Savings Summary

Maximize the value of your Smile Protection Plan with exclusive member discounts on all dental services.

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Summary of Savings & Discounted Fees

ADA Code Description Member Pays
Diagnostic & Preventative
0120 Periodic Exam - Established Patient NO CHARGE
0140 Limited Exam - Problem Focused NO CHARGE
0150 Comprehensive Exam - New or Established Patient NO CHARGE
0210 Full Mouth X-Rays NO CHARGE
0220 First Film NO CHARGE
0272 Bitewings - Two Films NO CHARGE
0274 Bitewings - Four Films NO CHARGE
0330 Panoramic Film NO CHARGE
1110 Adult Cleaning $75
1120 Child Cleaning $55
1208 Topical Application of Fluoride $30
1351 Sealant - Per Tooth $25
Restorative - Fillings
2330 Composite - One Surface, Anterior $105
2391 Composite - One Surface, posterior $125
Restorative - Crowns
2740 Crown - Porcelain/Ceramic substrate $875
2750 Crown - Porcelain Fused to High Noble Metal $930
2920 Recementation - Crown $80
2950 Core Buildup $165
2954 Prefabricated Post and Core $260
Endodontics - Root Canals
3310 Root Canal - Anterior $690
3320 Root Canal - Bicuspid $791
3330 Root Canal - Molar $975
Periodontics
4341 Periodontal Scaling & Root Planing - 4+ Teeth (Per Quadrant) $160
4355 Full Mouth Debridement $130
4381 Localized Delivery of Antimicrobial Agents (Per Tooth) $39
4910 Periodontal Maintenance $112
Prosthodontics - Dentures & Bridges - Dentures & Partials
5213 -5214 Partial Denture - Upper or Lower $1,100
5225 - 5226 Partial Denture - Flexible Base - Upper or Lower $1,250
Oral Surgery - Extractions performed by General
7140 Extraction - Erupted Tooth $100
7210 Surgical Removal of Erupted Tooth $200

*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.

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