Savings Summary
ADA CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
D0210 Complete Series - Including Bitewings Select State
D0330 Panoramic Film Select State
D0150 Comprehensive Oral Evaluation No Charge
D1120 Child Cleaning Select State
Restorative
D2330 Composite Filling - One Surface, Anterior Select State
D2930 Crown – Prefabricated Stainless Steel, Primary Tooth Select State
D7140 Extraction - Erupted Tooth or Exposed Root Select State
Orthodontics
D8080 Comprehensive Orthodontic Treatment of the Adolescent Dentition Select 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.