The Senior CA50 Plan Is Our
Premier HMO Plan

(Primary Applicant Must be 65 and Provide Faxed Proof of Age)

 

The most comprehensive coverage of all our Individual Plans. Should you be faced with major dental care needs, you can be assured , you’ll have the very best coverage we have to offer. There are no monthly premium payments and no waiting periods for any covered procedure. The CA50 has the lowest copayments of all three plans. You must choose your Primary Care Dentist and you must notify Liberty Dental if you need to change your dentist.

Partial List of Procedures	With Dental Plan CA50 Plan You Pay the Dentist A Co-Pay		What a Dentist Will Charge Without Insurance*
Exam	You pay the dentist $0		$81
X-Rays	You pay the dentist $0		$119
Cleaning (Prophylaxis) 2 per year	You pay the dentist $9		$75
Filling (1 Surface on One Tooth)	You pay the dentist $11		$90
Deep Cleaning (Periodontal Scaling)	You pay the dentist $50 (Per Quad)		$200
Porcelain Crown (Molar Teeth)	You pay the dentist $445		$800 to $1,070
Root Canal (Bicuspid Tooth)	You pay the dentist $120		$952
Orthodontics (Start-Up Fees)	You pay the dentist $175		$350
Dentures (Full Upper)	You pay the dentist $250		$1,451
Extractions (Erupted Tooth)	You pay the dentist $25		$254

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For Complete Coverage and
Detailed Co-Payment Schedule