
Savings to Smile About
Below is a list of common dental services and what you’ll pay with Perfect Teeth Dental Plan.
Savings Summary
ADA Code | Procedure Description | Member Pays* |
---|---|---|
Preventive & Diagnostic | ||
0120 | Periodic Exam | NO CHARGE |
0140 | Limited Exam - Problem Focused | NO CHARGE |
0150 | Comprehensive Exam | NO CHARGE |
0210 | Full Mouth X-Rays | NO CHARGE |
0330 | Panoramic X-Rays | NO CHARGE |
0431 | Oral Cancer Screening | NO CHARGE |
1110 | Adult Cleaning | 30% OFF |
1120 | Child Cleaning | 30% OFF |
Restorative | ||
2330 | Filling - 1 Surface, Anterior | 30% OFF |
2391 | Filling - 1 Surface, Posterior | 30% OFF |
2740 | Crown - Porcelain/Ceramic | 30% OFF |
Endodontics & Periodontics | ||
3310 | Root Canal - Anterior | 30% OFF |
3330 | Root Canal - Molar | 30% OFF |
4910 | Periodontal Maintenance | 30% OFF |
Prosthodontics & Oral Surgery | ||
7140 | Simple Extraction | 30% OFF |
7210 | Surgical Extraction | 30% OFF |
*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.
View Fee Schedule(s)