Savings to Smile About
Below is a list of common dental services and what you’ll pay with Smile Care Savings Plan.
| Savings Summary | ||
|---|---|---|
| ADA Code | Procedure Description | Member Pays* |
| Diagnostic | ||
| D0120 | Periodic Exam | 20-50% OFF |
| D0140 | Limited Exam - Problem Focused | 20-50% OFF |
| D0150 | Comprehensive Exam | 20-50% OFF |
| D0210 | Complete Series of X-Rays | 20-50% OFF |
| D0330 | Panoramic X-ray | 20-50% OFF |
| D0274 | 4 Bitewing X-rays | 20-50% OFF |
| Preventative | ||
| D1110 | Adult Cleaning | 20-50% OFF |
| D1120 | Child Cleaning | 20-50% OFF |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | 15-25% OFF |
| D2331 | Filling - 2 Surface, Anterior | 15-25% OFF |
| D2332 | Filling - 3 Surface, Anterior | 15-25% OFF |
| D2335 | Filling - 4 Surface, Anterior | 15-25% OFF |
| D2391 | Filling - 1 Surface, Posterior | 15-25% OFF |
| D2392 | Filling - 2 Surface, Posterior | 15-25% OFF |
| D2393 | Filling - 3 Surface, Posterior | 15-25% OFF |
| D2394 | Filling - 4 Surface, Posterior | 15-25% OFF |
*Member savings may vary by location. Exact member savings may vary if a board-certified specialist renders the dental services.