Savings to Smile About
Below is a list of common dental services and what you’ll pay with Gentle Dental Plan.
| Savings Summary | ||
|---|---|---|
| ADA Code | Procedure Description | Member Pays* |
| Preventive & Diagnostic | ||
| Any first 2 Exams needed per member/per annual membership term | NO CHARGE | |
| Any first 2 X-Rays needed per member/per annual membership term | NO CHARGE | |
| D0120 | Periodic Exam | $25.00 |
| D0140 | Limited Exam - Problem Focused | $25.00 |
| D1110 | Adult Cleaning | $85.00 |
| D1120 | Child Cleaning | $75.00 |
| D1206 | Fluoride - Including Varnish | $45.00 |
| D1351 | Sealant - Per Tooth | $45.00 |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | $160.00 |
| D2391 | Filling - 1 Surface, Posterior | $170.00 |
| D2740 | Crown - Porcelain/Ceramic | $1,135.00 |
| D2750 | Crown - Porcelain/High Noble Metal | $1,135.00 |
| D2950 | Core Buildup - Including Pins | $265.00 |
| Endodontics & Periodontics | ||
| D3310 | Root Canal - Anterior | $725.00 |
| D3320 | Root Canal - Bicuspid | $830.00 |
| D3330 | Root Canal - Molar | $1,030.00 |
| D4341 | Perio Scaling/Root Planing - 4+ Teeth | $199.00 |
| D4910 | Periodontal Maintenance | $135.00 |
| Prosthodontics & Oral Surgury | ||
| D5110 | Complete Denture (Upper or Lower) | $1,295.00 |
| D5213 | Partial Denture (Upper or Lower) | $1,335.00 |
| D7140 | Simple Extraction | $155.00 |
| D7210 | Surgical Extraction | $260.00 |
*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.