Savings to Smile About
Below is a list of common dental services and what you’ll pay with Preferred Dental Plan.
| SAVINGS SUMMARY | ||
|---|---|---|
| ADA Code | Procedure Description | Member 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 | 20-50% off |
| D1120 | Child Cleaning | 20-50% off |
| D1206 | Fluoride - Including Varnish | 20-50% off |
| D1208 | Fluoride - Excluding Varnish | 20-50% off |
| Restorative | ||
| D2331 | Filling - 2 Surface, Anterior | 20-50% off |
| D2392 | Filling - 2 Surface, Posterior | 20-50% off |
| D2740 | Crown - Porcelain/Ceramic | 20-50% off |
| Endodontics & Periodontics | ||
| D3320 | Root Canal - Bicuspid | 20-50% off |
| D3330 | Root Canal - Molar | 20-50% off |
| D4341 | Perio Scaling & Root Planing - 4+ Teeth (Per Quad) | 20-50% off |
| Prosthodontics & Oral Surgery | ||
| D7140 | Simple Extraction | 20-50% off |
| D7210 | Surgical Extraction | 20-50% off |
| Orthodontics | ||
| D8860 | Orthodontic Consult | NO CHARGE |
| Orthodontic Treatment | 5% off |
*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.