Amerinet Dental Network Plan

  • Cost Comparison & Savings

    The illustration below compares your costs and savings of an initial visit for an oral exam, full mouth x-rays and a cleaning with the Plan and without the Plan. The comparison also includes other dental procedures. As you can see, the savings with the Plan are substantial.

Procedure
Oral Examination
Full Mouth X-Rays
Teeth Cleaning
Initial Visit

Cost Without Plan
$120.00
$124.00
$95.00
$339.00

Cost With Plan
$15.00
$36.00
$55.00
$106.00

Savings
$105.00
$88.00
$40.00
$233.00

Procedure
Amalgam Filling (single)
Extraction (surgical)
Crown (porcelain/metal)
Root Canal (single)
Complete Denture

Cost Without Plan
$95.00
$203.00
$1,043.00
$563.00
$1,440.00

Cost With Plan
$70.00
$155.00
$525.00
$375.00
$825.00

Savings
$25.00
$48.00
$518.00
$188.00
$615.00

  • Continuity of Care

    In the event of termination of this agreement or the agreement with the dentist, the dentist shall complete all procedures started prior to the termination under the terms of this contract. For example: If a final impression has been taken, the dentist will complete the crown, bridge or denture for co-payment (plus lab fee where applicable). If assistance is required, the member may request assistance by calling (714) 838-8125. This continuity of care shall be provided for a term not to exceed 90 days.

ADN144 Benefit Schedule

Services

Co-Payments

DIAGNOSTIC
Office Visit  $5.00
Oral Examination & Diagnosis  $15.00
X-Rays
Full mouth  $36.00
Single film  $10.00
Each additional film  $5.00
PREVENTATIVE
Topical fluoride  $35.00
Sealant (chemical cured)  $30.00
KCP Sealant  $40.00
Prophylaxis (one every six months)
(Cleaning & light scaling, non-perio condition)
Child  $45.00
Adult  $55.00
FILLINGS
Bonding (involving incisal angle)  $175.00
Porcelain veneers (per tooth)  $850.00
Bleaching gel (per arch)  $159.00
Da Vinci Veneers  $1,700.00
Amalgam fillings (mercury)
Single surface  $70.00
Two surfaces  $85.00
Three surfaces  $99.00
Four or more surfaces  $135.00
Composite restorations (anterior)
One surface  $95.00
Two surfaces  $115.00
Three surfaces  $135.00
Composite restorations (posterior)
One surface  $120.00
Two surfaces  $145.00
Three surfaces  $160.00
ORAL SURGERY
Alveolectomy (in conjunction w/extractions) (per quadrant)  $175.00
Bone graft  $175.00
Synthetic bone graft (for implants)  $600.00
Extractions
Simple (local anesthesia)  $95.00
Surgical  $155.00
Soft tissue impaction  $225.00
Partially bony impaction  $285.00
Full bony impaction  $335.00
PERIODONTICS (as performed by general practitioner)
Emergency treatment (perio or endo)  $95.00
Peria recall (maintenance)  $155.00
Root planning and subgingival curettage (per quadrant)  $95.00
Gingivectomy (per quadrant) (including post surgical visits)  $385.00
Gingivectomy (per quadrant) (osseous or muco-gingival surgery) (including post surgical visits)  $425.00
Gingivectomy (treatment per tooth) (fewer than six teeth)  $105.00
CROWNS AND BRIDGES (plus lab costs)
Crowns, per unit
Full metal crown (non precious)  $485.00
Full gold crown  $750.00
Stainless steel crown  $170.00
Dowel point  $135.00
Plastic core or amalgam build  $115.00
Pins (each)  $25.00
Porcelain fused to metal  $525.00
Recement crown  $95.00
Recement bridge  $175.00
Replace tomporary crown  $175.00
Captek  $800.00
Lava  $850.00
PROSTHODONTICS
Complete Denture (upper or lower)  $825.00
Partial acrylic upper or lower (with chrome cobalt alloy clasps)  $1,200.00
Teeth and clasps, extra per unit  $65.00
Adjustment (denture or partial) (after 3 months) (per visit)  $55.00
Office reline (cold cure – acryclic)  $105.00
Denture reline (laboratory process)  $195.00
Stayplate (1 tooth)  $425.00
Additional teeth and clasp (per unit)  $75.00
Space mantainer (unilateral)  $275.00
Repair broken denture (no teeth involved)  $105.00
Replace or repair tooth on denture  $95.00
Each tooth (additional)  $55.00
ENDODONTICS
Apicoectomy  $445.00
Sedative filling  $95.00
Pulp capping  $45.00
Base/Liner  $35.00
Pulpotomy (vital)  $95.00
Root Canals
Single canal  $375.00
Two canals  $495.00
Three canals  $575.00
Four canals  $700.00
OTHER CHARGES
After hours emergency (plus procedures)  $350.00
Broken or cancelled appointment (without 24 hr notification)  $35.00
OTHER SERVICES OFFERED
Implants
Grafting (Bone)
Overdentures
“Simply Natural” Dentures & Partials
Cosmetic Whiting & Bleaching
Porcelain Inlays & Onlays
Soft & Hard Tissue Crown Lengthening
  • Low Annual Premiums

