| Zip Code | 93240 |
| Age | 58 |
| Blue Basic Dental PPO | 23.00 | Brochure | |
| Blue Enhanced Dental PPO | 52.00 | Brochure | |
| Prime Dental PPO Plan A | 24.05 | Brochure | |
| Prime Dental PPO Plan B | 37.05 | Brochure | |
| Prime Dental PPO Plan C | 46.80 | Brochure | |
| Dental Net 3000D DHMO | 16.06 | Brochure | |
| Blue View Vision Plan | 7.88 | Brochure | |