COMPARE OUR FEES   AMERICAN DENTAL PLAN FEES(1) PREVAILING FEES(2) PREVENTIVE DENTAL CARE Examination (2 per year)(3) No Charge (Per Exam) $ 85.00 Treatment Planning (2 per year)(3) No Charge No Data Available X-Rays-Up to Full Series (1 per year)(3) No Charge $ 115.00 Cleaning-Prophylaxis (1 per year)(3) No Charge $ 90.00 Fluoride Treatment for children (1 per year)(3) No Charge $ 40.00 CORRECTIVE DENTAL SERVICES Scaling (Per Arch) $ 35.00 $ 215.00 Filling: (Amalgam or Composite) AMALGAM COMPOSITE AMALGAM COMPOSITE 1 Surface $40.00 $45.00 $90.00 $120.00 2 Surfaces $55.00 $60.00 $120.00 $160.00 3 Surfaces $65.00 $70.00 $150.00 $200.00 ORAL SURGERY (Local Anesthesia Only) Simple Extraction $ 55.00 $ 145.00 Surgical Extraction $ 80.00 $ 285.00 Soft Tissue Impaction $ 160.00 $ 310.00 Partial Bony Impaction $ 185.00 $ 395.00 Full Bony Impaction $ 225.00 $ 510.00 ROOT CANAL THERAPY Pulp Capping $ 20.00 $ 85.00 Pulpotomy $ 50.00 $ 170.00 RCT -1 Canal $ 250.00 $ 585.00 RCT -2 Canals $ 295.00 $ 680.00 RCT -3 Canals $ 395.00 $ 845.00 PERIODONTICS (Per Quad) Gingivectomy $ 125.00 $ 510.00 Gingival Curretage $ 50.00 $ 255.00 Osseous Surgery $ 450.00 $ 910.00 REMOVABLE PROSTHETICS & REPAIRS Full Upper or Lower Denture $ 450.00 $ 1,420.00/1,445.00 Partial Upper or Lower Denture $ 450.00 $ 1,445.00/1,420.00 Repair Body of Denture $ 60.00 $ 200.00 Add A Tooth To A Denture $ 40.00 $ 170.00 Add New Clasp to a Partial $ 65.00 $ 215.00 Denture Reline $ 125.00 $ 395.00 CROWN AND BRIDGE Porcelain Fused to Metal Crown/Abutment,Pontic $ 475.00 $ 965.00/965.00 Cast Post & Core $ 100.00 $ 370.00 ORTHODONTIA Insertion of Bands and/or Appliance Monthly Adjustment Active and Passive (per month) $ 850.00 $ 100.00 $1,1510 $ 150.00 COSMETIC DENTISTRY In Office Full Mouth Teeth Whitening $ 225.00 No Data Available Laminates (per tooth) $ 475.00 $ 850.00 Cosmetic Bleaching (per arch Home Kit) $ 150.00 No Data Available OTHER TREATMENTS Special Consultation $ 25.00 No Data Avaliable Emergency Palliative Treatment $ 30.00 $ 95.00 Broken Appointment $ 25.00 No Data Available (1) The fees stated above must be paid at the time services are rendered. Any services not paid for at that time will be billed at prevailing fees. (2) Based upon National Dental Survey Trended Forward to year 2002, 90th Percentile (3) Valid for 1 year from date on membership card. This offer may not be combined with any other American Dental Centers discount programs. This is a limited time offer and may be subject to change. Not responsible for typographical errors or omissions. Plan offer expires 12/31/2008. This is not an insurance product. 35 Broadway, Hicksville, NY 11801-4266 - Toll Free: 1-800-44-SMILE - email: join@americandental.com