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Overview
With the HumanaOne Dental Plan C550 (formerly CompBenefits Plan 550), you won’t be surprised by any hidden costs. There just aren’t any. Your dental needs are covered right from the start. Any pre-existing condition you may have is covered immediately and the plan can be purchased on a standalone basis without a Humana health insurance plan.
The HumanaOne Pre-Paid Dental Plan C550 gives you access to services with low co-payments through a wide network of dentists. This is a great plan for individuals who want:
- No co-payments on many diagnostic and preventive procedures
- Confidence that you will save money on dental care.
- No benefit maximums
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Plan Features
- 100% coverage on many diagnostic and preventive procedures. You pay nothing for this dental work.
- Low $10 office visit co-payment
- Discounts on Specialty Care and certain Cosmetic Procedures
- No benefit maximum or claim forms
- A provider network with more than 5,000 network dentists
- Specialty care and some cosmetic procedures covered at a discount
How It Works
- First, sign up for coverage. When you are filling in your application you will need to select your Primary Care Dentist from the dental directory list. Participating dentists are located near your home or office. Each dentist is licensed and is a skilled and experienced professional. CompBenefits carefully reviews the credentials of each dentist in the network before they are selected. Family members under the same plan may select different dentists. You can find a dentist by visiting Humana’s Dentist Finder.
- When you see your participating dentist, you’ll receive no charge services on
- X-rays
- Routine Cleanings
- Topical Flouride
- Oral Exams
- Local Anesthesia
- You pay only the fees listed on the schedule of benefits.
Procedure Prices
Dental Services | You Pay |
---|---|
Office Visit | $10 copayment |
Periodic Oral Evaluation | $0 |
X-rays | $0 |
Filling (silver) | $30 |
Filling (tooth-colored) | $50 |
Extraction | $35 |
View a list of procedure prices |
Complete Procedure Price List
Code | Services | Member Pays |
---|---|---|
Appointments | ||
D9310 | Consultation (diagnostic service provided by dentist other than practitioner providing treatment). | $30.00 |
D9430 | Office visit (normal hours) | $10.00 |
D9440 | Office visit (after regularly scheduled hours) | $35.00 |
D9999 | Emergency visit during regularly scheduled hours, by report. | $20.00 |
D9999 | Broken appointments (without 24 hr. notice, per 15 min) -maximum $40 per broken appointment. No charge will be made due to emergencies | $10.00 |
Code | Diagnostic | Member Pays |
D0120 | Periodic oral examination | no charge |
D0140 | Limited/comprehensive/detailed and extensive oral eval | no charge |
D0150 | Limited/comprehensive/detailed and extensive oral eval | no charge |
D0160 | Limited/comprehensive/detailed and extensive oral eval | no charge |
D0180 | Comprehensive periodontal evaluation | $25.00 |
D0210 | X-ray intraoral-complete series including bitewings | no charge |
D0220 | X-ray intraoral-periapical, first film | no charge |
D0230 | X-ray intraoral-periapical, each additional film | no charge |
D0270 | X-ray bitewing-single film | no charge |
D0272 | X-ray bitewings-two films | no charge |
D0274 | Bitewings-four films | no charge |
D0330 | Panoramic film | no charge |
D0460 | Pulp vitality tests | no charge |
D0470 | Diagnostic casts | no charge |
Code | Preventive | Member Pays |
D1110 | Prophylaxis-adult, routine (once every 6 months) | no charge |
D1120 | Prophylaxis-child, routine (once every 6 months) | no charge |
D1110 | Prophylaxis-adult/child, (additional) | $35.00 |
D1120 | Prophylaxis-adult/child, (additional) | $35.00 |
D1203 | Topical application of fluoride (not including prophylaxis)— child (up to 16 years of age) | no charge |
