PROGRAMS OFFERED BY STONE DENTAL:

STONE DENTAL DISCOUNT PLAN OPTIONS

PLAN I - 100% Discount on Routine Hygiene (Preventative Care - refer to Certificate of Care), No Deductible, No Maximum, No Waiting Period, Pre-Existing Included

PLAN II - 50% Discount on Routine Hygiene (Preventative Care - refer to Certificate of Care), No Deductible, No Maximum, No Waiting Period, Pre-Existing Included
PLAN III - 100% Discount on Routine Hygiene (Preventative Care - refer to Certificate of Care), $50.00 Annual Deductible per person, $1000.00 Annual Maximum per person, $1000.00 Maximum on Ortho - Lifetime of contract , No Waiting Period, Pre-Existing Included
PLAN IV - 50% Discount on Routine Hygiene (Preventative Care - refer to Certificate of Care), $50.00 Annual Deductible per person, $1000.00 Annual Maximum per person, $1000.00 Maximum on Ortho - Lifetime of contract , No Waiting Period, Pre-Existing Included
PLAN V- This plan can only be used in combination with dental insurance. Stone Dental is not insurance it is a discount plan that can be used in combination with dental insurances. PREVENTATIVE CARE is excluded and all remaining coverage is equal to our Plan I (see certificate of care.) No Deductible, No Maximum, No Waiting Period, Pre-Existing Included

 

EACH PLAN PROVIDES 40-100% DISCOUNT
(see our certificate of care for exact cost per procedure)

MONTHLY PLAN RATES
PLAN I
PLAN II
*PLAN III
PLAN IV

SINGLE

38.96
31.00
24.46
16.50

COUPLE

48.96
41.00
29.96
22.00

COUPLE W/ORTHO

74.96
60.00
55.96
41.00

FAMILY 4 OR LESS

78.96
65.00
50.96
37.00

FAMILY 5 OR MORE

89.96
74.00
57.46
41.50

FAM 4 OR LESS W/ORTHO

94.96
79.00
66.96
51.00

FAM 5 OR MORE W/ORTHO

109.96
92.00
77.46
59.50

STONE DENTAL PROVIDES PARTICIPANTS WITH AN AVERAGE 62% DISCOUNT OVER PLAN DURATION - NOT INSURANCE, A DISCOUNT DENTAL PLAN

Company plan rates differ according to group size


Certificate of Care

Those procedures with discounted payments are shown in the following certificate of care.

Preventative(BLUE PLAN)
Code
With Plan
Without Plan
0120 Exam (Oral)
No Charge
49.00
0272 X-Ray Bitewing
No Charge
45.00
0330 X-ray Full Mouth (Panil)
No Charge
110.00
1110 Adult Prophy
No Charge
89.00
1201 Child Prophy W/ Fluoride Treatment
No Charge
69.00
1120 Child Prophy W/O Fluoride Treatment
No Charge
67.00
0120 Comp Oral Eval
No Charge
63.00
1204 Adult Flouride
No Charge
25.00

Preventative (GREEN PLAN)
Code  
With Plan
Without Plan
0120 Exam (Oral)
22.00
49.00
0272 X-ray Bitewing
18.00
45.00
0330 X-ray Full Mouth (Panil)
47.50
110.00
1110 Adult Prophy
37.50
89.00
1201 Child Prophy W/ Fluoride Treatment
31.00
62.00
1120 Child Prophy W/O Fluoride Treatment
23.50
47.00
0150 Comp Eoral Eval
51.50
63.00
1204 Adult Flouride
17.50
35.00
0150 NP Evaluation
35.00
70.00

