% off usual customary rate.
Savings on vision and hearing care are also included in the CignaPlus Savings plan. Click on the tabs below for an explanation of added savings with this plan.
Included in your CignaPlus Savings Plan is a vision network savings program powered by Cigna Vision that provides access to savings on your vision care needs.
Receive access to savings on the following benefits:
The Cigna Vision Network gives you access to 25,000+ participating optometrists, ophthalmologists, and opticians nationwide.
This includes major retailers such as:
JCPenney Optical, LensCrafters, Pearle Vision Centers, Sears Optical, Target Optical, Visionworks, and more.
Description | Without Cigna Vision2 | With Cigna Vision 1 | Typical Savings |
Eye Exam | $90.00 | $85.00 | $5.00 |
Designer Frames3 | $179.99 | $108.00 | $71.99 |
Contact Lens Exam | $120.00 | $110.00 | $10.00 |
Anti-reflective3 | $120.00 | $50.00 | $70.00 |
Notes
Cigna Vision Routine Vision Care Services | TypicalSavings |
---|---|
Routine Vision Examination | |
Including but not limited to eye health examination, dilation, refraction and prescription for glasses | 20% off at participating locations or $5 off routine exam at most major retailers |
Standard Clear Plastic or Glass Lenses | |
Single vision | Up to $50 |
Bifocal | Up to $75 |
Trifocal | Up to $105 |
Lens Options | |
Standard UV coating | Up to $15 |
Standard scratch-resistance | Up to $15 |
Standard polycarbonate | Up to $40 |
Standard anti-reflective coating | Up to $45 |
Progressives | Up to 20% |
Other add-ons and services | Up to 20% |
Frames | |
Most locations | 25% off retail prices on frames |
Retailers such as: JC Penney Optical, Sears Optical, Target Optical, Pearle Vision and Visionworks | 40% off retail prices on most frames |
Contact Lenses and Professional Services | |
Contact lens professional services (fitting and evaluation) | $10 off contact lens exam |
Contact lenses | Check with your Cigna Vision network eye care professional for any available offers on contact lenses. |
Non-Prescription Sunglasses | |
Non-Prescription Sunglasses | 20% savings |
Note: These discounts are only available through a Cigna Vision network eye care professional. Stated discounts cannot be used in conjunction with other discounts, promotions or prior orders. Network eye care professionals are independent contractors solely responsible for your routine vision examinations and products. 1. The Cigna Vision Network Savings program offered through Healthy Rewards is a discount program. Some programs are not available in all states and programs may be discontinued at any time. If your Cigna plan includes coverage for any of these services, this program is in addition to, not instead of, your plan coverage. Discount programs are separate from plan benefits. A discount program is NOT insurance, and you must pay the entire discounted charge directly to the participating eye care provider. 2. Provider participation is 100% voluntary. Please check with your eye care professional for any discount offer. 3. Select frames may not be available for savings. 4. Regional pricing and availability may vary depending on your location. Check with your Cigna Vision network eye care professional for details. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. |
Included in your CignaPlus Savings membership is a hearing benefit through Amplifon, which will provide you access to savings regarding your hearing care needs including exams, hearing aids, and other hearing care services.
The Amplifon hearing program provides savings on hearing exams and services at more than 4,500 locations nationwide, and offers deep discounts on hearing aid brands such as:
Oticon, Phonak, Starkey, and more.