RethinkMyHealthcare Dental Network

Offers you access to over 200,000 dentists and orthodontists nationwide who are part of the our network. You can now save thousands on dental care.

Savings start immediately when you become a Rethink My Healthcare member.
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Never Worry About Cost with Our Network

Savings apply to routine and preventative care like cleanings, exams, x-rays, and fillings, as well as more complex care like extractions, root canals and crowns.

The Dental Care Savings program also includes savings on dental specialist care, including care from oral surgeons, periodontists, Prosthodontists, and children?s specialists.
Procedure CodeDental ProcedureAverage Member Cost
D0230Intraoral - Periapical Each Additional Film13
D0220Intraoral - Periapical First Film18
D0270Bitewing - Single Film19
D9215Local Anesthesia In Conjunction With Operative Or Surgical Procedures21
D1208Topical Application Of Fluoride25
D9210Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures27
D0240Intraoral - Occlusal Film28
D0251Extra-Oral Posterior Dental Radiographic Image29
D0272Bitewings - Two Films29
D9211Regional Block Anesthesia30
D0120Periodic Oral Evaluation - Established Patient33
D1310Nutritional Counseling For Control Of Dental Disease33
D9610Therapeutic Parenteral Drug Single Administration33
D0273Bitewings - Three Films34
D0145Oral Evaluation For A Patient Under Three Years Of Age And Counseling With Primary Caregiver35
D0250Extraoral - First Film35
D0460Pulp Vitality Tests35
D1320Tobacco Counseling For The Control And Prevention Of Oral Disease36
D1351Sealant - Per Tooth36
D1352Preventive Resin Restoration In A Moderate To High Caries Risk Patient ? Permanent Tooth36
D1353Sealant Repair ? Per Tooth36
D1206Topical Fluoride Varnish; Therapeutic Application For Moderate To High Caries Risk Patients38
D2951Pin Retention - Per Tooth In Addition To Restoration39
D9230Inhalation Of Nitrous Oxide / Anxiolysis Analgesia39
D0274Bitewings - Four Films40
D0170Re-Evaluation - Limited Problem Focused (Established Patient; Not Post-Operative Visit)41
D3120Pulp Cap - Indirect (Excluding Final Restoration)41
D0350Oral/Facial Photographic Images45
D1330Oral Hygiene Instructions45
D8660Pre-Orthodontic Treatment Visit47
D1120Prophylaxis - Child48
D9612Therapeutic Parenteral Drugs Two Or More Administrations Different Medications48
D0140Limited Oral Evaluation - Problem Focused49
D9219Evaluation For Deep Sedation Or General Anesthesia49
D9430Office Visit For Observation (During Regularly Scheduled Hours) - No Other Services Performed49
D6096remove broken implant retaining screw50
D1550Re-Cementation Of Space Maintainer51
D3110Pulp Cap - Direct (Excluding Final Restoration)52
D5410Adjust Complete Denture - Maxillary52
D5411Adjust Complete Denture - Mandibular52
D5421Adjust Partial Denture - Maxillary52
D5422Adjust Partial Denture - Mandibular52
D7881Occlusal Orthotic Device Adjustment52
D8681Removable Orthodontic Retainer Adjustment52
D9943Occlusal Guard Adjustment52
D0150Comprehensive Oral Evaluation - New Or Established Patient54
D9970Enamel Microabrasion56
D9973External Bleaching - Per Tooth56
D1555Removal Of Fixed Space Maintainer62
D0180Comprehensive Periodontal Evaluation - New Or Established Patient64
D1110Prophylaxis - Adult64
D9932Cleaning And Inspection Of Removable Complete Denture Maxillary64
D9933Cleaning And Inspection Of Removable Complete Denture Mandibular64
D9934Cleaning And Inspection Of Removable Partial Denture Maxillary64
D9935Cleaning And Inspection Of Removable Partial Denture Mandibular64
D0277Vertical Bitewings - 7 To 8 Films65
D4381Localized Delivery Of Antimicrobial Agents Via A Controlled Release Vehicle Into Diseased Crevicular Tissue Per Tooth By Report65
D9110Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure65
D9248Non-Intravenous Conscious Sedation65
