COSMETIC PROCEDURESSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Cosmetic Bonding (per tooth) 340 425Porcelain Veneer (laminate) 600 750Procera Veneer (laminate) 900 1200Elite Bleaching 800 1095Zoom Bleaching (inc/ custom trays and 1 kit of bleach) 650 795Bleaching Trays (inc/ 1 kit of bleach) 370 495Bleaching Touch Up Kit 75 95

ANESTHESIASERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Local Anesthesia n/c n/cNitrous Oxide Per Visit 75 100Oral Sedation Per Visit 350 500IV Sedation 1st 30 minutes (Oral Surgeon) 200 300IV Sedation add 15 minutes (Oral Surgeon) 100 150

699 Middle Country RoadMiddle Island, NY 11953

1-800-PLAN-TDCwww.totaldentalcare.com

Plan Highlights:

• 24-HOUR EMERgENCY SERVICE

• 2 FREE CLEANINgS, ExAMS AND xRAYS PER YEAR

• IMPLANTS AND COSMETIC SERVICES

• ORAL SEDATION AND IV SEDATION

• TEETH WHITENINg

• NO ADDITIONAL LAb FEES

• NO HIDDEN SPECIALIST FEES

• ALL SERVICES AT THE ADVERTISED RATE

• UP TO 60% SAVINgS ON ALL PROCEDURES

2011 Fee Schedule

TDC DENTAL PLAN

FIxED PROSTHODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Crowns (per tooth) Crown- Porcelain & Noble Metal 650 1200Crown-CAPTEK (porcelain w/gold liner) 750 1300Crown-PROCERA (all ceramic) 850 1400Crown-LAVA (zirconia) 950 1500bridges (per tooth) Bridge- Porcelain & Noble Metal 650 1200Bridge- CAPTEK (porcelain w/gold liner) 750 1300Bridge- PROCERA (all ceramic) 850 1400Bridge- LAVA (zirconia) 950 1500Other Prefab Post & Core 250 300Cast Post & Core 310 425Core Build Up 185 235Lab Processed Temporary (per tooth) 210 270Recement Crown/Bridge (per tooth) 35 50Remove Crown/Bridge 85 150Post Removal 185 250

REMOVEAbLE PROSTHODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Complete Denture (per arch) 850 1260Simply Natural Denture (per arch) 1150 1500Partial Denture (per arch) 975 1350Valplast Partial Denture (per arch) 1250 1500Temporary Denture (single tooth) 375 550Immediate Denture (per arch) 850 1260Repairs Denture Adjustments n/c n/cAdd/Repair tooth -existing partial denture 120 150Add/Repair clasp -exisiting partial denture 130 175Reline Denture 225 325Repair Acrylic 130 160

ENDODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Direct/Indirect Pulp Cap 65 100Pulpotomy 85 100Anterior Root Canal* 350 500Bicuspid Root Canal* 575 725Molar Root Canal* 785 950* Initial Root Canal Therapy Only- Retreats not included

PEDIATRICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Pulpotomy 85 100Mineral Trioxide Aggregate (MTA) 250 325

Stainless Steel Crown 125 175Composite Crown 180 200

PERIODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Consultation w/ Periodontist 65 80Full Mouth Debridement 100 130Scaling & Root Planning (per quadrant) 110 130Irrigation w/medication 10 25Osseous Surgery (per quadrant) 585 775Bone Graft 1st site 250 325Bone Graft each add site 125 200Soft Tissue Graft 375 500Gingivectomy (per tooth) 200 250Gingivectomy (per quadrant) 420 445Crown Lengthening 475 550Periodontal Maintenance* 95 130Periodontal Laser Program 1200 1500

* following active therapy- 1 visit every 3 months is routine for this procedure. Every other visit n/c as long as d.o.s is 90-110 days from last perio maint appt.

ORAL SURgERYSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Consultation w/Oral Surgeon 55 75Simple Extraction 125 160Surgical Extraction 175 250Soft Tissue Impaction 220 275Partial Bony Impaction 300 375Full Bony Impaction 375 450Full Bony Complicated 425 500Alveoplasty w/extraction 185 210Alveoplasty w/out extraction 285 315Apictoectomy - Anterior 375 625Apicoectomy - Bicuspid 410 685Apicoectomy - Molar 500 820Apicoectomy each addt’l root 150 260Retrograde Fill (per root) 135 210Cyst Removal 100 210Hemisection 130 155

IMPLANT SERVICESSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Endosteal Implant 1200 1500Mini Implant 499 600Custom Abutment 650 850Crown-Porcelain-Noble Metal Implant Supp 950 1350Bridge-Porcelain-Noble Metal Implant Supp 950 1350Overdenture 3150 3900Hader Bar 2000 2550Semi Precision Attachment (each) 520 650

DIAgNOSTICSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Consultation (no xrays) n/c 45Comprehensive Exam n/c 65Emergency Exam 40 80Palliative Treatment 25 45Periodic Exam (recall) n/c 50Diagnostic Casts 50 80Oral/Facial Photographic Images 20 45Full Mouth Xrays n/c 80Panorex n/c 65DentScan (per arch) 275 350Oral Cancer Testing 35 65Caries Susceptibilty Testing 15 25Saliva Testing 35 50Periapical Xray 1st Film n/c 20Pericapical Xray each additional n/c 10Bitewing Xray single film n/c 15Bitewing Xrays 2films n/c 20Bitewing Xrays 4 films n/c 35

PREVENTIVESERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Child Cleaning & Polish n/c 45Adult Cleaning & Polish* n/c 80Topical Fluoride Treatment-child 30 40Topical Fluoride Treatment-adult 35 45Sealant (per tooth) 30 40Space Maintainer Unilateral 200 250Space Maintainer Bilateral 325 450Nightguard 375 525Occlusal Guard 300 450

