Summary of Discounts

Gold Dental Plans offering you choice, access, and affordability

California residents in

  • All other California counties

Diagnostic & Preventative

  • ADA Code Services Member
  • D0150 Comprehensive oral evaluation $37.00
  • D0120 Periodic oral evaluation $23.00
  • D0140 Limited oral evaluation - problem focused $33.00
  • D0210 Intraoral - complete series of radiographic images $59.00
  • D0220 Intraoral - periapical first radiographic image $18.00
  • D0230 Intraoral - periapical each additional radiographic image $9.00
  • D0272 Bitewings - two radiographic images $24.00
  • D0274 Bitewings - four radiographic images $31.00
  • D0330 Panoramic radiographic image $46.00
  • D1110 Prophylaxis (Cleaning) Adult $75.00
  • D1120 Prophylaxis (Cleaning) Child $57.00
  • D1351 Sealant - per tooth $44.00
  • D1208 Topical application of fluoride $32.00

Restorative - Fillings

  • ADA Code Services Member
  • Resin-based composite-anterior
  • D2330 One surface $133.00
  • D2331 Two surfaces $152.00
  • D2332 Three surfaces $176.00
  • Resin-based composite-posterior
  • D2391 One surface $136.00
  • D2392 Two surfaces $179.00
  • D2393 Three surfaces $219.00

Crowns

  • ADA Code Services Member
  • D2750 Crown - porcelain fused to high noble metal $915.00
  • D2751 Crown- porcelain fused to predominantly base metal $740.00
  • D2950 Core buildup $195.00
  • D2954 Prefabricated Post and Core in addition to crown $230.00

Endodontics

  • ADA Code Services Member
  • D3220 Therapeutic pulpotomy $132.00
  • D3310 Root canal (anterior) $550.00
  • D3320 Root canal (bicuspid) $640.00
  • D3330 Root canal (molar) $795.00

Periodontics

  • ADA Code Services Member
  • D4341 Periodontal scaling and root planing- (four or more teeth per quadrant) $190.00
  • D4342 Periodontal scaling and root planing- (one to three teeth per quadrant) $115.00
  • D4355 Full mouth debridement $71.00
  • D4910 Periodontal maintenance $104.00

Prosthodontics

  • ADA Code Services Member
  • D5110 Complete denture - maxillary (upper) $1.267,20
  • D5120 Complete denture - mandibular (lower) $1.298.00
  • D5213 Maxillary partial denture (upper) - cast metal framework with resin denture bases $1.416,80
  • D5214 Mandibular partial denture (lower) - cast metal framework with resin denture bases $1.416,80
  • D6750 Crown - porcelain fused to high noble metal (per unit) $915.00
  • D6751 Crown - porcelain fused to predominantly base metal (per unit) $740.00

Oral Surgery

  • ADA Code Services Member
  • D7111 Extraction, coronal remnants - deciduous tooth $64.00
  • D7140 Extraction, erupted tooth or exposed root $126.00
  • D7210 Surgical removal of erupted tooth $199.00
  • D7220 Removal of impacted tooth- soft tissue $219.00
  • D7230 Removal of impacted tooth- partially Bony $263.00
  • D7240 Removal of impacted tooth- completely Bony $304.00

Other Services

  • ADA Code Services Member
  • D9230 Inhalation of nitrous oxide/anxiolysis, analgesia 20% discount off UCR*
  • D9440 Office visit- after regularly scheduled hours $88.00
  • D9940 Occlusal guard, by report $398.00