| Zip Code | 92804 |
| Age | 33 |
| Spouse age | 33 |
| # Children | 2 |
| Blue Basic Dental PPO | 108.00 | Brochure | |
| Blue Enhanced Dental PPO | 202.00 | Brochure | |
| Prime Dental PPO Plan A | 90.10 | Brochure | |
| Prime Dental PPO Plan B | 138.75 | Brochure | |
| Prime Dental PPO Plan C | 175.25 | Brochure | |
| Dental Net 3000D DHMO | 52.20 | Brochure | |
| Blue View Vision Plan | 22.06 | Brochure | |