Savings Summary | Total Health Dental Plan | Dental Membership Plan

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Savings to Smile About

Below is a list of common dental services and what you’ll pay with Total Health Dental Plan.

Savings Summary

ADA Code	Procedure Description	Member Pays*
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	20% OFF
D1120	Child Cleaning	20% OFF
D1208	Fluoride - Excluding Varnish	20% OFF
D1351	Sealant - Per Tooth	20% OFF
D2330	Filling - 1 Surface, Anterior	20% OFF
D2391	Filling - 1 Surface, Posterior	20% OFF
D2740	Crown - Porcelain/Ceramic	20% OFF
D3330	Root Canal - Molar	20% OFF
D4341	Perio Scaling/Root Planing - 4+ Teeth	20% OFF
D4910	Periodontal Maintenance	20% OFF
D7140	Simple Extraction	20% OFF
D7420	Surgical Extraction	20% OFF

*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.

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Membership plan(s) featured on this website are NOT INSURANCE. Plan members pay periodic membership fees in exchange for access to discounts on certain identified health care services rendered by participating providers in accordance with the plan fee schedule. Plan members are obligated to pay providers directly for services rendered. Plan details, retail fees and member savings may vary by plan, provider and/or office location, please see specific plan terms and conditions for details. Discount membership plans are not qualified health plans under the Affordable Care Act, and do not meet the minimum creditable coverage requirements under M.G.L.c. 111M and 956 CMR 5.00. Membership plan(s) offered through this website are administered by Membersy LLC, a discount medical plan operator; with the exception of membership plans offered to consumers in the State of California, which are administered by The CDI Group, Inc., a licensed discount specialized health care plan. Mailing address: PO Box 163990, Austin, TX 78716-3990. Membersy and The CDI Group do not make payments to providers for services rendered to plan members. Membership plan(s) advertised on this website are not affiliated with or endorsed by any state insurance department. To obtain additional information about discount membership plans, please call (877)545-4188 or email questions to [email protected].