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 20-30% OFF
D1120 Child Cleaning 20-30% OFF
D1206 Fluoride w/ Varnish 20-30% OFF
Restorative
D2330 Filling - 1 Surface, Anterior 20-30% OFF
D2391 Filling - 1 Surface, Posterior 20-30% OFF
D2740 Crown - Porcelain/Ceramic 20-30% OFF
D2750 Crown - Porcelain/High Noble Metal 20-30% OFF
D2950 Core Buildup - Including Pins 20-30% OFF
Endodontics & Periodontics
D3310 Root Canal - Anterior 20-30% OFF
D3320 Root Canal - Bicuspid 20-30% OFF
D3330 Root Canal - Molar 20-30% OFF
D4341 Perio Scaling/Root Planing - 4+ Teeth 20-30% OFF
D4910 Periodontal Maintenance 20-30% OFF
Prosthodontics & Oral Surgery
D5110 Complete Denture (Upper or Lower) 20-30% OFF
D5213 Partial Denture (Upper or Lower) 20-30% OFF
D7140 Simple Extraction 20-30% OFF
D7210 Surgical Extraction 20-30% OFF

*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term. Any services not listed are 30% off the office's Retail Fee(s).