ADA CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
D0120Periodic ExamNO CHARGE
D0150Comprehensive ExamNO CHARGE
D0210Full Mouth X-RaysNO CHARGE
D0220Periapical X-RaysNO CHARGE
D0330Panoramic X-RaysNO CHARGE
D0140Limited Exam (After 3 Complimentary Exams)20% Off
D1110Adult Cleaning20% Off
D1206Topical Application Fluoride Varnish20% Off
Restorative
D2330Filling - 1 Surface, Anterior20% Off
D2391Filling - 1 Surface, Posterior20% Off
D2740Crown - Porcelain/Ceramic20% Off
D2950Core Buildup - Including Pins20% Off
Endodontics & Periodontics
VariousRoot Canal - General Dentistry Office20% Off
VariousRoot Canal - Endodontics Office10% Off
D4341Perio Scaling/Root Planing - 4+ Teeth20% Off
D4910Periodontal Maintenance20% Off
Prosthodontics & Oral Surgery
D5110Full Upper Denture20% Off
D7140Simple Extraction20% Off
D7210Surgical Extraction20% 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.