Wisconsin Dental Plan

/Wisconsin Dental Plan
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Wisconsin Dental Plan

$36.50 includes 1st month and $20.00
processing fee

Applying online is easy and takes just a few minutes. Applying online is safe and secure, or you can choose to print the application and mail it to us. Either way you have our promise that we will activate your membership immediately after we receive your completed application and payment.

ATTENTION!: Please check here to see if a dentist participates within your area before enrolling.

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Avia Dental Plan® — Annual Payment Options

Individual

$9900annual*

Individual +1

$14400annual*

Family (3 or More)

$15900**annual*

*Annual payment does not include the $20 Processing Fee.

Avia Dental Plan® — Monthly Payment Options

Individual

$825monthly

Individual +1

$1200monthly

Family (3 or More)

$1325monthly

*Initial Payment includes the $20 Processing Fee plus the first month of membership fees.

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Plan 103 AVIA SCHEDULE OF DENTAL SERVICES | Effective January 1, 2015 | THIS IS NOT AN INSURANCE PLAN | All procedures performed by General Dentists.


Procedure

National Average Fee

Avia Members Pay

DIAGNOSTIC
Periodic Oral Exam $57.00 $15.00
Limited Oral Exam-problem focused $85.00 $18.00
Comprehensive Oral Exam $100.00 $18.00
Full Mouth X-rays Intraoral-complete series, including bitewing $148.00 $45.00
Intraoral-periapical-first film $33.00 $12.00
Intraoral-periapical-each additional film $28.00 $8.00
Bitewing X-ray (single film) $32.00 $12.00
Bitewing X-rays-two films $50.00 $15.00
Bitewing X-rays-three films $61.00 $20.00
Bitewing X-rays-four films $73.00 $24.00
Panoramic X-ray $126.00 $45.00
Diagnostic casts $132.00 $35.00
PREVENTIVE    
Prophy-Adult Cleaning (includes scaling and polishing) $103.00 $35.00
Prophy- Child Cleaning (includes scaling & polishing) $75.00 $28.00
Fluoride Treatment $43.00 $18.00
Oral hygiene instructions $61.00 $8.00
Sealant- per tooth $63.00 $25.00
SPACE MAINTENANCE    
Space maintainer-fixed-unilateral $350.00 $120.00
Space maintainer-fixed-bilateral $473.00 $150.00
Space maintainer-removeable-unilateral $424.00 $130.00
Space maintainer-removeable-bilateral $527.00 $165.00
RESTORATIVE    
Amalgam-one surface, primary or permanent $165.00 $48.00
Amalgam-two surface, primary or permanent $210.00 $61.00
Amalgam-three surface, primary or permanent $256.00 $72.00
Amalgam-four or more surfaces, primary or permanent $300.00 $85.00
Resin-one surface-anterior $190.00 $58.00
Resin-two surface-anterior $232.00 $72.00
Resin -three surface-anterior $285.00 $92.00
Resin-four or more surface-anterior $351.00 $115.00
Resin/composite-one surface-posterior $204.00 $78.00
Resin/composite-two surface-posterior $261.00 $100.00
Resin/composite-three surface-posterior $324.00 $120.00
Resin/composite-four or more surface-posterior $394.00 $150.00
Crown-resin with high noble metal $1,221.00 $470.00
Crown-porcelain fused to high noble metal $1,270.00 $550.00
Crown-porcelain fused to predominantly base metal $1,182.00 $515.00
Crown-porcelain fused to noble metal $1,208.00 $545.00
Crown-full cast high noble metal $1,298.00 $560.00
Recement Crown $127.00 $40.00
Crown-prefabricated stainless steel, primary $300.00 $105.00
Crown-prefabricated stainless steel, permanent $360.00 $128.00
Sedative filling $136.00 $40.00
Core buildup, including pins $305.00 $110.00
Cast post and core, in addition to crown $475.00 $165.00
Prefabricated post and core in addition to crown $380.00 $135.00
ENDODONTICS    
Pulp cap-direct (excluding final restoration) $95.00 $25.00
Pulp cap-indirect(excluding final restoration) $94.00 $25.00
Therapeutic pulpotomy (excluding final restoration) $227.00 $63.00
Anterior Root Canal (excluding final restoration) $850.00 $320.00
Bicuspid Root Canal (excluding final restoration) $964.00 $380.00
Molar Root Canal (excluding final restoration) $1,169.00 $490.00
PERIODONTICS    
Gingivectomy or gingivoplasty-per quad $725.00 $315.00
Gingivectomy or gingivoplasty-per tooth $355.00 $100.00
Osseous surgery (including flap entry & closure) per quad $1,237.00 $510.00
Periodontal scaling & Root planing-per quad $285.00 $110.00
Full mouth debridement $202.00 $75.00
Periodontal maintenance procedures $156.00 $65.00
PROSTHODONTICS    
Complete denture-Maxillary $1,969.00 $690.00
Complete denture Mandibular $1,984.00 $690.00
Immediate Denture-Maxillary $2,077.00 $715.00
