California Dental Plans - LIBERTY Dental Plan
California Dental Plans

Review the costs below to determine which plan is right for you. The Annual Premium is due in full at the time of purchase. The Co-payment is the amount you pay to your dentist for the dental procedure performed.

  • The CA50 HMO Plan is slightly higher in annual premium, however you will pay lower co-payments for most procedures.
  • The CA80 Plan offers a lower annual premium than the CA50 HMO Plan, however you will pay higher co-payments. Although not required to have an assigned dentist, you MUST choose a network dentist.
  • The CA90 Plan is our most basic plan and offers the lowest annual premium, however you will pay higher co-payments than with the CA50 HMO Plan or CA80 Plan.
  • The Senior Rate is a discounted annual premium offered when the primary member is 65+ years of age. There is no difference in the dental coverage provided with the Senior Rate.

Annual Premiums (Yearly premium to be paid in full)
Plan Option CA50 HMO Plan CA80 Plan CA90 Plan



Member $279.51 $160.02 $120.47
Member +1 $455.73 $199.54 $154.30
Member +2 or more $666.44 $267.05 $176.52
Senior Member( 65+ ) $253.56 $146.02 N/A
Senior Member +1( 65+ ) $412.16 $181.59 N/A
Senior Member +2 or more( 65+ ) $601.79 $242.34 N/A
Sample Discounted Fees (Co-payment due to Dentist)
ADA Code Procedure/Description
With CA50 HMO
You Would Pay
With CA80
You Would Pay
With CA90
You Would Pay
If Uninsured
You Would Pay
D0150 Comprehensive oral evaluation $0.00 $8.00 $10.00 $98.44
D0210 Intraoral, complete series of radiographic images $0.00 $0.00 $24.00 $150.89
D1110 Prophylaxis, adult $9.00 $0.00 $17.00 $111.40
D2150 Amalgam, 2 surfaces, primary or permanent $13.00 $32.00 $55.00 $178.48
D2751 Crown, porcelain fused to predominantly base metal $195.00 $280.00 $440.00 $1131.57
D3330 Root canal, Molar (excluding final restoration) $265.00 $245.00 $395.00 $1177.53
D5110 Complete denture, maxillary $250.00 $385.00 $500.00 $1552.14
Click here for the full list of what's covered with the CA50 HMO Click here for the full list of what's covered with the CA80 Click here for the full list of what's covered with the CA90
*Average "Uninsured" fees are for illustrative purposes only, based on 50th percentile of MDR and are specific to a geographic area