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The Liberty Program of America


Coverage Information


» How It Works
» Fees and Rates
» General Practitioners Fees



How It Works

The Liberty Program of America offers big savings on dental health care. You can save 40-60% on your dental treatment!

Here's how the program works. A small annual fee is charged for membership into the Program. In return, you have access to a network of dentists in your area who participate with the program. Once in the program, you are entitled to heavily discounted fees. The discounted fees are listed in the fee schedule and can be up to 50% off from what you would pay without insurance. Almost every dental procedure is covered, so imagine never paying full price for dental treatment again. General dentists as well as dental specialists participate with the program, so it is unlikely that you would ever need a procedure that would not be covered. From cosmetic dentistry to dental implants, we offer discounted dental coverage to our members. If in the unlikely event that a procedure is not covered, participating providers have agreed to give a 25% discount off of their traditional fees. Below is a comparison of traditional fees for some common procedures:





PROCEDURE





TRADITIONAL FEE





LIBERTY PROGRAM





SAVINGS





Full mouth x-ray























Comprehensive Exam





$270.00





$125.00





$145.00





Comprehensive Exam























Cleaning and polishing























Fillings: Silver/White























1 Surface





$110/$135





$65/$85





$45/$50





2 Surface





$130/$145





$80/$100





$50/$45





Porcelain crown





$980.00





$775.00





$205.00





Root Canal (molar)





$920.00





$675.00





$245.00






General Practitioner Fees with The Liberty Program of America.


Diagnostic Services (Initial Visit)

D0150 Comprehensive Oral Exam $25.00
D0120 Periodic Oral Exam $25.00
D0210 Intraoral Complete Series of x-rays $50.00
D0330 Panoramic x-ray $50.00
D0220 Intraoralx-ray film, first No Charge*
D0230 Intraoral x-ray film, add'l No Charge*
D0272 Bitewing x-rays, two No Charge*
D0274 Bitewing x-rays, four No Charge*
D1110 Cleaning and polishing $50.00
D9999 Oral cancer screening No Charge*


Diagnostic Services (After Initial Visit)

D0120 Periodic Oral Exam $35.00
D0140 Focused Oral Exam $35.00
D0210 Intraoral Complete Series of x-rays $50.00
D0220 Intraoral x-ray film, first $8.00
D0230 Intraoral x-ray film, add'l $4.00
D0272 Bitewing x-ray single $8.00
D0272 Bitewing x-ray second $16.00
D0274 Bitewing x-rays, four $25.00
D0330 Panoramic film $50.00
D9998 Sterile Pack (each visit) $5.00


Preventative Services

D1110 Prophylaxis-adult (polishing & cleaning) $50.00
D1120 Prophylaxis-child to age 16 $30.00
D1203 Topical Application of fluoride (including prophylaxis-child) $40.00
D1351 Sealant-per tooth $20.00
D1550 Recement space maintainer $20.00
D151 Space Maintainer-fixed unilateral $145.00
D1515 Space Maintainer-fixed bilateral $185.00


Restorative Procedures

D2140 Amalgam-1 surface, permanent or primary $65.00
D2150 Amalgam-2 surface, permanent or primary $80.00
D2160 Amalgam-3 surface, permanent or primary $95.00
D2161 Amalgam-4 surface, permanent or primary $125.00
D2330 Resin-1surface, anterior $85.00
D2331 Resin-2 surface, anterior $100.00
D2332 Resin-3 surface, anterior $125.00
D2335 Resin-4+ surfaces, anterior, incl. Incisal angle $160.00
D2380 Resin-1 surface, post, primary $70.00
D2381 Resin-2 surface, post primary $90.00
D2382 Resin-3 surface post, primary $115.00
D2391 Resin-1 surface, post, permanent $80.00
D2392 Resin-2 surface, post permanent $105.00
D2393 Resin-3 surface, post permanent $125.00
D2394 Resin-4 surface, post, permanent $165.00
D2610 Inlay-porcelain/ceramic-1surf $350.00
D2620 Inlay-porcelain/ceramic-2surf $450.00
D2630 Inlay-porcelain/ceramic-3surf $550.00
D2740 Crown, All porcelain $775.00
D2750 Crown, Porcelain High noble $775.00
D2752 Crown , porcelain/semi precious $650.00
D2920 Recement crown $55.00
D2930 Prefab'd stainless steel crown $100.00
D2931 Prefab'd stainless steel crown permanent tooth $165.00
D2932 Prefabricated resin crown $150.00
D2940 Sedative filling $60.00
D2950 Crown Buildup $100.00
D2952 Prefab'd stainless steel crown permanent $180.00
D2954 Prefabricated post and core $150.00
D2970 Temporary crown $150.00