D2910Recement Inlay Onlay Or Partial Coverage Restoration67
D2915Recement Cast Or Prefabricated Post And Core68
D2920Recement Crown68
D2940Protective Restoration71
D2941Interim Therapeutic Restoration ? Primary Dentition71
D9120Fixed Partial Denture Sectioning71
D7111Extraction Coronal Remnants - Deciduous Tooth72
D0470Diagnostic Casts73
D9971Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections74
D0330Panoramic Film77
D2140Amalgam - One Surface Primary Or Permanent81
D7288Brush Biopsy - Transepithelial Sample Collection81
D6092Recement Implant/Abutment Supported Crown83
D9440Office Visit - After Regularly Scheduled Hours84
D5520Replace Missing Or Broken Teeth - Complete Denture (Each Tooth)86
D0210Intraoral - Complete Series (Including Bitewings)89
D2971Additional Procedures To Construct New Crown Under Existing Partial Denture Framework89
D9951Occlusal Adjustment - Limited89
D7287Exfoliative Cytological Sample Collection90
D5850Tissue Conditioning Maxillary91
D5851Tissue Conditioning Mandibular91
D4342Periodontal Scaling And Root Planing - One To Three Teeth Per Quadrant92
D6081Scaling And Debridement In The Presence Of Inflammation Or Mucositis Of A Single Implant Including Cleaning Of The Implant Surfaces Without Flap Entry And Closure92
D8691Repair Of Orthodontic Appliance92
D6091Replacement Of Semi-Precision Or Precision Attachment (Male Or Female Component) Of Implant/Abutment Supported Prosthesis Per Attachment93
D6093Recement Implant/Abutment Supported Fixed Partial Denture93
D6930Recement Fixed Partial Denture93
D5640Replace Broken Teeth - Per Tooth94
D0340Cephalometric Film97
D4346Scaling In Presence Of Generalized Moderate Or Severe Gingival Inflammation ? Full Mouth After Oral Evaluation97
D4910Periodontal Maintenance97
D2330Resin-Based Composite - One Surface Anterior99
D2921Reattachment Of Tooth Fragment Incisal Edge Or Cusp99
D7140Extraction Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)101
D9239intravenous moderate (conscious) sedation/analgesia- first 15 minutes101
D9243Intravenous Moderate (Conscious) Sedation/Analgesia ? Each 15 Minute Increment101
D5511repair broken complete denture base mandibular103
D5512repair broken complete denture base maxillary103
D4355Full Mouth Debridement To Enable Comprehensive Evaluation And Diagnosis104
D2150Amalgam - Two Surfaces Primary Or Permanent106
D1354Interim Caries Arresting Medicament Application108
D6080Implant Maintenance Procedures Including Removal Of Prosthesis Cleansing Of Prosthesis And Abutments And Reinsertion Of Prosthesis108
D2957Each Additional Prefabricated Post - Same Tooth112
D5611repair resin partial denture base mandibular112
D5612repair resin partial denture base maxillary112
D2391Resin-Based Composite - One Surface Posterior114
D2980Crown Repair By Report116
D2981Inlay Repair Necessitated By Restorative Material Failure116
D2982Onlay Repair Necessitated By Restorative Material Failure116
D2983Veneer Repair Necessitated By Restorative Material Failure116
D6090Repair Implant Supported Prosthesis By Report116
D7510Incision And Drainage Of Abscess - Intraoral Soft Tissue117
D3220Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament118
D0391Interpretation Of Diagnostic Image By A Practitioner Not Associated With Capture Of The Image Including Report119
D9310Consultation - Diagnostic Service Provided By Dentist Or Physician Other Than Requesting Dentist Or Physician119
D2331Resin-Based Composite - Two Surfaces Anterior125
D3352Apexification/Recalcification/Pulpal Regeneration - Interim Medication Replacement (Apical Closure/Calcific Repair Of Perforations Root Resorption Pulp Space Disinfection Etc.)125
D3356Pulpal Regeneration - Interim Medication Replacement125
D9222deep sedation/general anesthesia ? first 15 minutes125
D9223Deep Sedation/General Anesthesia ? Each 15 Minute Increment125
