Discount Dental Plan from Members Benefit Services of Tyler, Texas

Participating General Dentists

R. Britt Ruby, D.D.S. / F.A.G.D.
Limited Orthodontics

Education:
University of Texas - Houston Dental School

Address:
719 Turtle Creek Dr.
Tyler, TX 75701

Phone:
903.595.3662

Braces	UCR*	MBS
Child (baby teeth)	$2600- $3600	$1600
Adult (permanent teeth)	$3500- $4300	$2100
More difficult cases referred to participating orthodontists at 25% less than UCR. There will be an extra fee for retainers and record start-up. UCR = Usual and customary rates for geographic area..

Steve W. Lebo, D.D.S.
1980 Baylor College of Dentistry

Address:
212 Old Grande Blvd., Ste B-224
Tyler, TX 75703

Phone:
903.509.0505

Medicaid Accepted

Tyler Family Dental
www.tylerfamilydental.com

William R. Jennings, D.D.S.
1997 Baylor College of Dentistry

209 W.8th Street Tyler, Tx 75701

903-597-3940
(Mon-Fri. by appt.)
Espanol

East Texas Facial and Oral Surgery Center
Jamie F. Meyers, D.D.S. / M.D. / P.A.

Education:
University of Missouri - M.D. & Oral Surgery Cert.

Address:
1721 S. Sycamore
Palestine, TX 75801

Phone:
903.723.5111

Rate Schedule For Dental Services
Rates subject to change

* UCR = Usual and customary rates for geographical area.
** Routine only if patient has had regular cleaning. Normal fee charge for first time on plan. Does NOT coincide with ordinary insurance.

Class I Preventative Services	$UCR*	$MBS
Exam & Consultation	56	25
Palliative Emergency Treatment	60	25
Panoramic X-Ray or Full Mouth	82	35
Single X-Rays	23	10
Bitewing X-Rays	46	20
Additional X-Ray	16	5
Sealant	40	15
Routine Cleaning - Child	66	36
Routine Cleaning - Adult **	98	42
Scaling in the Presence of (Inflamation)	107	60
Scaling & Root Planning (Per Quad)	167	80
Sterilization Charge	10	6

Class II Restoration Services
1 Surface (Amalgam)	45-60	29
2 Surface	60-79	39
3 Surface	75-85	59
4 Surface	92-105	65
Add $40 for Composites
Build Ups	95-105	65
Sedative Filling	45	20

Class III Surgical Services
Simple Extraction	90	58
Each Additional Tooth	87	55
Root Removal	100	65
Surgical Extraction	115-125	90
Wisdom Extractions	250	100-200
Removal of Impacted Tooth - partially boney	250	150
Alveoloplasty in Conjunction	115	75
Alveoloplasty without Conjuction	130	85

Class IV Services - Root Canal Treatment
One Canal	400	250
Two Canal	500	325
Three Canal	700	450
Four Canal	700	450
Pulpotomy	95	60

Class V Major Services
Stainless Steel Crown	125	80
Porcelain Veneers	600-750	399
Porcelain to Metal	600	375
Nonprecious Metals (Silver)	550	350
Gold Crowns	600-750	399
Gold-Plated Designs	500	310
Denture Gold Designs (+ Lab Fee)	200	125

Class VI Dentures
Full Upper or Lower Dentures	800-1000	500
Upper or Lower Metal Partials	950-1200	600
Acrylic Partials or Temporary	500	275
Relines Permanent	200	125
Repairs - Partial or Denture (+ Lab Fee)	100	65
Local Anesthesia	15	7
Nitrous Oxide Gas (+ Lab Fee)	25	15

Any services not listed will have a 25% off discount.