| Zip Code | 91101 |
| Age | 71 |
| Bronze Dental PPO | 28.25 | Brochure | |
| Silver Dental PPO | 44.55 | Brochure | |
| Gold Dental PPO | 56.85 | Brochure | |
| Platinum Dental PPO | 67.80 | Brochure | |
| Incentive Dental PPO | 64.70 | Brochure | |
| Dental Net 3000D DHMO | 16.06 | Brochure | |
| Dental PPO | 44.50 | Brochure | |
| Dental PPO 50/1250 | 41.90 | Brochure | |
| Enhanced Dental PPO 50/2000 | 65.90 | Brochure | |
| Enhanced Dental PPO 50/2000 | 71.50 | Brochure | |
| Dental HMO | 24.90 | Brochure | |
| Dental Standard HMO | 14.90 | Brochure | |