Texas Fees for Common Services

Save on the treatment you need today.

The Smile Generation Dental Plan may provide you with immediate discounts of 20-50% on most dental treatments. It is not insurance; just a fast, simple way to save on the treatment you need for a full year.

Low-cost annual plans designed to help you save and stay healthy.

Individual

$119

for 12 months*

2 Individuals

$149

for 12 months*

3+ Individuals

$169

for 12 months*

*Includes a one-time, non-refundable $15 administration fee.

Smile Generation Dental Plan is NOT insurance and is not intended to replace health insurance. The plan does not pay providers directly. Members must pay for services at the time of treatment and will receive discounted rates from participating providers listed at . Discounted rates may vary depending on the type of provider and service. You may cancel within the first 30 days after payment and receive a refund of your annual fees, except the $15 non-refundable application fee. (Application fee is refundable for AR, LA, FL. MD receives a $10 refund). If you received services under the plan prior to cancellation, you may be responsible for paying your provider the difference between the discounted rated and your provider's standard rates for the services performed (excluding LA residents). If your plan expires and you later decide to renew, another $15 non-refundable application fee may apply. Wellfit Plans, LLC is located at 3900 Teleport Blvd., PO Box 140309, Irving, TX 75014-0309 and can be reached at 833-333-7437.

Texas Fees for Common Services

Plan members in Texas receive the following services at these specified fees and fee ranges when performed by a Smile Generation Dental Plan? provider:

SERVICES

YOU PAY

SERVICES

YOU PAY

Diagnostic & Preventative

Routine exams, diagnosis & full mouth X-ray Fluoride varnish Cleaning & polishing (prophylaxis) - adult

Mouth-Body Connection?

Salivary lab test for oral pathogen detection Salivary analysis for oral pathogen detection VELscope? oral cancer screening Periodontal maintenance visit (PMV) Scaling & root planing (SRP) per quadrant Laser bacterial decontamination with PMV or cleaning Laser bacterial decontamination with SRP per quadrant Antibacterial irrigation per quadrant

Restorative Dentistry

Fillings & Inlays Composite - front teeth (1-3 surfaces) Composite - back teeth (1-3 surfaces) CEREC? CAD/CAM inlay

Crowns, Implants & Veneers CEREC? CAD/CAM crown Premium CEREC? CAD/CAM crown Implant (implant, abutment, CEREC? CAD/CAM crown) Veneers

$0 $41 $100

$75-$151 $0 $34 $140 $170 $70-$85 $70-$85 $10

$162-$375 $204-$310 $720-$921

$1,055 $1,255 $3,860-$4,325 $1,100-$1,360

Endodontics

Root canal: 1-3 root procedures

Orthodontics

Clear aligner therapy Express/Lite/GO (Includes records and standard retention) Comprehensive clear aligner therapy (Includes records and standard retention) Phase 1 orthodontic treatment - child (Up to 12 months, includes records and standard retention) Comprehensive orthodontic treatment (Up to 24 months, includes records and standard retention)

Dentures

Immediate or complete dentures (per arch) Partial denture (per arch) Complete denture - premium (per arch)

Other Services

Simple extraction Surgical extraction

$903-$1,176

$3,500 $5,500 $1,649-$1,732 $4,099

$832-$1,200 $632-$2,460 $832-$2,200

$178 $312

Free electric toothbrush for pregnant or diabetic members to help improve your oral health!

Limit one per lifetime membership.

MEMBERSHIP ADVANTAGES

? Save 20%-50% on most dental procedures ? 20%-60% savings on Mouth-Body Connection?

procedures like oral cancer screenings, salivary lab tests and full-mouth periodontal treatment ? Since this is not insurance, there are no deductibles or annual maximums ? Discount applied upon enrollment--no waiting

Contact us at (833) 333-SGDP (7437)

Visit or scan the QR code to find the full fee schedule as well as exclusions & limitations.

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