D1206 | Topical fluoride varnish (for child <16) | no charge |
D1330 | Oral hygiene instruction | no charge |
D1351 | Sealant-per tooth | $20.00 |
D1510 | Space maintainer-fixed, unilateral | $65.00 + lab |
D1515 | Space maintainer-fixed, bilateral | $65.00 + lab |
D1520 | Space maintainer-removable, unilateral | $105.00 + lab |
D1525 | Space maintainer-removable, bilateral | $105.00 + lab |
D1550 | Recementation of space maintainer | $20.00 |
Code | Restorative | Member Pays |
D2140 | Amalgam-one surface, primary or permanent | $30.00 |
D2150 | Amalgam-two surfaces, primary or permanent | $35.00 |
D2160 | Amalgam-three surfaces, primary or permanent | $40.00 |
D2161 | Amalgam-four or more surfaces, primary or permanent. | $50.00 |
D2940 | Sedative filling | $30.00 |
D2999 | Sedative base (under fillings), by report | no charge |
Code | Resin Restorative | Member Pays |
D2330 | Resin based composite-one surface, anterior | $50.00 |
D2331 | Resin based composite-two surfaces, anterior | $55.00 |
D2332 | Resin based composite-three surfaces, anterior | $65.00 |
D2391 | Resin based composite-one surface, posterior | $90.00 |
D2392 | Resin based composite-two surfaces, posterior | $110.00 |
D2393 | Resin based composite-three surfaces, posterior | $130.00 |
D2394 | Resin based composite-four or more surfaces, posterior | $150.00 |
D2510 | Inlay-metallic, one surface | $155.00 |
D2520 | Inlay-metallic, two surfaces | $165.00 |
D2530 | Inlay-metallic, three or more surfaces | $190.00 |
Code | Crown and Bridge | Member Pays |
D2740 | Crown-porcelain/ceramic substrate | $370.00 + lab |
D2750* | Crown-porcelain fused to high noble metal | $370.00 |
D2751 | Crown-porcelain fused to predominantly base metal | $370.00 |
D2752* | Crown-porcelain fused to noble metal | $370.00 |
D2790* | Crown-full cast high noble metal | $370.00 |
D2791 | Crown-full cast predominantly base metal | $370.00 |
D2792* | Crown-full cast noble metal | $370.00 |
D2910 | Recement inlay | $30.00 |
D2920 | Recement crown | $30.00 |
D2930 | Prefabricated stainless steel crown-primary tooth | $120.00 |
D2950 | Core buildup, including any pins | $60.00 |
D2951 | Pin retention-per tooth, in addition to restoration | $30.00 |
D2952 | Cast post and core in addition to crown | $120.00 + lab |
D2953 | Each additional cast post-same tooth | $120.00 + lab |
D2954 | Prefabricated post and core in addition to crown | $120.00 |
D2962 | Labial veneer (porcelain laminate)—laboratory | $370.00 + lab |
Code | Endodontics | Member Pays |
D3220 | Therapeutic pulpotomy | $50.00 |
D3221 | Pulpal debridement, primary and permanent teeth | $130.00 |
D3310 | Root canal therapy-anterior (excluding final restoration) | $250.00 |
D3320 | Root canal therapy-bicuspid (excluding final restoration) | $350.00 |
D3330 | Root canal therapy-molar (excluding final restoration) | $450.00 |
D3410 | Apicoectomy/periradicular surgery-anterior | $200.00 |
Code | Peridontics (gum treatment) | Member Pays |
D4210 | Gingivectomy/gingivoplasty per quadrant | $200.00 |
D4211 | Gingivectomy/gingivoplasty per tooth | $55.00 |
D4341 | Periodontal scaling and root planing, per quadrant | $65.00 |
D4342 | Periodontal scaling and root planing 1 to 3 teeth per quadrant | $65.00 |
D4355 | Full mouth debridement to enable comprehensive evaluation and diagnosis | $60.00 |
D4381 | Localized delivery of chemotherapeutic agents (per tooth) | $60.00 |
D4910 | Periodontal maintenance | $65.00 |
Code | Prosthodontics | Member Pays |
D5110 | Complete denture-maxillary | $375.00+lab |
D5120 | Complete denture-mandibular | $375.00+lab |
D5130 | Immediate denture-maxillary | $375.00+lab |
D5140 | Immediate denture-mandibular | $375.00+lab |
D5211 | Maxillary partial denture-resin base | $375.00+lab |
D5212 | Mandibular partial denture-resin base | $375.00+lab |
