ADA CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
D0120 Periodic Exam NO CHARGE
D0150 Comprehensive Exam NO CHARGE
D0210 Full Mouth X-Rays NO CHARGE
D0220 Periapical X-Rays NO CHARGE
D0330 Panoramic X-Rays NO CHARGE
D0140 Limited Exam (After 3 Complimentary Exams) 20% Off
D1110 Adult Cleaning 20% Off
D1206 Topical Application Fluoride Varnish 20% Off
Restorative
D2330 Filling - 1 Surface, Anterior 20% Off
D2391 Filling - 1 Surface, Posterior 20% Off
D2740 Crown - Porcelain/Ceramic 20% Off
D2950 Core Buildup - Including Pins 20% Off
Endodontics & Periodontics
Various Root Canal - General Dentistry Office 20% Off
Various Root Canal - Endodontics Office 10% Off
D4341 Perio Scaling/Root Planing - 4+ Teeth 20% Off
D4910 Periodontal Maintenance 20% Off
Prosthodontics & Oral Surgery
D5110 Full Upper Denture 20% Off
D7140 Simple Extraction 20% Off
D7210 Surgical Extraction 20% Off

*Member savings may vary by location. Comprehensive and Periodic exams are limited to a combination of 3 per member/per annual membership term at General Dentistry locations only.