D3230Pulpal Therapy (Resorbable Filling) - Anterior Primary Tooth (Excluding Final Restoration)126
D5621repair cast partial framework mandibular126
D5622repair cast partial framework maxillary126
D3221Pulpal Debridement Primary And Permanent Teeth128
D5650Add Tooth To Existing Partial Denture128
D2160Amalgam - Three Surfaces Primary Or Permanent131
D7971Excision Of Pericoronal Gingiva133
D3240Pulpal Therapy (Resorbable Filling) - Posterior Primary Tooth (Excluding Final Restoration)137
D9942Repair And/Or Reline Of Occlusal Guard137
D2953Each Additional Indirectly Fabricated Post - Same Tooth140
D0160Detailed And Extensive Oral Evaluation - Problem Focused By Report141
D3429Bone Graft In Conjunction With Periradicular Surgery ? Each Additional Contiguous Tooth In The Same Surgical Site146
D4264Bone Replacement Graft - Each Additional Site In Quadrant146
D7311Alveoloplasty In Conjunction With Extractions - One To Three Teeth Or Tooth Spaces Per Quadrant146
D5630Repair Or Replace Broken Clasp147
D2332Resin-Based Composite - Three Surfaces Anterior151
D3333Internal Root Repair Of Perforation Defects151
D6104Bone Graft At Time Of Implant Placement151
D7953Bone Replacement Graft For Ridge Preservation ? Per Site151
D2392Resin-Based Composite - Two Surfaces Posterior153
D9410House/Extended Care Facility Call153
D4211Gingivectomy Or Gingivoplasty - One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant155
D5660Add Clasp To Existing Partial Denture156
D2161Amalgam - Four Or More Surfaces Primary Or Permanent160
D6920Connector Bar161
D6980Fixed Partial Denture Repair By Report161
D4341Periodontal Scaling And Root Planing - Four Or More Teeth Per Quadrant164
D2955Post Removal (Not In Conjunction With Endodontic Therapy)172
D7210Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth And Including Elevation Of Mucoperiosteal Flap If Indicated173
D3430Retrograde Filling - Per Root175
D2950Core Buildup Including Any Pins176
D3331Treatment Of Root Canal Obstruction; Non-Surgical Access176
D2335Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior)180
D7250Surgical Removal Of Residual Tooth Roots (Cutting Procedure)186
D2393Resin-Based Composite - Three Surfaces Posterior190
D2930Prefabricated Stainless Steel Crown - Primary Tooth193
D5740Reline Maxillary Partial Denture (Chairside)196
D5741Reline Mandibular Partial Denture (Chairside)196
D9420Hospital Or Ambulatory Surgical Center Call205
D7310Alveoloplasty In Conjunction With Extractions ? Four Or More Teeth Or Tooth Spaces Per Quadrant208
D2390Resin-Based Composite Crown Anterior209
D4274Distal Or Proximal Wedge Procedure (When Not Performed In Conjunction With Surgical Procedures In The Same Anatomical Area)213
D6940Stress Breaker213
D7220Removal Of Impacted Tooth - Soft Tissue213
D7511Incision And Drainage Of Abscess - Intraoral Soft Tissue - Complicated (Includes Drainage Of Multiple Fascial Spaces)213
D5730Reline Complete Maxillary Denture (Chairside)214
D5731Reline Complete Mandibular Denture (Chairside)214
D2931Prefabricated Stainless Steel Crown - Permanent Tooth218
D2954Prefabricated Post And Core In Addition To Crown220
D7294Surgical Placement: Temporary Anchorage Device Without Surgical Flap221
D2394Resin-Based Composite - Four Or More Surfaces Posterior230
D3426Apicoectomy/Periradicular Surgery (Each Additional Root)231
D1510Space Maintainer - Fixed - Unilateral241
D1575Distal Shoe Space Maintainer ? Fixed ? Unilateral241
D7321Alveoloplasty Not In Conjunction With Extractions - One To Three Teeth Or Tooth Spaces Per Quadrant248
D2799Provisional Crown? Further Treatment Or Completion Of Diagnosis Necessary Prior To Final Impression252
D6085Provisional Implant Crown252
D6793Provisional Retainer Crown252
D2932Prefabricated Resin Crown260
D6253Provisional Pontic264
D7293Surgical Placement: Temporary Anchorage Device Requiring Surgical Flap266
D4321Provisional Splinting - Extracoronal271