Endodontic Procedures

D3110 Pulp cap-direct (excl.final rest.) $20.00
D3120 Pulp cap-indirect (excl. final rest.) $20.00
D3310 Root canal, Anterior (excl.rest.) $400.00
D3220 Therapeutic Pulpotomy (excl. rest.) $125.00
D3320 Root canal, Bicuspid (excl.rest.) $500.00
D3330 Root canal, Molar (excl. rest.) $675.00
D3340 Root canal, Molar 4 or more canals $725.00


Periodontic Services

D4210 Gingivectomy or gingivoplasty per quadrant $275.00
D4211 Gingivectomy or gingivoplasty per tooth $70.00
D4240 Gingival flap procedure incl. Root planing, per quadrant $450.00
D4260 Osseous surgery, incl. Flap per quadrant $575.00
D4270 Pedicle soft tissue graft $350.00
D4341 Periodontal scaling/ root planing per quadrant $120.00
D4345 Periodontal scaling in the presence of gingival inflammation $80.00
D4910 Periodontal maintenance (following therapy) $90.00


Prosthodontics, Procedures (removable)

D5110 Complete upper denture, incl. 6 months post-insertion care $750.00
D5120 Complete lower denture, incl. 6 months post-insertion care $750.00
D5130 Immediate upper denture, incl. 6 months post-insertion care $800.00
D5140 Immediate lower denture, incl. 6 months post-insertion care $800.00
D5211 Upper partial denture-acrylic base, incl. clasps and rests $500.00
D5212 Lower partial denture-acrylic base, incl. Clasps and rests $500.00
D5213 Upper partial denture-cast base with acrylic saddles $850.00
D5214 Lower partial denture-cast base with acrylic saddles $850.00
D5410 Adj. complete denture-upper $55.00
D5411 Adj. complete denture-lower $55.00
D5421 Adj. partial denture-upper $55.00
D5422 Adj. partial denture-lower $55.00
D5510 Repair broken complete denture base $225.00
D5520 Replace missing/broken tooth $85.00
D5610 Repair partial denture saddle or base $85.00
D5620 Repair cast metal framework $105.00
D5630 Repair or replace partial denture clasp $90.00
D5640 Replace broken tooth-partial denture $85.00
D5650 Add tooth to existing partial $85.00
D5660 Add clasp to existing partial $120.00
D5730 Reline complete upper denture (chairside) $190.00
D5731 Reline complete lower denture (chairside) $190.00
D5740 Reline upper partial denture (chairside) $140.00
D5741 Reline lower partial denture (chairside) $140.00
D5750 Reline complete upper (lab) $250.00
D5751 Reline complete lower (lab) $250.00
D5760 Reline partial upper (lab) $200.00
D5761 Reline partial lower (lab) $200.00


Prosthodontics Procedures (fixed)

D6010 Endosteal implant placement $1,200.00
D6057 Custom abutment $500.00
D6061 Implant retainer for bridge  $1,000.00
D6066 Implant crown $1,000.00
D6199 Implant pontic $1,000.00
D6242 Pontic-porcelain to semi-precious $650.00
D6545 Cast metal retainer for acid etch bridge $225.00
D6752 Crown (abutment) porcelain, semi-prec. $650.00
D6930 Recement bridge $75.00


Oral Surgery Procedures

D7140 Extraction (simple) single tooth $90.00
D7210 Surgical removal of erupted tooth requiring elevation of flap/sectioning $130.00
D7250 Surgical removal of residual tooth roots (cutting procedure) $160.00
D7310 Alveoplasty in conjunction with extractions (per quadrant) $85.00
D7320 Alveoplasty not in conjunction with extractions (per quadrant) $180.00
D7971 Excision of pericoronal gingival $125.00


Adjunctive Procedures

D9110 Palliative treatment $30.00
D9230 Nitrous Oxide $45.00


Cosmetic Procedures

D2960 Laminate veneer (chairside) $500.00
D2962 Laminate veneer (lab) $700.00
D9972 Bleaching (per arch) $160.00
D9974 Bleaching (per tooth/internal) $75.00



Please Note:
Procedures not listed are available at a 25% discount from usual and customary fees charged by participating General Practitioners. All fees listed are paid directly to the participating dentist. Procedures done by participating specialists are available at a 25% discount from their usual and customary fees. Fees updated January 2016.


 

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