10645 N Tatum Blvd.
Suite 200-444
Phoenix, AZ 85028
Phone: 480.836.9966
Fax: 480.767.3436
Fee Schedule
DentaLine Plan members are entitled to reduced professional fees from our Member Dentists that are much lower than average fees charged by dentists in Arizona. This results in significant savings in your out-of-pocket costs.
Below is an abbreviated list of fees for common services.
Procedure
Usual Fee
Dentaline Fee
Member Savings
Diagnostic Service
Periodic Exam (Check Up)
$ 55
$ 25
$ 30
Comprehensive Exam
$ 95
$45
$ 50
Full Set X-rays
$138
$ 80
$ 58
Preventative Services
Adult Cleaning
$ 99
$ 50
$ 49
Child Cleaning
$ 73
$ 37
$ 36
Sealant per tooth
$ 58
$ 35
$ 23
Silver Fillings
1 Silver Filling
$142
$ 80
$ 62
White Fillings
1 White Filling
$150
$ 85
$ 65
Crowns
Crown
$1066
$655
$411
Extractions
Extraction, Erupted Tooth or Exposed Root
$185
$100
$ 85
Bleaching
Power Bleaching
$500
$350
$150
* All other services not listed are reduced 20% for General Plan Members
* Member Dentists may charge patients for missed appointments. Check with your dentist for more information.
* Specialists (Periodontists, Endodontists, Orthodontists, Prosthodontists, Oral Surgeons, etc) charge an 18% discount off of usual and customary fees.
*Any other procedures not covered on the completeschedule of fees will be discounted 20% off the provider's usual and customary fee. Consult with your Member Dentist before beginning any treatment.
