Savings Summary
Maximize the value of membership with exclusive member discounts on all dental services.
| Code | Procedure Description | Retail Fee* | Member Fee* | Member Savings* |
|---|---|---|---|---|
| D0120 | Periodic Exam | $77 | $25 | 68% |
| D0140 | Limited Exam | $120 | NO CHARGE | 100% |
| D0150 | Comprehensive Exams | $127 | NO CHARGE | 100% |
| D0210 | Full Mouth X-Rays | $189 | $25 | 87% |
| D0330 | Panoramic X-Rays | $186 | $50 | 73% |
| D0431 | Oral Cancer Screening | $93 | NO CHARGE | 100% |
| D1110 | Adult Cleaning | $129 | $65 | 50% |
| D1120 | Child Cleaning | $95 | $55 | 42% |
| D1351 | Sealant - Per Tooth | $71 | $50 | 30% |
| D1510 | Space Maintainer - Fixed, Unilateral | $447 | $313 | 30% |
| D1516 | Space Maintainer - Fixed, Bilateral | $626 | $438 | 30% |
| D2330 | Composite Filling - One Surface, Anterior | $230 | $161 | 30% |
| D2331 | Composite Filling - Two Surfaces, Anterior | $294 | $206 | 30% |
| D2332 | Composite Filling - Three Surfaces, Anterior | $360 | $252 | 30% |
| D2335 | Composite Filling - Four/More Surfaces, Anterior | $425 | $298 | 30% |
| D2391 | Composite Filling - One Surface, Posterior | $270 | $189 | 30% |
| D2392 | Composite Filling - Two Surfaces, Posterior | $353 | $247 | 30% |
| D2393 | Composite Filling - Three Surfaces, Posterior | $473 | $331 | 30% |
| D2740 | Crown - Porcelain/Ceramic | $1,905 | $1,335 | 30% |
| D2750 | Crown - Porcelain/High Noble Metal | $1,779 | $999 | 44% |
| D2930 | Prefabricated Stainless Steel Crown | $375 | $262 | 30% |
| D2950 | Core Buildup | $358 | $252 | 30% |
| D3310 | Root Canal - Anterior | $1,335 | $934 | 30% |
| D3320 | Root Canal - Bicuspid | $1,462 | $1,023 | 30% |
| D3330 | Root Canal - Molar | $1,683 | $1,178 | 30% |
| D4341 | Perio Scaling and Root Planing, Per Quadrant | $366 | $256 | 30% |
| D4355 | Full Mouth Debridement | $245 | $171 | 30% |
| D4910 | Periodontal Maintenance | $221 | $155 | 30% |
| D5110 | Complete Denture - Upper | $2,339 | $1,637 | 30% |
| D5120 | Complete Denture - Lower | $2,339 | $1,637 | 30% |
| D5213 | Partial Denture - Upper | 2,584 | 1,809 | 30% |
| D5214 | Partial Denture - Lower | 2,584 | 1,809 | 30% |
| D6750 | Porcelain Retainer Crown | $1779 | $1,247 | 30% |
| D7140 | Simple Extraction | $243 | $170 | 30% |
| D7210 | Surgical Extraction | $384 | $269 | 30% |
| D8030 | Limited Orthodontic Treatment - Child | $TBD | $TBD | 30% |
| D8040 | Limited Orthodontic Treatment - Adult | $TBD | $TBD | 30% |
| All Other Services | $TBD | $TBD | 30% | |
*Member savings may vary by location. Free exams limited to 2x per member/per annual membership term.