These discounts are equal on both plans offered

Restorative
Code  
With Plan
Without Plan
0220 X-RAY P.A.
18.00
29.00
1351 Sealant per tooth
40.00
61.00
0230 Additional X-Ray
20.00
25.00
2140 Amalgam 1 Surface
105.00
167.00
2150 Amalgam 2 Surface
116.00
194.00
2160 Amalgam 3 Surface
135.00
232.00
2161 Amalgam 4 Surface
155.00
272.00
2951 Retention Pin
36.00
50.00
2330 Comp. 1 Surface Anterior
109.00
179.00
2331 Comp. 2 Surface Anterior
125.00
209.00
2332 Comp. 3 Surface Anterior
150.00
246.00
2335 Comp. 4 Surface Anterior
188.00
306.00
2385 Posterior composite 1 surface
145.00
198.00
2386 Posterior composite 2 surface
177.00
242.00
2387 Posterior composite 3 surface
219.00
285.00
2394 Posterior composite 4 surface
253.00
318.00
2920 Recement Crown or Bridge
83.00
111.00
2930 Stainless Steel Crowns (Pedo)
191.00
310.00
2932 Temp. Crowns
236.00
380.00
2954 Post & Core
233.00
333.00
2940 Sedative Temp. Fillings
305.00
340.00
2950 Crown Build Up (incl. Pin)
173.00
263.00
2931 Crown, Stainless Steel (pre-fab)
191.00
310.00

Endodontics
Code  
With Plan
Without Plan
3110 Pulp Cap (including base)
54.00
83.00
3220 Pulpotomy-Primary Teeth
142.00
200.00
3310 Root Canal Anterior
522.00
728.00
3320 Root Canal Bicuspid
582.00
828.00
3330 Root Canal Molar
722.00
1020.00
3421 Apicoectomy per Root
466.00
764.00
3920 Hemisecton
447.00
672.00
3120 Pulp Cap Indirect (incl. Base)
50.00
82.00
3220 Emergency Endo. (Open & Drain)
118.00
176.00

Periodontics
Code  
With Plan
Without Plan
0150 FL. Probe Exam
31.50
63.00
0180 Perio Exam & Trt Plan
32.00
80.00
0170 Perio Examination & treatment plan
32.00
80.00
1204 Adult Fluoride
19.00
25.00
4910 Perio Prophylaxis
84.00
133.00
0410 Reprobe Perio Evaluation
68.00
80.00
4341 Heavy Calculus Per Quad
145.00
250.00
4260 Osseous Surg. Per Quad
698.00
1063.00
4355 Heavy Debridement Removal
142.00
300.00
4210 Gingivectomy Per Quad
604.00
682.00
9951 Occlusal Adj. Limited
138.00
238.00
9952 Occlusal Adj. Complete
495.00
655.00
4320 A-Splint (2-6 Teeth)
301.00
465.00
7270 Splint from Accident
256.00
420.00
7880 TMJ Guard
314.00
414.00
9940 Night Guard (Soft or Hard)
484.00
584.00

Prosthodontics
Code  
With Plan
Without Plan
5211 Partial Upper, with Chrome Clasps Acrylic Base
918.00
1387.00
5212 Partial Lower, with Chrome Clasps Acrylic Base
918.00
1387.00
5213 Upper Cast Partial Denture Designed-Chrome, Specifc, any number of clasps & rest. acrylic base
1179.00
1767.00
5214 Lower Cast Partial Denture Designed-Chrome, Specifc, any number of clasps & rest. acrylic base
1179.00
1767.00
5110 Complete Upper Denture
1395.00
1721.00
5120 Complete Lower Denture
1395.00
1721.00
D5130 Deluxe Immed. Upper Denture
1424.00
2067.00
D5140 Deluxe Immed. Lower Denture
1424.00
2067.00
5410 Adjust UpperDentures
67.00
89.00
5411 Adjust Lower Dentures
67.00
89.00
5850 Tissue Conditioning max.
153.00
211.00
5851 Tissure Conditioning mand.
146.00
204.00

Denture Relining
Code  
With Plan
Without Plan
5730 Reline Upper of Lower Complete Denture-Offce
281.00
389.00
5731 Reline Upper or Lower Partial
281.00
389.00
5750 Reline or Rebase Upper or Lower Complete Denture-Lab.
312.00
464.00
(5751) Reline or Rebase Upper or Lower Partial Denture-Lab.
312.00
464.00