D9974Internal Bleaching - Per Tooth274
D3920Hemisection (Including Any Root Removal) Not Including Root Canal Therapy275
D3428Bone Graft In Conjunction With Periradicular Surgery ? Per Tooth Single Site276
D4263Bone Replacement Graft - First Site In Quadrant276
D6103Bone Graft For Repair Of Periimplant Defect ? Not Including Flap Entry And Closure Or When Indicated Placement Of A Barrier Membrane Or Biologic Materials To Aid In Osseous Regeneration276
D3351Apexification/Recalcification/Pulpal Regeneration ? Initial Visit (Apical Closure/Calcific Repair Of Perforations Root Resorption Pulp Space Disinfection Etc.)277
D3355Pulpal Regeneration - Initial Visit277
D3357Pulpal Regeneration - Completion Of Treatment277
D2952Post And Core In Addition To Crown Indirectly Fabricated279
D5760Reline Maxillary Partial Denture (Laboratory)285
D5761Reline Mandibular Partial Denture (Laboratory)285
D7230Removal Of Impacted Tooth - Partially Bony286
D5750Reline Complete Maxillary Denture (Laboratory)288
D5751Reline Complete Mandibular Denture (Laboratory)288
D6545Retainer - Cast Metal For Resin Bonded Fixed Prosthesis291
D6549Resin Retainer ? For Resin Bonded Fixed Prosthesis291
D1520Space Maintainer - Removable - Unilateral294
D2929Prefabricated Porcelain/Ceramic Crown ? Primary Tooth298
D2933Prefabricated Stainless Steel Crown With Resin Window298
D2934Prefabricated Esthetic Coated Stainless Steel Crown - Primary Tooth298
D7286Biopsy Of Oral Tissue - Soft304
D4241Gingival Flap Procedure Including Root Planing - One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant311
D4320Provisional Splinting - Intracoronal311
D6101Debridement Of A Periimplant Defect And Surface Cleaning Of Exposed Implant Surfaces Including Flap Entry And Closure311
D4266Guided Tissue Regeneration - Resorbable Barrier Per Site313
D2712Crown - ? Resin-Based Composite (Indirect)314
D2710Crown - Resin-Based Composite (Indirect)319
D7972Surgical Reduction Of Fibrous Tuberosity323
D1516space maintainer ? fixed ? bilateral maxillary324
D1517space maintainer ? fixed ? bilateral mandibular324
D7270Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth332
D7240Removal Of Impacted Tooth - Completely Bony335
D7251Coronectomy ? Intentional Partial Tooth Removal335
D7295Harvest Of Bone For Use In Autogenous Grafting Procedure335
D8680Orthodontic Retention (Removal Of Appliances Construction And Placement Of Retainer(S))348
D9972External Bleaching - Per Arch350
D5820Interim Partial Denture (Maxillary)351
D6548Retainer - Porcelain/Ceramic For Resin Bonded Fixed Prosthesis352
D3450Root Amputation - Per Root354
D5720Rebase Maxillary Partial Denture358
D5721Rebase Mandibular Partial Denture358
D5711Rebase Complete Mandibular Denture361
D7320Alveoloplasty Not In Conjunction With Extractions ?four Or More Teeth Or Tooth Spaces Per Quadrant372
D5821Interim Partial Denture (Mandibular)373
D4245Apically Positioned Flap375
D5710Rebase Complete Maxillary Denture380
D7280Surgical Access Of An Unerupted Tooth382
D7960Frenulectomy ? Also Known As Frenectomy Or Frenotomy ? Separate Procedure Not Incidental To Another Procedure389
D6950Precision Attachment404
D4267Guided Tissue Regeneration - Nonresorbable Barrier Per Site (Includes Membrane Removal)405
D3353Apexification/Recalcification - Final Visit (Includes Completed Root Canal Therapy - Apical Closure/Calcific Repair Of Perforations Root Resorption Etc.)410
D3332Incomplete Endodontic Therapy; Inoperable Unrestorable Or Fractured Tooth411
D8210Removable Appliance Therapy411
D8220Fixed Appliance Therapy411
D1526space maintainer ? removable ? bilateral maxillary414
D1527space maintainer ? removable ? bilateral mandibular414
D7970Excision Of Hyperplastic Tissue - Per Arch415
D7292Surgical Placement: Temporary Anchorage Device [screw Retained Plate] Requiring Surgical Flap425
D7241Removal Of Impacted Tooth - Completely Bony With Unusual Surgical Complications428
