Savings to Smile About
Below is a list of common dental services and what you’ll pay with Oral Care 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 | Up to 50% off |
| D1120 | Child Cleaning | Up to 50% off |
| D1206 | Fluoride - Including Varnish | Up to 50% off |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | Up to 50% off |
| D2391 | Filling - 1 Surface, Posterior | Up to 50% off |
| D2740 | Crown - Porcelain/Ceramic | Up to 50% off |
| D2750 | Crown - Porcelain/High Noble Metal | Up to 50% off |
| D2950 | Core Buildup | Up to 50% off |
| Endodontics & Periodontics | ||
| D3310 | Root Canal - Anterior | Up to 50% off |
| D3320 | Root Canal - Bicuspid | Up to 50% off |
| D3330 | Root Canal - Molar | Up to 50% off |
| D4341 | Perio Scaling/Root Planing - 4+ Teeth | Up to 50% off |
| D4910 | Periodontal Maintenance | Up to 50% off |
| Prosthodontics & Oral Surgery | ||
| D5110 | Complete Denture (Upper or Lower) | Up to 50% off |
| D7140 | Simple Extraction | Up to 50% off |
| D7210 | Surgical Extraction | Up to 50% off |
*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.
View Fee Schedule(s)