Savings Summary
ADA CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
D0210Complete Series - Including BitewingsSelect State
D0330Panoramic FilmSelect State
D0150Comprehensive Oral EvaluationNo Charge
D1120Child CleaningSelect State
Restorative
D2330Composite Filling - One Surface, AnteriorSelect State
D2930Crown – Prefabricated Stainless Steel, Primary Tooth Select State
D7140Extraction - Erupted Tooth or Exposed RootSelect State
Orthodontics
D8080Comprehensive Orthodontic Treatment of the Adolescent DentitionSelect State
Vision
-Frames and Lenses (combined)Select State

*Member savings may vary by location. Free x-rays limited to 2x per member/per annual membership term.