Savings to Smile About
Below is a list of common dental services and what you’ll pay with Prosmile+ Membership.
| ADA Code | Procedure Description | Member Pays* |
|---|---|---|
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | $38.00 |
| D0140 | Periodic Exam - Problem Focused | $59.00 |
| D0150 | Comprehensive Exam | $49.00 |
| First 2 X-Rays | 2 Free X-Rays Per Yr. | No Charge |
| D0210 | Full Mouth X-Rays | $79.00 |
| D0330 | Panoramic X-Rays | $79.00 |
| D1110 | Adult Cleaning | $75.00 |
| Restorative | ||
| D2331 | Filling - 2 Surface, Anterior | $159.00 |
| D2392 | Filling - 2 Surface, Posterior | $179.00 |
| D2740 | Crown - Porcelain/Ceramic | $900.00 |
| Endodontics & Periodontics | ||
| D3310 | Root Canal - Anterior | $545.00 |
| D3320 | Root Canal - Bicuspid | $654.00 |
| D3330 | Root Canal - Molar | $763.00 |
| D4341 | Perio Scaling/Root Planing - 4+ Teeth | $147.00 |
| D4910 | Periodontal Maintenance | $169.00 |
| Prosthodontics, Oral Surgery, & Orthodontics | ||
| D7140 | Simple Extraction | $139.00 |
| D7210 | Surgical Extraction | $295.00 |
| D8080 | Comprehensive Ortho Treatment | $4,800.00 |
| D8040 | Limited Adult Ortho Treatment | $2,320.00 |
| D8010 | Limited Child Ortho Treatment | $2,080.00 |
*Member savings may vary by location. Free x-rays limited to 2x per member/per membership term.