Savings to Smile About
Below is a list of common dental services and what you’ll pay.
| Savings Summary | ||
|---|---|---|
| ADA Code | Procedure Description | Member Pays* |
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | NO CHARGE |
| D0150 | Comprehensive Exam | NO CHARGE |
| D0210 | Full Mouth X-Rays | NO CHARGE |
| D0330 | Panoramic X-Rays | NO CHARGE |
| D1110 | Adult Cleaning | NO CHARGE |
| D1120 | Child Cleaning | NO CHARGE |
| D11206 | Fluoride - with Varnish | $22 |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | $150 |
| D2391 | Filling - 1 Surface, Posterior | $155 |
| Footer |
10-40% OFF OTHER SELECT SERVICES, SEE YOUR DENTAL OFFICE FOR COMPLETE LIST OF SAVINGS