| Zip Code | |
| Age |
| Bronze Dental PPO | 25.20 | Brochure | |
| Silver Dental PPO | 39.75 | Brochure | |
| Gold Dental PPO | 50.75 | Brochure | |
| Platinum Dental PPO | 60.50 | Brochure | |
| Incentive Dental PPO | 57.75 | Brochure | |
| Dental PPO | 0.00 | Brochure | |
| Dental PPO 50/1250 | 0.00 | Brochure | |
| Enhanced Dental PPO 50/2000 | 0.00 | Brochure | |
| Enhanced Dental PPO 50/2000 | 0.00 | Brochure | |
| Dental HMO | 22.80 | Brochure | |
| Dental Standard HMO | 12.00 | Brochure | |