Savings to Smile About
Below is a list of common dental services and what you’ll pay with Smile Saver Dental Plan.
| Savings Summary | ||
|---|---|---|
| ADA Code | Procedure Description | Member Pays* |
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | $63.21 (30% Off) |
| D0140 | Limited Exam - Problem Focused | NO CHARGE |
| D0150 | Comprehensive Exam | NO CHARGE |
| D0431 | Oral Cancer Screening | NO CHARGE |
| D0210 | Full Mouth X-Rays | $25.00 (91% Off) |
| D0330 | Panoramic X-Rays | $113.93 (30% Off) |
| D1110 | Adult Cleaning | $65.00 (55% Off) |
| Restorative | ||
| D2331 | Filling - 2 Surfaces, Anterior | $202.86 (30% Off) |
| D2392 | Filling - 2 Surfaces, Posterior | $253.58 (30% Off) |
| D2740 | Crown - Porcelain/Ceramic | $1,322.27 (30% Off) |
| D2750 | Crown - Porcelain/High Noble Metal | $1,175.27 (30% Off) |
| Endodontics & Periodontics | ||
| D4341 | Perio Scaling/Root Planing - 4+ teeth | $271.22 per quad (30% Off) |
| D4910 | Periodontal Maintenance | $174.20 (30% Off) |
| D3351 | Apexification/recalcification – Initial visit | $524.00 (30% Off) |
| Prosthodontics & Oral Surgery | ||
| D7140 | Simple Extraction | $206.54 (30% Off) |
| D7210 | Surgical Extraction | $324.14 (30% Off) |
| D5130 / D5140 | Immediate Denture Maxillary/Mandibular | $1,836.77 per arch (30% Off) |
| D5213 / D5214 | Maxillary/Mandibular partial denture | $1,983.77 per arch (30% Off) |
| Adjunct Services | ||
| Consultation | $185.50 (30% Off) |
*Member savings may vary by location. Free exams limited to 2x per member/per annual membership term.