D7963Frenuloplasty430
D6056Prefabricated Abutment - Includes Placement438
D4210Gingivectomy Or Gingivoplasty - Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant452
D5810Interim Complete Denture (Maxillary)457
Grand Total458
D4261Osseous Surgery (Including Flap Entry And Closure) - One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant464
D6102Debridement And Osseous Contouring Of A Periimplant Defect; Includes Surface Cleaning Of Exposed Implant Surfaces And Flap Entry And Closure464
D9952Occlusal Adjustment - Complete476
D9944occlusal guard ? hard appliance full arch478
D9945occlusal guard ? soft appliance full arch478
D9946occlusal guard ? hard appliance partial arch478
D3310Endodontic Therapy Anterior Tooth (Excluding Final Restoration)481
D5811Interim Complete Denture (Mandibular)487
D5670Replace All Teeth And Acrylic On Cast Metal Framework (Maxillary)488
D5671Replace All Teeth And Acrylic On Cast Metal Framework (Mandibular)488
D2650Inlay - Resin-Based Composite - One Surface494
D2662Onlay - Resin-Based Composite - Two Surfaces495
D7880Occlusal Orthotic Device By Report505
D8010Limited Orthodontic Treatment Of The Primary Dentition518
D8020Limited Orthodontic Treatment Of The Transitional Dentition518
D8030Limited Orthodontic Treatment Of The Adolescent Dentition518
D8040Limited Orthodontic Treatment Of The Adult Dentition518
D7952Sinus Augmentation Via A Vertical Approach527
D4240Gingival Flap Procedure Including Root Planing - Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant528
D6052Semi-Precision Attachment Abutment541
D6057Custom Abutment - Includes Placement541
D2510Inlay - Metallic - One Surface544
D4275Soft Tissue Allograft548
D4285Non-Autogenous Connective Tissue Graft Procedure (Including Recipient Surgical Site And Donor Material) ? Each Additional Contiguous Tooth Implant Or Edentulous Tooth Position In Same Graft Site548
D3410Apicoectomy/Periradicular Surgery - Anterior560
D3427Periradicular Surgery Without Apicoectomy560
D2960Labial Veneer (Resin Laminate) - Chairside564
D6604Inlay - Cast Predominantly Base Metal Two Surfaces570
D4249Clinical Crown Lengthening - Hard Tissue575
D6606Inlay - Cast Noble Metal Two Surfaces576
D6602Inlay - Cast High Noble Metal Two Surfaces583
D3320Endodontic Therapy Bicuspid Tooth (Excluding Final Restoration)587
D6600Inlay - Porcelain/Ceramic Two Surfaces593
D5282removable unilateral partial denture ? one piece cast metal (including clasps and teeth) maxillary602
D5283removable unilateral partial denture ? one piece cast metal (including clasps and teeth) mandibular602
D2520Inlay - Metallic - Two Surfaces604
D2651Inlay - Resin-Based Composite - Two Surfaces608
D2663Onlay - Resin-Based Composite - Three Surfaces609
D3421Apicoectomy/Periradicular Surgery - Bicuspid (First Root)626
D4270Pedicle Soft Tissue Graft Procedure626
D6055Connecting Bar ? Implant Supported Or Abutment Supported634
D6608Onlay -Porcelain/Ceramic Two Surfaces634
D2610Inlay - Porcelain/Ceramic - One Surface639
D6612Onlay - Cast Predominantly Base Metal Two Surfaces640
D2961Labial Veneer (Resin Laminate) - Laboratory641
D4277Free Soft Tissue Graft Procedure (Including Donor Site Surgery) First Tooth Or Edentulous Tooth Position In Graft641
D4278Free Soft Tissue Graft Procedure (Including Donor Site Surgery) Each Additional Contiguous Tooth Or Edentulous Tooth Position In Same Graft Site641
D6605Inlay - Cast Predominantly Base Metal Three Or More Surfaces646
D6614Onlay - Cast Noble Metal Two Surfaces650
D2652Inlay - Resin-Based Composite - Three Or More Surfaces653
D6610Onlay - Cast High Noble Metal Two Surfaces653
D2664Onlay - Resin-Based Composite - Four Or More Surfaces654
D6241Pontic - Porcelain Fused To Predominantly Base Metal654
D6607Inlay - Cast Noble Metal Three Or More Surfaces654
D7485Surgical Reduction Of Osseous Tuberosity658
D6205Pontic - Indirect Resin Based Composite659
