Capitol Hill Dental

Choose A Plan

Capitol Hill Elite Plan

$349

For each member, the Elite Plan includes:
1 periodic exam, routine x-rays, 1 oral screening, 2 cleanings, 2 fluoride treatments, and up to 20% off of other services

$309 per extra member

Colonial Dental Elite Savings Plan Details

Worry-free, affordable dental savings plans! With an Elite Plan, you’ll have no copays or deductibles to deal with, plus no claim denials or annual maximums. Enroll today and start saving immediately!

Plan Options

Membership Levels
Elite, Individual
Elite, Family

Effective Plan Period:
1 Year from Enrollment Date

Membership Fees:
Elite, Individual – $349/year
Elite, Family – $349/year for First Member; $309/year for Each Additional Member

Value¹:
$695

Potential Savings:
$346

Plan Value and Savings

Description	CDT Code	Quantity	Value¹	You Pay
Exam	D0150	1	$115	$0
Oral Screening	D0190	1	$50	$0
Routine X-Rays	Varies	As Needed	$170	$0
Professional Cleanings	D1110	2	$250	$0
Fluoride Treatments	D1208	2	$110	$0
TOTAL			$695	$0
Membership Fee				$349
Savings				$346

Discounts Off Other Services
Up to 20% Discount²

Description	CDT Code	Normal Fee	Member Fee	Savings
Resin composite 1 surface, posterior	D2391	$248	$198.	$50
Resin composite 2 surfaces, posterior	D2392	$308	$246	$62
Crown – porcelain/ceramic substrate	D2740	$1,523	$1,218	$305
Crown – porcelain fused to high noble metal	D2750	$1,554	$1,243	$311
Endodontic therapy, bicuspid (exc. final restoration)	D3320	$1,265	$1,012	$253
Endodontic therapy, molar (exc. final restoration)	D3330	$1,540	$1,232	$308
Periodontal scale/root planing – 4+ teeth per quadrant	D4341	$330	$264	$66
Complete denture – maxillary	D5110	$2,300	$1,840	$460
Maxillary partial – resin base	D5211	$1,650	$1,320	$330
Surgical placement of impact: endosteal	D6010	$2,475	$1,980	$495
Extraction, erupted tooth or exposed root	D7140	$303	$242	$61
Invisalign Complete		$5,950	$5,500	$450

Exceptions

The following treatments and procedures may not be eligible for inclusion in Colonial Dental savings plans.

Orthodontics such as comprehensive orthodontic treatment and appliance therapy (CDT Code D8000-D8999)
Procedures completed by a specialist outside of the treating practice.

Disclosures

Any Colonial Dental membership plan should not be considered to be insurance and is not a qualified health plan under the Affordable Care Act. Colonial Dental plans are also not intended to be used as pre-payment for future services or payment to access discounted services. Each membership plan is a direct discount arrangement between the member patient and his/her dentist.
The membership plan is administered by Colonial Dental Plan, LLC for your participating dentist. Learn more about Colonial Dental Plan at www.colonialdentalplan.com or by calling 1-877-460-7475.
Dentists in our participating offices establish their own fees and terms. The information and pricing provided above should be considered an example of how a plan may work.
Colonial Dental does not make payments to dentists for medical services. You are required to pay dentists directly for medical services rendered.
You can receive a full refund up to 30 days after purchase if no services of the plan have been used. If services have been used, you may be eligible to receive a prorated refund. Refunds after 30 days will be at the discretion of your dentist.
The membership plan runs for 12 months and requires a manual renewal.
Your membership plan payments must be current to receive the services and discounts included in the membership plan.
Payment for treatment not included in the membership plan is due at the time of service.
The pricing offered by your dentist may not be combined with any other offers or discounts.

¹Value is based on local dentists’ usual and customary fees.

²Discounts are based on office fee schedules of the practice in which you are treated.