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Yes! Please enroll me in this
exclusive discount plan so I may
receive member only discounts!
Name:
______________________
Address:
______________________
______________________
Phone:
______________________
Email:
______________________
Start Date:
______________________
Exp. Date:
______________________
D.O.B.:
______________________
Type of Plan:
Self:
Family*: _____
“Because Everyone Deserves to Smile”
Villalobos Dental Care
4801-07 Bergenline Ave.
Union City, NJ 07087
Phone: 201-865-6740
Fax: 201-865-6739
E-mail:
Website: Vivianvillalobosdds.com
An affordable discount plan
exclusive to our patients
Services
Villalobos Dental care is an all-
encompassing practice providing a wide
array of services for the entire family.
We provide basic and comprehensive
services, endodontic, prosthodontics,
periodontics, oral surgery, cosmetic
dentistry, Implants and more. Some of
the services we provide are as follows:
• Dentures and Bridges
• Root Canal Treatments
• Dental Implants
• Botox and facial fillers
• Tooth Colored Fillings
Enrollment Fees*
Self $84.99
Family $42.50 each addtl.
* Enrollment Fee includes Oral Exam
and 4 bitewing x-rays
# of people
4801-07 Bergenline Ave.
Union 4City, NJ 07087
Phone: 201-865-6740
Fax: 201-865-6739
E-mail: [email protected]
Website: Vivianvillalobosdds.com
PROCEDURE STANDARD
FEE
DISCOUNT
FEE
Diagnostic & Preventative
Comprehensive exam $54 $43
Periodic exam $35 $28
Full mouth x-rays $120 $96
Single x-ray $20 $16
Bitewing x-rays—2 films $40 $32
Adult cleaning $99 $79
Child cleaning $85 $68
Topical fluoride child $15 $12
Sealant-per tooth $100 $80
Palliative (emergency ) TX $80 $64
Restorative (Fillings)
Resin Anterior 1 surface $150 $120
Resin Anterior 2 surfaces $160 $128
Resin Anterior 3 surfaces $170 $136
Resin Anterior 4+ surfaces $180 $144
Resin Posterior 1 surface $150 $120
Resin Posterior 2 surfaces $160 $128
Resin Posterior 3 surfaces $170 $136
Resin Posterior 4+ surfaces $180 $144
Implant Services
Endosteal implant place-
ment
$1200 $960
Custom abutment $1100 $880
Implant supported crown
solid zirconia
$900 $720
Implant crown porcelain
fused to high noble metal
$900 $720
PROCEDURE STANDARD
FEE
DISCOUNT
FEE
Periodontics
Scaling and root planning
per quadrant
$180 $144
Periodontal maintenance $120 $96
Laminate veneer
(porcelain)
laboratory
$900 $720
Laminate veneer
(composite) chairside
$308 $246
Endodontics (root canals)
Anterior $600 $480
Bicuspid (premolars) $720 $576
Molars $930 $744
Removable prosthodontics
(Upper or lower)
Complete denture $925 $740
Cast metal partial denture $1200 $960
Flex resin partial denture $1200 $960
Oral Surgery
Extraction (erupted tooth) $150 $120
Surgical extraction $225 $180
Cosmetic Dentistry
Teeth whitening chair side $250 $200
Teeth whitening home kit $500 $400
Nova facial threading (per
lifting thread)
$400 $300
Collagen forming
threading incl. lips
$400-$600 $300-$500
Botox $11 per unit $10 per unit
Facial fillers $350-$750 $300-$650
PROCEDURE STANDARD
FEE
DISCOUNT
FEE
Fixed prosthodontics
Crown—porcelain fused
to base metal
$800 $640
Crown—zirconia/emax $900 $720
Pre-fabricated post &
core
$325 $260
Cast post & core $285 $228
Core buildup $190 $152
Bio-Temps temporary
Crown (per unit)
$82 $65
Villalobos Dental Care Discount Plan is NOT an
insurance plan. It can not be combined with any
other discount or insurance plans. Fees listed
are performed by general dentists . Patients are
responsible financially for specialist treatments
outside of where this plan was purchased.
20 % off all other services not listed
@ Villalobosdentalcare1
@Villalobosdds
