Savings Summary
With transparent rates front and center, priced far below your dentist’s normal retail fees, you can get the services you need at the prices you can afford.
| ADA Code | Procedure Description | Member Pays* |
|---|---|---|
| DIAGNOSTIC & PREVENTATIVE | ||
| D0120 | Periodic Oral Exam | $35.00 |
| D0150 | Comprehensive Oral Exam | $35.00 |
| D0140 | Limited Problem Focused | $75.00 |
| D0330 | Panoramic X-Ray | No Charge |
| D0220 | X-Ray - Periapical First Image | No Charge |
| D0230 | X-Ray - Periapical Each Additional Image | No Charge |
| (D0272-0274) | Bitewings | $50.00 |
| D1110 | Adult Cleaning | $140.00 |
| D1120 | Child Cleaning | $115.00 |
| D1206 | Topical Fluoride | No Charge |
| RESTORATIVE | ||
| D2330 | Composite Filling - One Surface, Anterior | $175.00 |
| D2335 | Composite Filling - Four Surface, Anterior | $325.00 |
| D2391 | Composite Filling - One Surface, Posterior | $225.00 |
| D2394 | Composite Filling - Four Surface, Posterior | $400.00 |
| D2740 | Crown - Ceramic | $1,350.00 |
| D2920 | Crown – Recementation | $115.00 |
| PROSTHODONTICS & ORAL SURGERY | ||
| D3310 | Root Canal - Anterior | $800.00 |
| D3320 | Root Canal - Bicuspid | $875.00 |
| D3330 | Root Canal - Molar | $925.00 |
| D4341 | Perio Scaling/Root Planing - 4+ teeth | $300.00 |
| D4910 | Periodontal Maintenance | $190.00 |
*Services listed on Summary of Discounts, with the exception of Orthodontic services, are performed by your selected general dentist. Certain procedures may not be within the scope of practice or the ability of the general dentist. In such cases, if a participating specialist is available to perform such procedures they will be provided at a 10-60% discount off the participating specialist’s usual and customary fee for such procedures.
View Fee Schedule