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

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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