| Especialidad | Tratamiento | Cobertura | PVP | Precio Afiliados | Descuentos |
| Diagnostico preventivo | 100% | $10.00 | $0.00 | 100% | |
| Interconsulta con especialista | 100% | $25.00 | $0.00 | 100% | |
| Preventivo | Radiografías periapicales | 100% | $5.00 | $0.00 | 100% |
| Atención de emergencias | 100% | $20.00 | $0.00 | 100% | |
| Limpieza dental profunda | 100% | $28.00 | $0.00 | 100% | |
| Calces simples | Copago | $19.00 | $10.45 | 45% | |
| Operatoria | Calces compuestos | Copago | $24.00 | $13.20 | 45% |
| Calces complejas | Copago | $32.00 | $17.60 | 45% | |
| Endodoncia en anteriores | Copago | $150.00 | $80.00 | 47% | |
| Endodoncia en premolares | Copago | $300.00 | $120.00 | 60% | |
| Endodoncia | Endodoncia en molares | Copago | $204.00 | $106.08 | 48% |
| Extracción simple | 100% | $30.00 | $0.00 | 100% | |
| Extracción con odontosección | Copago | $75.00 | $34.50 | 54% | |
| Capuchones pericoronarios | Copago | $63.00 | $15.12 | 76% | |
| Cirugía | Drenaje de absceso intraoral | Copago | $60.00 | $22.20 | 63% |
| Frenectomía | Copago | $120.00 | $72.00 | %40 | |
| Extracción pediátrica | 100% | $22.00 | $0.00 | 100% | |
| Sellantes | Copago | $20.00 | $10.00 | 50% | |
| Odontopediatría | Fluorización | 100% | $20.00 | $0.00 | 10% |
| Ortodoncia metálica | Copago | $1750.00 | Desde 665.00 | 62% | |
| Carillas de resina | Copago | $120.00 | $70.00 | 42% | |
| Carillas de porcelana | Copago | $350.00 | $210.00 | 40% | |
| Estética dental | Corona metal/porcelana | Copago | $380.00 | $171.00 | 55% |
| Blanqueamiento dental | Copago | $190.00 | $80.00 | 58% |