D6603Inlay - Cast High Noble Metal Three Or More Surfaces662
D6710Crown - Indirect Resin Based Composite663
D6609Onlay - Porcelain/Ceramic Three Or More Surfaces665
D3346Retreatment Of Previous Root Canal Therapy - Anterior670
D6211Pontic - Cast Predominantly Base Metal670
D7471Removal Of Lateral Exostosis (Maxilla Or Mandible)671
D2620Inlay - Porcelain/Ceramic - Two Surfaces674
D6601Inlay - Porcelain/Ceramic Three Or More Surfaces675
D6615Onlay - Cast Noble Metal Three Or More Surfaces676
D7285Biopsy Of Oral Tissue - Hard (Bone Tooth)679
D6634Onlay - Titanium680
D2542Onlay - Metallic-Two Surfaces683
D6781Crown - 3/4 Cast Predominantly Base Metal683
D6242Pontic - Porcelain Fused To Noble Metal690
D6791Crown - Full Cast Predominantly Base Metal694
D2642Onlay - Porcelain/Ceramic - Two Surfaces695
D6782Crown - 3/4 Cast Noble Metal695
D2530Inlay - Metallic - Three Or More Surfaces696
D2962Labial Veneer (Porcelain Laminate) - Laboratory698
D6212Pontic - Cast Noble Metal699
D6613Onlay - Cast Predominantly Base Metal Three Or More Surfaces700
D6751Crown - Porcelain Fused To Predominantly Base Metal704
D3425Apicoectomy/Periradicular Surgery - Molar (First Root)708
D6624Inlay - Titanium708
D2781Crown - 3/4 Cast Predominantly Base Metal710
D4273Subepithelial Connective Tissue Graft Procedures Per Tooth712
D4283Autogenous Connective Tissue Graft Procedure (Including Donor And Recipient Surgical Sites) ? Each Additional Contiguous Tooth Implant Or Edentulous Tooth Position In Same Graft Site712
D6240Pontic - Porcelain Fused To High Noble Metal713
D6792Crown - Full Cast Noble Metal713
D6210Pontic - Cast High Noble Metal714
D2543Onlay - Metallic-Three Surfaces719
D2791Crown - Full Cast Predominantly Base Metal721
D6611Onlay - Cast High Noble Metal Three Or More Surfaces721
D6245Pontic - Porcelain/Ceramic725
D6752Crown - Porcelain Fused To Noble Metal726
D6214Pontic - Titanium727
D2630Inlay - Porcelain/Ceramic - Three Or More Surfaces728
D2751Crown - Porcelain Fused To Predominantly Base Metal730
D6780Crown - 3/4 Cast High Noble Metal730
D2792Crown - Full Cast Noble Metal732
D6783Crown - 3/4 Porcelain/Ceramic732
D2782Crown - 3/4 Cast Noble Metal734
D6790Crown - Full Cast High Noble Metal737
D7473Removal Of Torus Mandibularis738
D2643Onlay - Porcelain/Ceramic - Three Surfaces745
D5864Overdenture ? Partial Maxillary745
D5866Overdenture ? Partial Mandibular745
D6794Crown - Titanium750
D2752Crown - Porcelain Fused To Noble Metal751
D2780Crown - 3/4 Cast High Noble Metal754
D2790Crown - Full Cast High Noble Metal757
D2544Onlay - Metallic-Four Or More Surfaces761
D3330Endodontic Therapy Molar (Excluding Final Restoration)766
D6985Pediatric Partial Denture Fixed767
D2783Crown - 3/4 Porcelain/Ceramic774
D6740Crown - Porcelain/Ceramic776
D3347Retreatment Of Previous Root Canal Therapy - Bicuspid780
D7472Removal Of Torus Palatinus782
D6750Crown - Porcelain Fused To High Noble Metal783
D5211Maxillary Partial Denture - Resin Base (Including Any Conventional Clasps Rests And Teeth)787
D5221Immediate Maxillary Partial Denture ? Resin Base (Including Any Conventional Clasps Rests And Teeth)787
D2794Crown - Titanium789
D2750Crown - Porcelain Fused To High Noble Metal802
D2644Onlay - Porcelain/Ceramic - Four Or More Surfaces804
D2740Crown - Porcelain/Ceramic Substrate806
D4276Combined Connective Tissue And Double Pedicle Graft Per Tooth829
D4260Osseous Surgery (Including Flap Entry And Closure) - Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant833
D5863Overdenture ? Complete Maxillary840
D5865Overdenture ? Complete Mandibular840
D5212Mandibular Partial Denture - Resin Base (Including Any Conventional Clasps Rests And Teeth)878
D5222Immediate Mandibular Partial Denture ? Resin Base (Including Any Conventional Clasps Rests And Teeth)878
D7520Incision And Drainage Of Abscess - Extraoral Soft Tissue907
D5110Complete Denture - Maxillary934
