ADA CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
D0120 Periodic Exam NO CHARGE
D0140 Limited Exam - Problem Focused NO CHARGE
D0150 Comprehensive Exam NO CHARGE
D0210 Full Mouth X-Rays NO CHARGE
D0330 Panoramic X-Rays NO CHARGE
D1110 Adult Cleaning 30% Off
D1120 Child Cleaning 30% Off
Restorative
D2330 Filling - 1 Surface, Anterior 30% Off
D2391 Filling - 1 Surface, Posterior 30% Off
D2740 Crown - Porcelain/Ceramic 30% Off
D2950 Core Buildup - Including Pins 30% Off
Endodontics & Periodontics
D3310 Root Canal - Anterior 30% Off
D3320 Root Canal - Bicuspid 30% Off
D3330 Root Canal - Molar 30% Off
D4341 Perio Scaling/Root Planing - 4+ Teeth 30% Off
D4910 Periodontal Maintenance 30% Off
Prosthodontics & Oral Surgery
D5110 Complete Denture (Upper or Lower) 30% Off
D5213 Partial Denture (Upper or Lower) 30% Off
D7140 Simple Extraction 30% Off
D7210 Surgical Extraction 30% Off
Orthodontics
D8090 Comprehensive Orthodontic Treatment of the Adult Dentition 15% Off
D8020 Limited Orthodontic Treatment of the Transitional Dentition 15% Off

*Member savings may vary by location. Comprehensive and Periodic exams are limited to a combination of 2 per member/per annual membership term.