Savings to Smile About
Below is a list of common dental services and what you’ll pay with Resolution Dental Plan.
| ADA Code | Procedure Description | Member Pays* |
|---|---|---|
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | NO CHARGE |
| D0140 | Limited Exam - Problem Focused | NO CHARGE |
| D0150 | Comprehensive Exam | NO CHARGE |
| D0210 | Full-Mouth X-Rays | NO CHARGE |
| D0330 | Panoramic X-Rays | NO CHARGE |
| D1110 | Adult Cleaning | $56.35 |
| D1120 | Child Cleaning | $44.85 |
| D1206 | Fluoride - Including Varnish | $30.00 |
| Restorative | ||
| D2330 | Filling - 1 Surface, Anterior | $113.85 |
| D2391 | Composite - One Surface, Posterior | $142.80 |
| D2740 | Crown - Porcelain/Ceramic | $1,078.80 |
| D2950 | Core Buildup - Including Pins | $214.80 |
| Endodontics & Periodontics | ||
| D3310 | Root Canal - Molar | $504.85 |
| D4341 | Perio Scaling/Root Planing - 4+ Teeth | $175.00 |
| D4266 | Guided Tissue Regeneration- Resorbable Barrier- per site | $400.00 |
| D4267 | Guided Tissue Regeneration- Non- Resorbable Barrier- per site | $300.00 |
| Prosthodontics & Oral Surgery | ||
| D5110 | Complete Denture (Upper or Lower) | $1,198.80 |
| D5213 | Partial Denture (Upper or Lower) | $1,318.80 |
| D7140 | Simple Extraction | $130.80 |
| D7210 | Surgical Extraction | $214.80 |
*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.