D5120Complete Denture - Mandibular934
D6094Abutment Supported Crown - (Titanium)945
D3348Retreatment Of Previous Root Canal Therapy - Molar955
D6194Abutment Supported Retainer Crown For Fpd - (Titanium)979
D6063Abutment Supported Cast Metal Crown (Predominantly Base Metal)987
D5225Maxillary Partial Denture - Flexible Base (Including Any Clasps Rests And Teeth)991
D5226Mandibular Partial Denture - Flexible Base (Including Any Clasps Rests And Teeth)991
D7521Incision And Drainage Of Abscess - Extraoral Soft Tissue - Complicated (Includes Drainage Of Multiple Fascial Spaces)997
D5130Immediate Denture - Maxillary1011
D5140Immediate Denture - Mandibular1011
D5213Maxillary Partial Denture - Cast Metal Framework With Resin Denture Bases (Including Any Conventional Clasps Rests And Teeth)1029
D5214Mandibular Partial Denture - Cast Metal Framework With Resin Denture Bases (Including Any Conventional Clasps Rests And Teeth)1029
D5223Immediate Maxillary Partial Denture ? Cast Metal Framework With Resin Denture Bases (Including Any Conventional Clasps Rests And Teeth)1029
D5224Immediate Mandibular Partial Denture ? Cast Metal Framework With Resin Denture Bases (Including Any Conventional Clasps Rests And Teeth)1029
D6064Abutment Supported Cast Metal Crown (Noble Metal)1044
D6073Abutment Supported Retainer For Cast Metal Fpd (Predominantly Base Metal)1068
D6060Abutment Supported Porcelain Fused To Metal Crown (Predominantly Base Metal)1126
D6067Implant Supported Metal Crown (Titanium Titanium Alloy High Noble Metal)1126
D6077Implant Supported Retainer For Cast Metal Fpd (Titanium Titanium Alloy Or High Noble Metal)1129
D6070Abutment Supported Retainer For Porcelain Fused To Metal Fpd (Predominantly Base Metal)1132
D6074Abutment Supported Retainer For Cast Metal Fpd (Noble Metal)1135
D6062Abutment Supported Cast Metal Crown (High Noble Metal)1146
D6061Abutment Supported Porcelain Fused To Metal Crown (Noble Metal)1152
D6071Abutment Supported Retainer For Porcelain Fused To Metal Fpd (Noble Metal)1155
D6066Implant Supported Porcelain Fused To Metal Crown (Titanium Titanium Alloy High Noble Metal)1163
D6076Implant Supported Retainer For Porcelain Fused To Metal Fpd (Titanium Titanium Alloy Or High Noble Metal)1163
D6072Abutment Supported Retainer For Cast Metal Fpd (High Noble Metal)1169
D6065Implant Supported Porcelain/Ceramic Crown1189
D6075Implant Supported Retainer For Ceramic Fpd1195
D6069Abutment Supported Retainer For Porcelain Fused To Metal Fpd (High Noble Metal)1198
D6059Abutment Supported Porcelain Fused To Metal Crown (High Noble Metal)1199
D6068Abutment Supported Retainer For Porcelain/Ceramic Fpd1204
D6058Abutment Supported Porcelain/Ceramic Crown1210
D6110Implant /Abutment Supported Removable Denture For Edentulous Arch ? Maxillary1575
D6111Implant /Abutment Supported Removable Denture For Edentulous Arch ? Mandibular1575
D6112Implant /Abutment Supported Removable Denture For Partially Edentulous Arch ? Maxillary1575
D6113Implant /Abutment Supported Removable Denture For Partially Edentulous Arch ? Mandibular1575
D6010Surgical Placement Of Implant Body: Endosteal Implant2109
D6013Surgical Placement Of Mini Implant2109
D8050Interceptive Orthodontic Treatment Of The Primary Dentition2153
D8060Interceptive Orthodontic Treatment Of The Transitional Dentition2153
D8070Comprehensive Orthodontic Treatment Of The Transitional Dentition4310
D8080Comprehensive Orthodontic Treatment Of The Adolescent Dentition4310
D8090Comprehensive Orthodontic Treatment Of The Adult Dentition4310
Our plans provides discounts at certain providers for healthcare, wellness, and lifestyle services. Members must pay for all services at the time of service, but will receive a reduced price from those providers who have contracted with the program operator. Providers may not be available in all locations. Offers are subject to change without notice.