ADA CodeProcedure DescriptionMember Pays*
Preventative, Diagnostic, & Hygiene
D0120Periodic ExamNO CHARGE
D0150Comprehensive ExamNO CHARGE
D0140Limited Exam - Problem FocusedNO CHARGE
D0210Full Mouth X-RaysNO CHARGE
D0274Bitewings - 4 ImagesNO CHARGE
D0330Panoramic X-RaysNO CHARGE
D0220Periapical X-RaysNO CHARGE
D1110Adult Cleaning30% Off
D0431Oral Cancer Screening30% Off
D1208Fluoride30% Off
Hygiene Services
D4910Periodontal Maintenance20% Off
D4341Perio Scaling / Root Planing - per quad20% Off
Miscellaneous Hygiene Services20% Off
Major Services
D6010Implants20% Off
D2740Crowns20% Off
D6245Bridges20% Off
D2950Core Buildup20% Off
Signature and Signature Elite Dentures20% Off
Other Denture Treatment20% Off
Basic Services
D2140Fillings15% off
D7140Simple Extraction15% off
D9000Miscellaneous General Dentistry15% off
Transformative
Take - Home Whitening Kits20% Off
Motto® Clear Aligners10% Off
This is just a Savings Summary - ADDITIONAL DISCOUNTS MAY BE AVAILABLE, SEE YOUR DENTAL OFFICE FOR COMPLETE LIST OF SAVINGS

Unless otherwise specified in this fee schedule, plan discounts do not apply to services performed by a dental specialist (i.e., periodontics, endodontics, orthodontics, and oral surgery) or dental hygiene products (e.g., chlorhexidine, toothbrushes, etc.). Member savings and plan incentives are exclusive to participating dental offices. Exact member savings and availability of certain procedures may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.