Immediate denture- Mandibular $2,100.00 $715.00
Partial denture-Maxillary-resin base $1,536.00 $615.00
Partial denture -Mandibular- resin base $1,534.00 $615.00
Partial denture-Maxillary-cast metal framework with resin denture base $2,018.00 $775.00
Partial denture-Mandibular-cast metal framework with resin denture base $2,024.00 $775.00
(all of the above includes conventional clasps, rests and teeth)    
Adjust complete denture-Maxillary $100.00 $35.00
Adjust complete denture-Mandibular $99.00 $35.00
Repair broken complete denture base $246.00 $63.00
Replace missing or broken teeth (each tooth) $217.00 $58.00
Add tooth to existing partial denture $259.00 $68.00
Add clasp to existing partial denture $303.00 $80.00
Reline complete Maxillary denture (chairside) $420.00 $145.00
Reline complete Mandibular denture (chairside) $417.00 $145.00
Reline partial Maxillary denture (chairside) $405.00 $145.00
Reline partial Mandibular denture (chairside) $411.00 $145.00
Reline complete Maxillary denture (lab) $525.00 $190.00
Reline complete Mandibular denture (lab) $525.00 $190.00
Reline partial Maxillary denture (lab) $520.00 $185.00
Reline partial Mandibular denture (lab) $524.00 $185.00
Pontic-cast high noble metal $1,251.00 $495.00
Pontic-porcelain fused to high noble metal $1,250.00 $495.00
Pontic-porcelain fused to predominantly base metal $1,185.00 $455.00
Crown-porcelain fused to high noble metal $1,271.00 $510.00
Crown-porcelain fused to predominantly base metal $1,163.00 $465.00
Crown-full cast high noble metal $1,275.00 $510.00
ORAL AND MAXILLOFACIAL SURGERY    
Extraction- single tooth-erupted tooth or exposed root $200.00 $60.00
Surgical Removal of erupted tooth $310.00 $115.00
Removal of impacted tooth, soft tissue $350.00 $125.00
Removal of impacted tooth, partially bony $439.00 $165.00
Removal of impacted tooth, completely bony $531.00 $225.00
Surgical Removal of residual tooth roots (cutting procedure) $349.00 $125.00
Alveolplasty- in conjunction with extractions (per quad) $336.00 $105.00
Alveolplasty- not in conjunction with extractions (per quad) $500.00 $155.00
Incision and drainage of abscess-Intraoral soft tissue $271.00 $75.00
ORTHODONTICS    
Comprehensive Orthodontic treatment of the transitional dentition $5,622.00 20% off normal fees   
Comprehensive Orthodontic treatment of the adolescent dentition $5,800.00 20% off normal fees   
Comprehensive Orthodontic treatment of the adult dentition $5,841.00 20% off normal fees   
GENERAL    
Pallative (emergency) treatment $145.00 $40.00
Local Anesthesia $85.00 $15.00
Analgesia $90.00 $27.00
Broken appointment (without notice) $50.00 $25.00
*These are typical fees based on the 80th percentile of the National Dental Advisory Service Fee Report for 2014. Member is responsible for all charges at the time of service. This entire fee schedule is for participating Avia Dental General Dentists only. Cosmetic and any other procedures not listed are 20% off the provider’s normal fee. Some fees may vary where unusual services and/ or materials are required. Please discuss all fees with dentist prior to treatment. Lab fees are additional. Fees schedules are subject to change without prior notice to members. Be sure to verify that a dentist is a participating Avia provider before seeking treatment. Avia cannot guarantee the continued participation of any dentist. If dentist leaves plan, you will need to select another participating provider. Any dental procedures performed by a non participating dentist are charged dentist’s normal fees. Not all types of dentists may be available in your area. Avia does not guarantee the quality of service of the providers.
Participating Specialists do not charge according to this fee schedule. Avia Members receiving treatment from any participating specialists including Oral surgeons, Orthodontists, Periodontists, Pediatrics, Pedodontists, Prosthodontists and Endodontists will receive a 20% discount off their normal fees.
THIS IS NOT AN INSURANCE PLAN

Prescription Drug Discount Program

Membership in the Avia Dental Plan® also entitles you to all the benefits of our discount prescription drug program . You enjoy special discounts on prescription drugs plus extra savings on select medications for common health conditions as well as high tech and injectable drugs. What’s more, you can use your drug card any time your prescription is not covered by your other plan.

With the cost of prescription drugs rising, now’s the time to discover the advantages of an affordable discount prescription plan.


