| DIAGNOSTIC – D01000-D0999 |
|
|
| Examinations (D0120/D0150) |
$95 |
NO CHARGE |
| X-Rays |
$30 – $140 |
NO CHARGE |
| Oral Cancer Screening with VELscope® |
$10 |
NO CHARGE |
| Emergency Examination (D0140) |
$80 |
$40 |
| All Other Diagnostic Services |
|
35% OFF |
| PREVENTIVE CLEANINGS/HEALTHY GUMS |
|
|
| Adult Cleaning/Prophylaxis (D1110) |
$98 |
$0 2 Per Year |
| Child Cleaning/Prophylaxis (14 and under) (D1120) |
$72 |
$0 2 Per Year |
| DEEP CLEANINGS/PERIODONTAL THERAPY |
|
|
| Full-Mouth Debridement (D4355) |
$200 |
$80 |
| Periodontal Scaling & Root Planing (D4341/D4342) |
$275/$200 |
$150 |
| Periodontal Maintenance Cleaning (D4910) |
$150 |
$50 |
| PREVENTIVE – D1000-D99 |
|
|
| All Preventative Services other than Cleanings |
|
35% OFF |
| RESTORATIVE – D2000-D2999 |
|
|
| Fillings, Inlays, Onlays, Single Crowns |
|
35% OFF |
| ENDODONTICS – D3000-D3999 |
|
|
| Pulpotomies, Simple Root Canals |
|
35% OFF |
| PERIODONTICS – D4000-D4999 |
|
|
| Gingivectomy and Minor Periodontal Procedures |
|
35% OFF |
| PROSTHODONTICS – D5000-D5999 (REMOVABLE) |
|
|
| Partials and Complete Dentures, Repairs |
|
35% OFF |
| PROSTHODONTICS – D6200-D6999 (FIXED) |
|
|
| Crowns, Bridges, Inlays & Onlays |
|
35% OFF |
| ORAL SURGERY – D7000-D7999 |
|
|
| Simple Extractions |
|
35% OFF |
| ADJUNCTIVE SERVICES – D9000-D9999 |
|
|
| Consultations, Sedation, Bleaching & other miscellaneous services (excludes all retail products) |
|
20% OFF |
