Frequently Asked Questions
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Find answers to your most commonly asked questions!
| CPT Code | Procedure Description | Essential Plan | Advantage Plan | Premier Plan | Discount Plan |
|---|---|---|---|---|---|
| Plan Inclusions | |||||
| D0120 | Periodic Exam | No Charge x 2 | No Charge x 2 | No Charge x 2 | No Charge x 2 |
| D0150 | Comprehensive Exam | No Charge x 2 | No Charge x 2 | No Charge x 2 | No Charge x 2 |
| D0145 | ORAL EVAL PT UNDER <3/PRIM CAREGIVER | No Charge x 2 | No Charge x 2 | No Charge x 2 | No Charge x 2 |
| D0180 | COMPREHENSIVE PERIODONTAL EVALUATION | No Charge x 2 | No Charge x 2 | No Charge x 2 | No Charge x 2 |
| D0190 | SCREENING OF A PATIENT | No Charge x 2 | No Charge x 2 | No Charge x 2 | No Charge x 2 |
| D0191 | ASSESSMENT OF A PATIENT | No Charge x 2 | No Charge x 2 | No Charge x 2 | No Charge x 2 |
| D1120 | Child Cleaning | No Charge x 2 | No Charge x 2 | No Charge x 3 | 30% off |
| D1110 | Adult Cleaning | $50 x 2 | No Charge x 2 | No Charge x 3 | 30% off |
| D4910 | Periodontal Maintenance | $75 x 2 | $25 x 2 | No Charge x 3 | 30% off |
| D0210 | Full Mouth X-Rays | No Charge | No Charge | No Charge | No Charge x 1 |
| D0220 | Intraoral periapical first radiographic image | No Charge | No Charge | No Charge | No Charge x 1 |
| D0230 | Intraoral periapical additional radiographic image | No Charge | No Charge | No Charge | No Charge x 1 |
| D0240 | Intraoral - occlusal radiographic image | No Charge | No Charge | No Charge | No Charge x 1 |
| D0260 | Extraoral - each additional radiographic image | No Charge | No Charge | No Charge | No Charge x 1 |
| D0270 | Bitewing single radiographic image | No Charge | No Charge | No Charge | No Charge x 1 |
| D0272 | Bitewings - two radiographic images | No Charge | No Charge | No Charge | No Charge x 1 |
| D0273 | Bitewings - 4 Images | No Charge | No Charge | No Charge | No Charge x 1 |
| D0274 | Bitewings — four radiographic images | No Charge | No Charge | No Charge | No Charge x 1 |
| D0277 | Vertical Bitewings | No Charge | No Charge | No Charge | No Charge x 1 |
| D0330 | Panoramic X-Rays | No Charge | No Charge | No Charge | 30% off |
| D0350 | 2D Oral Photographic Image | No Charge | No Charge | No Charge | 30% off |
| D0250 | EXTRAORAL-FIRST FILM | No Charge | No Charge | No Charge | No Charge x 1 |
| D0290 | POST., ANT. OR LATERAL SKULL AND FACIAL | No Charge | No Charge | No Charge | No Charge x 1 |
| D0140 | Emergency Exam | No Charge | No Charge | No Charge | No Charge |
| D0160 | DETAILED & EXTENS ORAL EVAL-PRB FOCUSED | No Charge | No Charge | No Charge | No Charge |
| D0170 | RE-EVAL. - LIMITED, PROBLEM FOCUSED | No Charge | No Charge | No Charge | No Charge |
| Plan Discounts | |||||
| D0000 - D0999 | Diagnostic | 30% off | 30% off | 30% off | 30% off |
| D1000 - D1999 | Preventive | 30% off | 30% off | 30% off | 30% off |
| D2000 - D2999 | Restorative | 30% off | 30% off | 30% off | 30% off |
| D3000 - D3999 | Endodontics | 30% off | 30% off | 30% off | 30% off |
| D4000 - D4999 | Periodontics | 30% off | 30% off | 30% off | 30% off |
| D5000 - D5899 | Prosthodontics - Removable | 30% off | 30% off | 30% off | 30% off |
| D5900 - D5999 | Maxillofacial Prosthetics | 30% off | 30% off | 30% off | 30% off |
| D6000 - D6199 | Implant Services | 30% off | 30% off | 30% off | 30% off |
| D6200 - D6999 | Prosthodontics - Fixed | 30% off | 30% off | 30% off | 30% off |
| D7000 - D7999 | Oral and Maxillofacial Surgery | 30% off | 30% off | 30% off | 30% off |
| D8000 - D8999 | Orthodontics | 30% off | 30% off | 30% off | 30% off |
| D9000 - D9999 | Adjunctive General Services | 30% off | 30% off | 30% off | 30% off |