DESCRIPTION OF SERVICES
ADA CodeProcedure DescriptionMember Pays*
HYGIENE BUNDLES
1st Hygiene Child Bundle:Exam, X-Rays, Fluoride, & Child Cleaning$71.00
Additional Member Pays:Exam, X-Rays, Fluoride, & Child Cleaning$150.00
1st Hygiene Adult Bundle:Exam, X-Rays, Fluoride, & Adult Cleaning$121.00
Additional Member Pays:Exam, X-Rays, Fluoride, & Child Cleaning$200
2nd Hygiene Child Bundle of the year:Exam, X-Rays, Fluoride, & Child Cleaning$150.00
2nd Hygiene Adult Bundle of the year:Exam, X-Rays, Fluoride, & Adult Cleaning$200.00
PREVENTATIVE & DIAGNOSTIC
D0140Limited Exam (Problem focused w/ necessary x-rays)Up to 85% off
D1351Sealant - Per ToothUp to 85% off
D1354Interim Caries Arresting Medicament ApplicationUp to 85% off
RESTORATIVE
D1510Space Maintainer - Fixed, Unilateral, per quad30-60% off
D1575Distal Shoe Space Maintainer - per quad30-60% off
D2330Composite Filling - One Surface, Anterior30-60% off
D2390Composite Crown, Anterior30-60% off
D2929Porcelain/Ceramic Crown30-60% off
D9230Nitrous Oxide30-60% off
Cell 1Cell 2Cell 3
20-50% OFF MOST OTHER SERVICES

*Services listed on Summary of Discounts, with the exception of Orthodontic services, are performed by your selected general dentist. Certain procedures may not be within the scope of practice or the ability of the general dentist.