Savings to Smile About
Below is a list of common dental services and what you’ll pay with Alliance Dental Plan.
Savings Summary
| ADA Code | Procedure Description | Member Pays* |
|---|---|---|
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | Select State |
| D0140 | Limited Exam - Problem Focused | Select State |
| D0150 | Comprehensive Exam | Select State |
| D0210 | Full Mouth X-Rays | Select State |
| D0330 | Panoramic X-Rays | Select State |
| 1D110 | Adult Cleaning | Select State |
| D1120 | Child Cleaning | Select State |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | Select State |
| D2391 | Filling - 1 Surface, Posterior | Select State |
| D2740 | Crown - Porcelain/Ceramic | Select State |
| Endodontics & Periodontics | ||
| D3330 | Root Canal - Molar | Select State |
| D4341 | Perio Scaling/Root Planing - 4+ Teeth | Select State |
| D4910 | Periodontal Maintenance | Select State |
| Prosthodontics & Oral Surgury | ||
| D7140 | Simple Extraction | Select State |
*Member savings may vary by location.