Savings to Smile About
Below is a list of common dental services and what you’ll pay with Smile Select Membership.
Savings Summary
| ADA Code | Procedure Description | Member Pays* |
|---|---|---|
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | NO CHARGE |
| D0140 | Limited Exam - Problem Focused | NO CHARGE |
| D0150 | Comprehensive Exam | NO CHARGE |
| D0210 | Full Mouth X-Rays | NO CHARGE |
| D0330 | Panoramic X-Rays | NO CHARGE |
| D1110 | Adult Cleaning | $60.00 |
| D1120 | Child Cleaning | $40.00 |
| D1206 | Fluoride - Including Varnish | $27.00 |
| D1351 | Sealant - Per Tooth | $28.00 |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | $121.00 |
| D2391 | Filling - 1 Surface, Posterior | $122.00 |
| D2740 | Crown - Porcelain/Ceramic | 25% OFF |
| D2750 | Crown - Porcelain/High Noble Metal | 25% OFF |
| D2950 | Core Buildup - Including Pins | 25% OFF |
| Endodontics & Periodontics | ||
| D3310 | Root Canal - Anterior | 25% OFF |
| D3320 | Root Canal - Bicuspid | 25% OFF |
| D3330 | Root Canal - Molar | 25% OFF |
| D4341 | Perio Scaling/Root Planing - 4+ Teeth | $150.00 |
| D4910 | Periodontal Maintenance | $105.00 |
| Prosthodontics & Oral Surgery | ||
| D5110 | Complete Denture (Upper or Lower) | 25% OFF |
| D5213 | Partial Denture (Upper or Lower) | 25% OFF |
| D7140 | Simple Extraction | 25% OFF |
| D7210 | Surgical Extraction | 25% 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)