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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