    The prepaid annual premiums for this Plan are very reasonable. The yearly premiums are as follows:

    • Individual………………………………………………………………..$69.00
    • Two Family Members……………………………………$99.00
    • Family of Three or More……………………………..$129.00
  • Eligibility

    The Plan is available to all individuals and groups within the approved service area in the state of California. Eligible dependents are husband, wife, and unmarried children to age 19 and full time students to age 26.

  • Coordination of Benefits

    Your Plan benefits can be coordinated with many dental coverages to reduce your “out of pocket” expenses.

  • Binding Arbitration

    In the event of any controversy or dispute between interested parties (which term includes the Subscriber, a Member or Dependent, and the Plan, Agents, Plan Providers, or employees) including disputes which are not adequately resolved by the Plan’s grievance procedures, shall be submitted to binding arbitration. Such arbitration may be initiated by calling the American Arbitration Association and requesting a demand for arbitration. The Arbitrator shall determine which party shall bear the cost of arbitration, including reasonable attorney’s fees.
    The Subscriber, Dependent, or Member and the Plan will follow applicable law with regard to arbitration. California law may require, for a dispute involving $100,000 or less, that the Subscriber, Dependent, or Member and the Plan select a single, neutral arbitration. In that situation, the arbitrator will not have the power to award more than $100,000.

  • Out of Area Dental Benefits

    When a member is more than 50 miles from the plan’s service area, the plan provides for emergency treatment at any dental office of your choice (worldwide) for a scheduled benefit. Maximum annual benefit of $100.00 per individual or family $50.00 per occurrence. For reimbursement the member must file a claim with the plan. The member may call the administrative office at (714) 838-8215 for assistance.

  • Termination

    After the date of termination, the participating dentist will complete any “services in progress.”
    Plan benefits shall terminate as follows:

    1. The date coverage expires, if not renewed
    2. Any monies owed to plan for more than 15 days
    3. A dependent attaining age 19, unless full time student to age 26
  • Renewal

    Plan member agreement will remain in effect for one year from effective date and may be renewed on an annual basis. Members will be mailed a notice of renewal at least 30 days prior to the expiration of their coverage.

  • Exclusions

    Specialist Referrals
    General Anesthesia
    Teeth extracted for orthodontic purposes
    Treatment of Temporomandibular Joint Syndrome (TMJ)
    Any treatment of fractures

  • Limitations

    Prosthodontics (Dentures and Partials): Limited to once every five years and only if appliance can not be made serviceable.

    Relines: not more than twice per year

    Full mouth x-rays: once every three years
    All family members must be assigned to the same dental office

    Some orthodontic services

For more information please contact our office at (626) 856-3317 OR Amerinet Dental Network at (714) 838-8125