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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 CodeProcedure DescriptionMember Pays*
Preventive & Diagnostic
0120Periodic ExamNO CHARGE
0140Limited Exam - Problem FocusedNO CHARGE
0150Comprehensive ExamNO CHARGE
0210Full Mouth X-RaysNO CHARGE
0330Panoramic X-RaysNO CHARGE
0431 Oral Cancer ScreeningNO CHARGE
1110Adult Cleaning30% OFF
1120Child Cleaning30% OFF
Restorative
2330Filling - 1 Surface, Anterior 30% OFF
2391Filling - 1 Surface, Posterior 30% OFF
2740Crown - Porcelain/Ceramic30% OFF
Endodontics & Periodontics
3310Root Canal - Anterior 30% OFF
3330Root Canal - Molar30% OFF
4910Periodontal Maintenance30% OFF
Prosthodontics & Oral Surgery
7140Simple Extraction30% OFF
7210Surgical Extraction30% 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)