Fixed Prosthodontics
Code  
With Plan
Without Plan
6061 Implant Crown
721.00
1120.00
2710 Bell Glass Crown
500.00
500.00
2740 Crown-porcelain/ceramic substrate
774.00
1105.00
2750 Crown-porcelain fused to high noble metal
774.00
1105.00
2751 Crown-porcelain fused to predominantly base metal
774.00
1105.00
2752 Crown-porcelain fused to noble metal
774.00
1105.00
2790 Crown-full cast high noble metal
774.00
1105.00
2791 Crown-full cast noble predominantly base metal
774.00
1105.00
2792 Crown-full cast noble metal
774.00
1105.00
6210 Pontic-cast high noble metal
774.00
1105.00
6211 Pontic-cast predominantly base metal
774.00
1105.00
6212 Pontic-cast noble metal to high noble metal
774.00
1105.00
6240 Pontic-porcelain fusedto high noble metal
774.00
1105.00
6241 Pontic-porcelain fused to predominantly base metal
774.00
1105.00
6242 Pontic-porcelain fused to noble metal
774.00
1105.00
6750 Crown-porcelain fused to high noble metal
774.00
1105.00
6751 Crown-porcelain fused to predominantly base metal
774.00
1105.00
6752 Crown-porcelain fused to noble metal
774.00
1105.00
6790 Crown-full cast high noble metal
774.00
1105.00
6791 Crown-full cast predominantly base metal
774.00
1105.00
6792 Crown-full cast noble metal
774.00
1105.00

Oral Surgery
Code
With Plan
Without Plan
7140
Routine Extraction, Single Tooth
127.00
174.00
7210
Surgical Extraction Erupted Tooth
208.00
272.00
7220
Soft Tissue Impaction
213.00
303.00
7230
Partial Bony Impaction
304.00
462.00
7240
Full Bony Impaction (Surg. Rem. of Residual Root)
378.00
554.00
7250
Root Recovery
240.00
301.00
7310
Alveoloplasty in conjunction with extraction per quad
205.00
294.00
7280
Surgical Exposure of Impacted or Unerupted Tooth for orthodontic Reasons
212.00
420.00
7320
Alveoloplasty (per Quad - Not with extraction)
545.00
880.00
7472
Surgical Excision of Cyst
727.00
869.00
7473
Removal of Exostosis (Tori)
282.00
805.00
7510
Surgical Incision & Drainage
156.00
252.00
7960
Frenectomy
318.00
490.00
7970
Excision of Hyperplastic Tissue per quad
269.00
550.00
7260
Oral Antral Fistula Closure
957.00
1147.00
21210
Bone Graft Maxilla
120.00
186.00
21215
Bone Graft Mandible
120.00
186.00
7820
Surgicle Exposu Ortho
277.00
500.00

Orthodontics
(Under 19 years of age)
Code  
With Plan
Without Plan
1510 Unilateral Fixed Space Maintainer
186.00
305.00
1515 Bilateral Fixed Space Maintainer
321.00
525.00
8660 Ortho Treatment Plan (Records & Models)
305.00
334.00
8070
8080
8090

Orthodontic Therapy
Class, I, II, III, Fixed
Banded (Or bonded brackets) Buccal comprehensive Orthodontic Treatment Normal 24 Month Care for Children (up to 19 years of age)

3880.00
4199.00

Other Services
Code  
With Plan
Without Plan
9430 Offce Visit
34.00
55.00
9440 Saturday Offce Visit
50.00
81.00
9110 Emergency Offce Visit
45.00
70.00
9248 Non IV Sedation
59.00
75.00
9230 Nitrous Oxide laugh gas
67.00
77.00
9910 Protect & Seal
38.00
38.00
0140 NP Offce Visit
52.00
74.00