D5213 | Maxillary partial denture-cast metal framework, resin denture bases | $375.00+lab |
D5214 | Mandibular partial denture-cast metal framework, resin denture bases | $375.00+lab |
D5410 | Adjust complete denture-maxillary | $30.00 |
D5411 | Adjust complete denture-mandibular | $30.00 |
D5421 | Adjust partial denture-maxillary | $30.00 |
D5422 | Adjust partial denture-mandibular | $30.00 |
Code | Repairs to prosthetics | Member Pays |
D5510 | Repair broken complete denture base | $30.00+lab |
D5520 | Replace missing or broken teeth-complete denture (each tooth) | $30.00+lab |
D5610 | Repair resin denture base | $30.00+lab |
D5630 | Repair or replace broken clasp | $30.00+lab |
D5640 | Replace broken teeth-per tooth | $30.00+lab |
D5650 | Add tooth to existing partial denture | $45.00+lab |
D5730 | Reline complete maxillary denture (chairside) | $65.00 |
D5731 | Reline complete mandibular denture (chairside) | $65.00 |
D5740 | Reline maxillary partial denture (chairside) | $65.00 |
D5741 | Reline mandibular partial denture (chairside) | $65.00 |
D5750 | Reline complete maxillary denture (laboratory) | $50.00+lab |
D5751 | Reline complete mandibular denture (laboratory) | $50.00+lab |
D5760 | Reline maxillary partial denture (laboratory) | $50.00+lab |
D5761 | Reline mandibular partial denture (laboratory) | $50.00+lab |
D5850 | Tissue conditioning-maxillary | $45.00 |
D5851 | Tissue conditioning-mandibular | $45.00 |
Code | Prosthodontics (fixed) | Member Pays |
D6210* | Pontic-cast high noble metal | $370.00 |
D6211 | Pontic-cast predominantly base metal | $370.00 |
D6212* | Pontic-cast noble metal | $370.00 |
D6240* | Pontic-porcelain fused to high noble metal | $370.00 |
D6241 | Pontic-porcelain fused to predominantly base metal | $370.00 |
D6242* | Pontic-porcelain fused to noble metal | $370.00 |
D6750* | Crown-porcelain fused to high noble metal | $370.00 |
D6751 | Crown-porcelain fused to predominantly base metal | $370.00 |
D6752* | Crown-porcelain fused to noble metal | $370.00 |
D6790* | Crown-full cast high noble metal | $370.00 |
D6791 | Crown-full cast predominantly base metal | $370.00 |
D6792* | Crown-full cast noble metal | $370.00 |
D6930 | Recement fixed partial denture (per unit) | $25.00 |
Code | Extractions/oral and maxillofacial surgery | Member Pays |
D7111 | Coronal remnants, deciduous tooth | $35.00 |
D7140 | Extraction, erupted tooth or exposed tooth | $35.00 |
D7210 | Surgical removal of erupted tooth | $55.00 |
D7220 | Removal of impacted tooth-soft tissue | $100.00 |
D7230 | Removal of impacted tooth-partially bony | $125.00 |
D7240 | Removal of impacted tooth-completely bony | $150.00 |
D7250 | Surgical removal of residual tooth roots | $65.00 |
D7310 | Alveoloplasty in conjunction with extractions-per quadrant | $65.00 |
D7311 | Alveoplasty in conjunction with extractions-one to three teeth or tooth spaces, per quadrant | $65.00 |
D7320 | Alveoloplasty not in conjunction with extractions-per quadrant | $100.00 |
D7321 | Alveoplasty not in conjunction with extractions-one to three teeth or tooth spaces, per quadrant | $100.00 |
D7510 | Incision and drainage of abscess-intraoral | $40.00 |
Code | Anesthesia | Member Pays |
D9215 | Local anesthesia | no charge |
D9230 | Analgesia (nitrous oxide), per 15 minutes | $30.00 |
Code | Adjunctive general services | Member Pays |
D9450 | Case presentation, detailed and extensive treatment planning | no charge |
D9951 | Occlusal adjustment-limited | $40.00 |
D9952 | Occlusal adjustment-complete | $225.00 |
Orthodontics | ||
NOTE: Members can receive a 25 percent savings by visiting an in-network orthodontist. |
* The above copayments do not include the additional cost of precious (high noble) and semi-precious (noble) metal. The additional cost of precious metal shall not exceed $125 per unit and $75 per unit for semi-precious metal.
