See How Much You Can Save
Sample Savings - Most Common Procedures General Dentist
*Note: there are more than 300+ procedures under this plan - the most common are listed below
| ADA Code | Description | Cost Without Plan** | You Pay | Your Savings*** |
|---|---|---|---|---|
| DIAGNOSTIC (Exam and X-Rays) | ||||
| D0210 | Complete Series of Radiograph Images - Intraoral | $165 | $0 | 100% |
| D0274 | Check-Up X-rays | $82 | $0 | 100% |
| D0220 | Intraoral - Periapical - First Radiographic Image | $42 | $0 | 100% |
| D0230 | Intraoral - Periapical - Each Additional Radiographic Image | $37 | $0 | 100% |
| D0270 | Bitewing - Single Radiographic Image | $42 | $0 | 100% |
| D0272 | Bitewing - Two Radiographic Images | $61 | $0 | 100% |
| D0273 | Bitewing - Three Radiographic Images | $71 | $0 | 100% |
| D0274 | Bitewing - Four Radiographic Images | $82 | $0 | 100% |
| D0330 | Panoramic Radiographic Image | $142 | $0 | 100% |
| D0140 | Emergency Visit | $90 | $20 | 78% |
| D0120 | Routine Visit | $66 | $30 | 55% |
| D0150 | Comprehensive Exam | $102 | $40 | 61% |
| D0145 | Check-Up For A Child (age 3 or under) | $79 | $20 | 75% |
| PREVENTATIVE (Cleanings, etc) | ||||
| D1110 | Prophy - Adult Cleaning (without bone loss) | $116 | $55 | 53% |
| D1120 | Prophy - Child Cleaning | $85 | $40 | 53% |
| D1351 | Sealant - Per Tooth | $66 | $35 | 53% |
| PERIODONTICS (Deep Cleaning) | ||||
| D4341 | Deep Cleaning (4 or more teeth per quad) | $310 | $140 | 55% |
| D4342 | Deep Cleaning (1-3 teeth per quad) | $230 | $110 | 53% |
| D4910 | Periodontal Maintenance (after deep cleaning) | $167 | $80 | 53% |
| RESTORATIVE (Fillings) | ||||
| D2140 | Amalgam - One Surface Filling | $190 | $70 | 64% |
| D2150 | Amalgam - Two Surface Filling | $238 | $90 | 63% |
| D2160 | Amalgam - Three Surface Filling | $285 | $105 | 64% |
| D2330 | Resin - Based Composite - One Surface Anterior | $217 | $90 | 59% |
| D2331 | Resin - Based Composite - Two Surface Anterior | $251 | $110 | 57% |
| D2332 | Resin - Based Composite - Three Surface Anterior | $302 | $120 | 60% |
| D2391 | Resin - Based Composite - One Surface Posterior | $220 | $100 | 55% |
| D2392 | Resin - Based Composite - Two Surface Posterior | $284 | $125 | 56% |
| D2393 | Resin - Based Composite - Three Surface Posterior | $368 | $150 | 60% |
| ENDODONTICS (Root Canals) | ||||
| D3310 | Root Canal – front tooth | $950 | $500 | 48% |
| D3320 | Root Canal – premolar | $1083 | $600 | 45% |
| D3330 | Root Canal – molar | $1220 | $700 | 43% |
| ORAL SURGERY (Extractions) | ||||
| D7140 | Extraction (erupted tooth) | $215 | $80 | 63% |
| D7210 | Extraction - Surgical removal of erupted tooth requiring removal of bone/sectioning tooth and including flap if indicated | $365 | $130 | 65% |
| D7220 | Extraction-Impacted Tooth (soft tissue) | $357 | $160 | 56% |
| D7230 | Extraction- Impacted Tooth (partial bony) | $415 | $199 | 53% |
| D7240 | Extraction-Impacted Tooth (complete bony) | $510 | $225 | 56% |
| PROSTHODONTICS (Crowns) | ||||
| D2750 | Crown - porcelain fused to high noble | $1480 | $740 | 50% |
| D2740 | Crown - porcelain | $1600 | $795 | 50% |
| D2950 | Core Buildup - Including Pins | $330 | $125 | 63% |
| D6240 | Bridge Pontic (Porcelain Fused to High Noble Metal) | $1480 | $740 | 50% |
| D6750 | Bridge Crown - Retainer (Porcelain Fused to High Noble Metal) | $1480 | $740 | 50% |
| PROSTHODONTICS (Dentures, Partials) | ||||
| D5110 | Complete Denture (top) | $2243 | $900 | 60% |
| D5120 | Complete Denture (bottom) | $2243 | $900 | 60% |
| D5130 | Immediate Denture (top) | $2284 | $900 | 61% |
| D5140 | Immediate Denture (bottom) | $2303 | $900 | 61% |
| D5213 | Removable Partial Denture (top) | $2131 | $950 | 56% |
| D5214 | Removable Partial Denture (bottom) | $2131 | $950 | 56% |
| ORTHODONTICS (Braces) | ||||
| D8080 | Braces (adolescent) | $8000* | $4200 | 50% |
| D8090 | Braces (adult) | $8000* | $4200 | 50% |
| IMPLANTS | ||||
| D6010 | Dental Implant | $2800 | $1400 | 50% |
| D6057 | Custom Fabricated Abutment - includes placement | $1200 | $600 | 50% |
| D6059 | Abutment supported porcelain fused to high noble crown | $1672 | $830 | 51% |
| ELECTIVE SERVICES (Cosmetic) | ||||
| D9972 | Teeth Whitening - In Office (Per Arch) | $450 | $250 | 58% |
| D2962 | Veneer | $1590 | $795 | 50% |
| D9941 | Night Guard/Athletic Mouthguards | $450 | $220 | 52% |
*Average Price is the 85th percentile cost in the United States of the usual and customary fee as reported by the American Dental Association 2018 Survey of Dental Fees for Orthodontists.
**Average Price is the 85th percentile cost in the Mountain Division of the United States of the usual and customary fee as reported by the American Dental Association 2018 Survey of Dental Fees.
***Sample savings reflect an average; exact savings may vary