With the Avia Dental, Prescription Drug Discount Program, you benefit from:

  • Average savings of 20% and even more on generic drugs
  • Access to over 59,000 participating pharmacies nationwide including most major chains
  • Unlimited use
  • No restrictions
  • No claim forms to complete
  • Extra savings when you use our mail order program


Click here to search for participating Pharmacies
  |  Click here to Check Drug Cost


 

Discounts not available from Illinois Providers

This is NOT insurance. Discounts are only available at participating pharmacies. By using this card, you agree to pay the entire prescription cost less any applicable discount. Savings may vary by drug and by pharmacy. Savings are based on actual 2013 drug purchases for all drug discount card programs administered by CVS Caremark located in Woonsocket, RI. The program administrator may obtain fees or rebates from manufacturers and/or pharmacies based on your prescription drug purchases. These fees or rebates may be retained by the program administrator or shared with you and/or your pharmacy. Prescription claims through this program will not be eligible for reimbursement through Medicaid, Medicare or any other government program. This program does not guarantee the quality of the services or products offered by individual providers. We do not sell your personal information. Call the member toll-free number on the back of your ID card to file a complaint related to this program. Note to Texas Consumers: You may contact the Texas Department of Insurance if you remain dissatisfied after completing this program’s complaint process.

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Avia Vision Plan

Enjoy savings off the retail price of eyeglass frames and lenses, contact lenses and eye exams from more than 30,000 providers nationwide at leading optical retailers such as Pearle Vision, LensCrafters, Sears Optical, Target Optical, JCPenney Optical and many more including access to independent Optometrists, Ophthalmologists, and Opticians. Also receive 15% off the retail price or 5% off the promotional price of LASIK or PRK procedures.


Sample Vision Savings

Vision Care Services

Member Cost

Exam with Dilation as Necessary $5 off routine exam
$10 off contact lens exam
Complete Pair of Glasses Purchase*: frame, lenses and lens options must be purchased in the same transaction to receive full discount.
Standard Plastic Lenses:
Single Vision $50
Bifocal $70
Trifocal $105
Frames: 35% off retail price
Any frame available at provider location
Lens Options:
UV Coating $15
Tint (Solid and Gradient) $15
Standard Scratch-Resistance $15
Standard Polycarbonate $40
Standard Progressive(Add-on to Bifocal) $65
Standard Anti-Reflective Coating $45
Other Add-Ons and Services 20% discount
Contact Lens: 15% off retail price
(Discount applied to materials only)
Conventional
Laser Vision Correction**:  15% off retail price – or –
Lasik or PRK 5% off promotional price
Frequency:
Examination Unlimited
Frame Unlimited
Lenses Unlimited
Contact Lenses Unlimited

For additional information or to locate a provider please visit www.eyemedvisioncare.com or call member services at 1-866-723-0391. Be sure to reference your group # located on your membership card. Items purchased separately will be discounted 20% off of the retail price. Discounts not available from Illinois Providers.


 

THIS IS NOT INSURANCE

**Since Lasik or PRK vision correction is an elective procedure, performed by specially trained providers, this discount may not always be available from a provider in your immediate location. For a location near you and the discount authorization, please call l-877-5LASER6. Member will receive a 20% discount on those items purchased at participating Providers that are not specifically covered by this Discount design. The 20% discount may not be combined with any other discounts or promotional offers, and the discount does not apply to EyeMed Provider’s professional services, or contact lenses. Retail prices may vary by location.

LIMITATIONS/ EXCLUSIONS:

  • Orthoptic or vision training, subnormal vision aids, and any associated supplemental testing, Medical and/or surgical treatment of the eye, eyes, or supporting structures
  • Corrective eyewear required by an employer as a condition of employment, and safety eyewear unless specifically covered under plan
  • Services provided as a result of any Worker’s Compensation law
  • Discount is not available on those frames where the manufacturer prohibits a discount

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Product Description

Affordable Dentistry in Wisconsin with Avia Dental Plan®

If you live in Wisconsin and need help with dental costs, Avia Dental Plan® can help. We have more than 40,000 qualified dental benefit providers in 29 states and all will save you 50% or more on:

  • Exams
  • Cleaning
  • Braces
  • Cosmetic
  • Implants
  • Dentures
  • and other procedures

All these savings for a low monthly fee or one annual payment. Our dental discount plans are available to everyone whether a family, individual, senior citizen, or group. We also guarantee acceptance. Avia Dental Plan® has no waiting period and no limit to the number of dental visits you can make per year. All you need to do is show your card at your appointment and you receive the discount. In addition to substantial savings on dental costs, with most of our plans you also get prescriptions and vision discounts free of charge.

Now is the time to take control of your dental health and get low cost dental work with Avia Dental Plan® in Wisconsin.