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