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					                                                           WESPORT, CT 06880
                                                           1771 POST ROAD EAST
                                                           NATIONAL DENTAL PLAN, INC.
  Individual $72.00/yearly                                                               National Dental Plan
     Couple                   $120.00/yearly
                                                                                        Better smiles, change lives….
     Family (4)               $145.00/yearly

  Individual $68.00/yearly
     Couple                   $112.00/yearly
     Family (4)               $135.00/yearly
Payments can be made by mail or credit
card, debit card, or online by Pay Pal.
Checks and money orders allow 7 to 10
business days for processing.

National Dental Plan, Inc, is not an insurance company.
It is a discount program. Member is obligated to pay the
dentist directly for any of the services provided to you
but the member will receive a pre-negotiated discount
from the dentist listed as providers in the plan in
accordance with the pre-negotiated discounted fee
schedule. This plan does not make any payments
directly to dental providers or to the members of the
plan. Members have the right to cancel registration
within the first 72 hours of joining at no charge, but
within a total of 30 days from the enrollment day, a
                                                                                        Call: 1-800-241-9252
$39.00 processing fee will apply to the member along
with a charge of $10.00 for each household member if
they are also on the Plan. Memberships are not
“We’ll     keep you smiling!”
                                                     ADA                                           MEMBER        USUAL      ADA                                      MEMBER           USUAL
                                                     CODE     PROCEDURE                               FEE          FEE      CODE PROCEDURE                              FEE             FEE

AFFORDABLE DENTAL CARE                               DIAGNOSTIC & PREVENTIVE PROCEDURES                                      FIXED PROSTHETICS (crowns & bridge)
                                                                                                                            2752/6752-Crown Porcelain Noble Metal        725.00      1,028.00
Now you can afford the dental care that you          9310-Consult (and/or second opinion & estimate) FREE          $80.00   2751/6751-Crown Porcelain Base Metal         635.00        921.00
                                                     0220-Two X-rays (any type)                          FREE       46.00   6242-Pontic-Porcelain Noble Metal            750.00      1080.00
always wanted. National Dental Plan offers its       0210-Full mouth X-rays (minimum 4 films)           $56.00     128.00   6241-Pontic-Porcelain Base Metal             660.00        983.00
members access to a complete general and             0330-Panorex                                       63.00     122.00    2791-Full Meta Crown                         595.00        825.00
specialty network of doctors.                        0150-Oral Exam & Diagnosis *                       FREE        68.00   2954-Prefabricated Post                      160.00        338.00
                                                     0120- Pallitive Treatment (Emrg. treatment of pain) 57.00      92.00   2952-Post made in Lab (non-gold)             240.00        433.00
In order to keep up with inflation, a patient        1110-Prophy-Adult                                   62.00      88.00   2950-Core Buildup w/pins                     145.00        249.00
would need at least $6,000. of dental insurance      1120-Prophy-Child                                   48.00      78.00   2920-Recement Crown                           48.00         77.00
                                                     1203-Topical Flouride-Child                         24.00      35.00   REMOVAL PORSTHETICS
each year. The cost of this would be very            1351-Sealants (per tooth)                                      40.00   5110-20 Full Upper or Lower Denture made
expensive. Because this is not insurance, the        TOOTH COLORED FILLINGS FRONT TEETH                                              with Plastic Teeth (each denture) 895.00        1,510.00
cost is less and there is no annual maximum          2330-1 Surface                                      89.00    133.00    5211-2 Upper or Lower Acrylic Partials       675.00      1,137.00
                                                     2331-2 Surface                                     104.00    167.00    5213-4 Partials metal frame & resin base    925.00       1,200.00
and no waiting period.                               2332-3 Surface                                     116.00    205.00    5130-40 Immediate Full Denture             1,150.00      1,785.00
                                                     2335 4 Surfaces or more                            144.00    255.00    5730-31-Full Relines,Chairside (each)        228.00        379.00
                                                     TOOTH COLORED FILLINGS POSTERIOR TEETH                                 5510-Repair Broken ,Denture                  110.00        198.00
HOW THE PLAN WORKS                                   2391-1 Surface                                               147.00    5520-Replace Tooth,Denture                    90.00        154.00
                                                     2392-2 Surface                                     129.00    195.00    9940-Occlusal guard                          345.00        628.00
After an application is sent to us it is processed   2393-3 Surface                                     150.00    242.00
                                                                                                                                 Denture fees listed above are for each denture.
                                                     2394-4 Surface                                     191.00    289.00
within 5 to 7 business days and a membership         2940-Sedative Filling                                         95.00         Consult with dentist for additional fees that may apply
                                                                                                                                  based upon their increased lab costs.
card is sent to you. You call us after choosing a    COMSETIC PROCEDURES
                                                     2960-Tooth Veneer (CHARDSIDE)                      395.00     540.00        All general dentistry fees for the procedures not listed
participating dental office, then you make an        2962-Porcelain Veneer (lab)                                 1,041.00         on this schedule are subject to at least a 20%
appointment, and the dental office will charge       9999A-Cosmetic Whitening (Chairside By Light)                                discount.
                                                                                                                                 Dentist may charge for nitrous oxide.
you a reduced fee according to the fee schedule      Full Mouth                                         399.00    700.00
                                                     9999A- Whitening with trays                        350.00    650.00         Dentist may charge for copying x-rays for members.
Your first visit for a consult or second opinion     ROOT CANALS                                                                 It is at the dentist’s discretion to whether or not to co-
and x-rays is FREE as a Plan member. This            3110-Pulp Cap-Direct                                50.00     75.00          ordinate benefits with another dental plan or
                                                     3120-Pulp Cap-Indirect                              47.00     75.00          insurance.
value alone more than pays for the annual cost
                                                     3220-Pulpotomy                                      88.00    179.00         Member is responsible for confirming that the dentist
of membership! Your savings on dental care           3310-Root Canal Anterior                           400.00    687.00          is active participant in the Plan at the time member
can be more than 50%. You may save even              3320-Root Canal Bicuspid                           560.00    801.00          calls for an appointment.
                                                     3330-Root Canal Molar                              720.00    975.00         All specialty fees are discounted 20% of the specialists
more money by combing this Plan with                 PERIODONTICS (GUMS)                                                          normal office fee. No charge for consult & 2 x-rays.
another plan or dental insurance.                    4341-Scaling and Root Planing (each Quadrent)      134.00    225.00
       USUAL FEE is the average current rate        4355-Full Mouth Debrisment                         100.00    173.00         NATIONAL DENTAL PLAN.INC.
        dentists charge NON-PLAN members             4910-Perio Maintenance                              88.00    150.00                         1771 Post Road East
                                                     ORAL SURGERY
        based on an NDPI survey in the               6010-Impalnt Surgically Placed                   1,350.00   1,950.00
                                                                                                                                                 Westport, CT 06880
        geographical area of the Plan.               7110-Simple Extractions                             86.00     146.00
       MEMBER FEE is the discounted Plan fee        7210-Surgical Extraction                           150.00     248.00            133 E. 58th St, #1204, NY, NY 10022
                                                     7510-Incision & Drainage                           115.00     227.00
        the member pays directly to the dentist.     7250-Root Removal                                             282.00
       General dentistry fees apply only to fees    7310-Alveoplasty (per Quadrant)                    127.00     268.00                 3032 E. Commercial Blvd.
        charged by Plan General Dentists, not                                                                                               Ft. Lauderdale, FL 33308
                                                                                                                                               Call (888) 241-9252