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Humana - Dental Plan C550


Sign up for Humana C550 Individual Dental Plan

Dental Plan C550

Our Rating:

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

HumanaOne Dental Plan C550 (Formerly CompBenefits C550)

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 PDF icon.

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 PDF icon

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:
  1. NOT ALL PARTICIPATING DENTISTS PERFORM ALL LISTED PROCEDURES, INCLUDING AMALGAMS. PLEASE CONSULT YOUR DENTIST PRIOR TO TREATMENT FOR AVAILABILITY OF SERVICES.
  2. UNLISTED PROCEDURES ARE AT THE DENTIST'S USUAL FEE LESS 25 percent INCLUDING, BUT NOT LIMITED TO, MAXILLOFACIAL PROSTHETICS, ENAMEL MICROABRASION, AND BLEACHING.
  3. 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


DHMO (Dental C550) effective dates are calculated as follows:

  • 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 any time?

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.