Savings to Smile About
Below is a list of common dental services and what you’ll pay with DecisionOne Dental Plan.
| Savings Summary | ||
|---|---|---|
| ADA Code | Procedure Description | Member Pays* |
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | 40% OFF |
| D0140 | Limited Exam - Problem Focused | 40% OFF |
| D0150 | Comprehensive Exam | 40% OFF |
| D0210 | Full Mouth X-Rays | 40% OFF |
| D0220 | Intraoral - First Film | 40% OFF |
| D0230 | Intraoral - Additional Films | 40% OFF |
| D0272 | Bitewings - Two Films | 40% OFF |
| D0274 | Bitewings - 4 Films | 40% OFF |
| D0330 | Panoramic X-Rays | 40% OFF |
| D1110 | Adult Cleaning | 40% OFF |
| D1120 | Child Cleaning | 40% OFF |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | 20% OFF |
| D2391 | Filling - 1 Surface, Posterior | 20% OFF |
| D2740 | Crown - Porcelain/Ceramic | 20% OFF |
| Endodontics & Periodontics | ||
| D3310 | Root Canal - Anterior | 20% OFF |
| D3320 | Root Canal - Bicuspid | 20% OFF |
| D3330 | Root Canal - Molar | 20% OFF |
| D4341 | Perio Scaling & Root Planing - 4+ Teeth (Per Quad) | 15% OFF |
| D4910 | Periodontal Maintenance - Single Visit | 40% OFF |
| Prosthodontics & Oral Surgery | ||
| D5110 | Complete Denture - Maxillary (Upper) | 20% OFF |
| D5213 | Partial Denture - Maxillary (Upper) | 20% OFF |
| D7140 | Simple Extraction | 20% OFF |
| D7210 | Surgical Extraction | 20% OFF |
*Member savings may vary by location. Free oral cancer screening limited to 1x per member/per annual membership term.