* More involved cleanings see periodontics 1 routine cleaning covered per member in a 6 month period

RESTORATIVESERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Amalgam (silver) Fillings 1 Surface n/a n/a2 Surface n/a n/a3 Surface n/a n/aComposite (white) Fillings Anterior (front) 1 Surface 100 1552 Surface 130 1853 Surface 155 210Posterior (back) 1 Surface 130 1852 Surface 155 2103 Surface 220 2754 Surface 255 310Sedative Filling 35 45

FIXED PROSTHODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Crowns (per tooth) Crown- Porcelain & Noble Metal 650 1200Crown-CAPTEK (porcelain w/gold liner) 750 1300Crown-PROCERA (all ceramic) 850 1400Crown-LAVA (zirconia) 950 1500Bridges (per tooth) Bridge- Porcelain & Noble Metal 650 1200Bridge- CAPTEK (porcelain w/gold liner) 750 1300Bridge- PROCERA (all ceramic) 850 1400Bridge- LAVA (zirconia) 950 1500Other Prefab Post & Core 250 300Cast Post & Core 310 425Core Build Up 185 235Lab Processed Temporary (per tooth) 210 270Recement Crown/Bridge (per tooth) 35 50Remove Crown/Bridge 85 150Post Removal 185 250

REMOVEABLE PROSTHODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Complete Denture (per arch) 850 1260Simply Natural Denture (per arch) 1150 1500Partial Denture (per arch) 975 1350Valplast Partial Denture (per arch) 1250 1500Temporary Denture (single tooth) 375 550Immediate Denture (per arch) 850 1260Repairs Denture Adjustments n/c n/cAdd/Repair tooth -existing partial denture 120 150Add/Repair clasp -exisiting partial denture 130 175Reline Denture 225 325Repair Acrylic 130 160

ENDODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Direct/Indirect Pulp Cap 65 100Pulpotomy 85 100Anterior Root Canal* 350 500Bicuspid Root Canal* 575 725Molar Root Canal* 785 950* Initial Root Canal Therapy Only- Retreats not included

PEDIATRICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Pulpotomy 85 100Mineral Trioxide Aggregate (MTA) 250 325

Stainless Steel Crown 125 175Composite Crown 180 200

PERIODONTICSSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Consultation w/ Periodontist 65 80Full Mouth Debridement 100 130Scaling & Root Planning (per quadrant) 110 130Irrigation w/medication 10 25Osseous Surgery (per quadrant) 585 775Bone Graft 1st site 250 325Bone Graft each add site 125 200Soft Tissue Graft 375 500Gingivectomy (per tooth) 200 250Gingivectomy (per quadrant) 420 445Crown Lengthening 475 550Periodontal Maintenance* 95 130Periodontal Laser Program 1200 1500

* following active therapy- 1 visit every 3 months is routine for this procedure. Every other visit n/c as long as d.o.s is 90-110 days from last perio maint appt.

ORAL SURGERYSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Consultation w/Oral Surgeon 55 75Simple Extraction 125 160Surgical Extraction 175 250Soft Tissue Impaction 220 275Partial Bony Impaction 300 375Full Bony Impaction 375 450Full Bony Complicated 425 500Alveoplasty w/extraction 185 210Alveoplasty w/out extraction 285 315Apictoectomy - Anterior 375 625Apicoectomy - Bicuspid 410 685Apicoectomy - Molar 500 820Apicoectomy each addt’l root 150 260Retrograde Fill (per root) 135 210Cyst Removal 100 210Hemisection 130 155

IMPLANT SERVICESSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Endosteal Implant 1200 1500Mini Implant 499 600Custom Abutment 650 850Crown-Porcelain-Noble Metal Implant Supp 950 1350Bridge-Porcelain-Noble Metal Implant Supp 950 1350Overdenture 3150 3900Hader Bar 2000 2550Semi Precision Attachment (each) 520 650

DIAGNOSTICSERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Consultation (no xrays) n/c 45Comprehensive Exam n/c 65Emergency Exam 40 80Palliative Treatment 25 45Periodic Exam (recall) n/c 50Diagnostic Casts 50 80Oral/Facial Photographic Images 20 45Full Mouth Xrays n/c 80Panorex n/c 65DentScan (per arch) 275 350Oral Cancer Testing 35 65Caries Susceptibilty Testing 15 25Saliva Testing 35 50Periapical Xray 1st Film n/c 20Pericapical Xray each additional n/c 10Bitewing Xray single film n/c 15Bitewing Xrays 2films n/c 20Bitewing Xrays 4 films n/c 35

PREVENTIVESERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Child Cleaning & Polish n/c 45Adult Cleaning & Polish* n/c 80Topical Fluoride Treatment-child 30 40Topical Fluoride Treatment-adult 35 45Sealant (per tooth) 30 40Space Maintainer Unilateral 200 250Space Maintainer Bilateral 325 450Nightguard 375 525Occlusal Guard 300 450

* More involved cleanings see periodontics 1 routine cleaning covered per member in a 6 month period

RESTORATIVESERVICE

DESCRIPTIONTDC

PLANTDC

PRIVATE

Amalgam (silver) Fillings 1 Surface n/a n/a2 Surface n/a n/a3 Surface n/a n/aComposite (white) Fillings Anterior (front) 1 Surface 100 1552 Surface 130 1853 Surface 155 210Posterior (back) 1 Surface 130 1852 Surface 155 2103 Surface 220 2754 Surface 255 310Sedative Filling 35 45