ADA CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
D0120Periodic ExamNO CHARGE
D0140Limited Exam - Problem FocusedNO CHARGE
D0150Comprehensive ExamNO CHARGE
D0210Full Mouth X-RaysNO CHARGE
D0330Panoramic X-RaysNO CHARGE
D1110Adult Cleaning30% Off
D1120Child Cleaning30% Off
Restorative
D2330Filling - 1 Surface, Anterior30% Off
D2391Filling - 1 Surface, Posterior30% Off
D2740Crown - Porcelain/Ceramic30% Off
D2950Core Buildup - Including Pins30% Off
Endodontics & Periodontics
D3310Root Canal - Anterior30% Off
D3320Root Canal - Bicuspid30% Off
D3330Root Canal - Molar30% Off
D4341Perio Scaling/Root Planing - 4+ Teeth30% Off
D4910Periodontal Maintenance30% Off
Prosthodontics & Oral Surgery
D5110Complete Denture (Upper or Lower)30% Off
D5213Partial Denture (Upper or Lower)30% Off
D7140Simple Extraction30% Off
D7210Surgical Extraction30% Off
Orthodontics
D8090Comprehensive Orthodontic Treatment of the Adult Dentition15% Off
D8020Limited Orthodontic Treatment of the Transitional Dentition15% Off

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