Savings Summary
ADA CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
2 Limited Exams & X-Rays per yearNO CHARGE
Adult Comprehensive Exam (D0150) & X-Rays Bundle$149
Child Comprehensive Exam (D0150) & X-Rays Bundle$59
D0120Periodic Exam$52.73
D0210Full Mouth X-Rays$123.20
D0220Intraoral - First Film$27.53
D0230Intraoral - Additional Films$22.17
D0272Bitewings - Two Films$42.00
D0274Bitewings - 4 Films$60.43
D0330Panoramic X-Rays$107.10
D1110Adult Cleaning$89
D1120Child Cleaning$49
D1208Fluoride - Excluding Varnish$37.21
Restorative
D2330Filling - 1 Surface, Anterior$153.07
D2331Filling - 2 Surfaces, Anterior$186.09
D2332Filling - 3 Surfaces, Anterior$229.03
D2391Filling - 1 Surface, Posterior$166.05
D2740Crown - Porcelain/Ceramic$1,062.12
D2750Crown - Porcelain/High Noble Metal$1,046.27
Endodontics & Periodontics
D3310Root Canal - Anterior$787.29
D3320Root Canal - Bicuspid$930.43
D3330Root Canal - Molar$965.30
D4341Perio Scaling & Root Planing - 4+ Teeth (Per Quad)$226.33
D4342Perio Scaling & Root Planing - 1-3 Teeth (Per Quad)$165.90
D4910Periodontal Maintenance - Single Visit$146.30
Prosthodontics & Oral Surgery
D5110Complete Denture (Upper)$1,574.57
D7140Simple Extraction$200.40
D7210Surgical Extraction$279.13

*Member savings may vary by location. Free limited exams and necessary x-rays limited to 2x per member/per annual membership term.