Summary of Discount Fees

DIAGNOSTIC & PREVENTIVE

Full-mouth digital x-raysNo Charge
Single filmNo Charge
Each additional filmNo Charge
Oral examination & diagnosisNo Charge
Office visit$ 5.00
Prophylaxis (cleaning & polishing)$ 75.00
Oral hygiene instructionNo Charge
Sealants$ 41.00
Flouride Varnish$ 30.00

RESTORATIVE DENTISTRY (Fillings)

Amalgam (primary or permantent teeth)
$ 90.00
$100.00
$ 110.00
Composite Restorations(anterior teeth)
$ 105.00
$ 130.00
$ 150.00
Composite restorations (posterior teeth)
$ 140.00
$ 180.00
$ 195.00
Veneers (per tooth)$ 895.00
Lumineers$ 1,095.00

ENDODONTICS

Single-rooted canal therapy$ 448.00
Two-rooted canal therapy$ 506.00
Three-rooted canal therapy$ 624.00
Pulp capping$ 65.00
Pulpotomy$ 188.00

PERIODONTICS

Perio maintenance$ 95.00
Scaling and root planing (per quad)$ 160.00
Full mouth debridement$ 110.00
Laser w/ SRP$ 95.00

PROSTHODONTICS - REMOVABLE

Complete denture$ 1,250.00
Immediate denture$ 1,250.00
Premium denture$ 1,895.00
Partial lower or upper, chrome cobalt alloy lingual or palatal bar & acrylic saddles base$ 1,250.00
Premium partial$ 1,795.00
Stayplate$ 500.00
$ 38.00
Office reline - cold cure - acrylic$ 210.00
Denture reline - laboratory processed $ 281.00
Broken denture repair (no teeth involved)$ 80.00
$ 69.00

CROWNS & BRIDGES

Porcelain fused to metal crown$ 495.00
Porcelain fused to gold crown$ 780.00
3rd generation crowns$ 845.00
Full gold crown$ 1,150.00
Recementation$ 113.00
Endo cast post$ 225.00
Plastic core amalgam buildup$ 140.00
LAVA™ crown$ 1,150.00
Cerec® CAD/CAM crown$ 855.00
Cerec® CAD/CAM inlay$ 350.00
Cerec® CAD/CAM onlay$ 725.00
Blue Block Cerec® CAD/CAM crown$ 1,050.00

ORAL SURGERY

Extractions
$ 125.00
$ 221.00
$ 236.00
$ 281.00
$ 340.00

ORTHODONTICS

Comprehensive ortho treatment
$ 4,150.00
Limited ortho treatment
$ 1,700.00
Phase I ortho treatment
$ 1,950.00
Invisalign®$ 5,500.00

OTHER SERVICES

After hours emergency$ 145.00
Nightguard$ 431.00
Teeth-whitening (full mouth) w/ custom take-home trays$ 245.00
Nitrous$ 105.00
Implant (incl. abut. & crown)$ 3,250.00

Exclusions

  • Treatment of fractures or dislocations, congenital malformations, malignancies, cysts or neoplasms, or Temporomandibular Joint Syndrome (TMJ).
  • Prescription drugs and over the counter drugs.

Limitations

  • Prophylaxis (Cleaning) is limited to once every six months.
  • ll mouth x-rays are limited to once every 24 months.
  • Replacement of partial dentures is limited to once every five years.
  • Full upper and/or lower dentures are not to exceed one each in any five-year period.
  • Denture relines are limited to one per arch in any 12 month period.
  • Services performed by a non-participating provider are not covered.

Downloadable Forms and Documents

Downloadable Forms and Documents (Texas Residents Only)


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The CDI Group is required to provide prospective Members a copy of the Individual and Family Combined Membership agreement and Description of Services and Disclosure Form prior to enrollment.