NOTE:
- NOT ALL PARTICIPATING DENTISTS PERFORM ALL LISTED PROCEDURES, INCLUDING AMALGAMS. PLEASE CONSULT YOUR DENTIST PRIOR TO TREATMENT FOR AVAILABILITY OF SERVICES.
- UNLISTED PROCEDURES ARE AT THE DENTIST’S USUAL FEE LESS 25 percent INCLUDING, BUT NOT LIMITED TO, MAXILLOFACIAL PROSTHETICS, ENAMEL MICROABRASION, AND BLEACHING.
- WHEN CROWN AND/OR BRIDGEWORK EXCEEDS SIX UNITS IN THE SAME TREATMENT PLAN, THE PATIENT MAYBE CHARGED AN ADDITIONAL $50.00 PER UNIT.
Waiting Periods on Types of Services | |
---|---|
Preventive | None |
Diagnostic | None |
Basic | None |
Major | None |
Preventive care
- Routine oral exams
- Prophylaxis (cleaning and scaling of teeth) – two per year
- Topical fluoride application (up to age 16 and not including prophylaxis) – two per calendar year
Diagnostic care
- Intra-oral occlusal film
- Bitewing X-rays (up to a set of four)
- Full-mouth X-rays (panoramic film)
Endodontics care
- Root canal therapy
- Pulpal debridement, primary and permanent teeth
- Apexification/recalcification
- Apicoectomy/periradicular surgery
Periodontics care
- Gingivectomy/gingivoplasty
- Osseous surgery
- Pedicle/free soft tissue grafts
- Periodontal scaling and root planing
Orthodontia
- NOTE: Members can receive a 25 percent savings by visiting an in-network orthodontist.
Plan C550 Rates
Fee | Price |
---|---|
One-Time Enrollment Fee | $35.00 (total) The fee for both 1 person or 4 persons is $35. |
Monthly Premium (1 person) | $14.18 |
Monthly Premium (2 persons) | $23.50 |
Monthly Premium (3 persons) | $31.52 |
Monthly Premium (4 persons) | $39.37 |
Monthly Admin Fee (Included in rates above, waived if you pay yearly) | $1.00 |
Effective Dates
- If application is received between the 1st and 15th of the month, the policy effective date will be the 1st of the following month 1. Example: Application received on May 10th will have an effective date of June 1st.
- If application is received between the 16th and end of the month, the policy effective date will be the 1st of the 2nd following month (the month after the following month) 1. Example: Application received May 18th for processing will have a policy effective date of July 1st.
The reason for the difference in effective dates is due to the member having to select a primary care dentist and being included in the monthly membership rosters sent to providers.
Can I Terminate My Coverage at Anytime?
No, there is a one year contract with these plans. However, Dental C550 members can terminate their coverage within the first 30 days of their effective date, but they will only be refunded their premium (not enrollment fee) and will be responsible for any claims incurred during this time. After the 30 day window, cancellations are not accepted unless for approved exceptions.
Payment Options
Payment options include monthly and annual bank draft, monthly and annual credit card payments (Visa and MasterCard), and monthly and annual bills.
After Enrollment
After enrollment, members will receive a welcome packet and ID cards 7-10 days after the application is received and enrollment is processed, and should bring their ID cards with them when visiting the dentist. Members should inform their provider of their plan when scheduling their appointment to avoid any issues at the time of service.
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