Summary of Discounts

Gold Dental Plans offering you choice, access, and affordability

Residents in

  • Arizona
  • Florida
  • Oregon
  • New Mexico
  • Colorado
  • Hawaii
  • Nevada
  • Texas

Diagnostic & Preventative

  • ADA Code Services Member
  • D9999 Office Visit $5.00
  • D0150 Comprehensive oral evaluation No Charge
  • D0120 Periodic oral evaluation No Charge
  • D0140 limited oral evaluation - problem focused No Charge
  • D0180 comprehensive periodontal evaluation – new or established patient No Charge
  • D0210 Intraoral - complete series of radiographic images No Charge
  • D0220 Intraoral - periapical first radiographic image No Charge
  • D0230 Intraoral - periapical each additional radiographic image No Charge
  • D0240 intraoral – occlusal radiographic image No Charge
  • D0250 extraoral – first radiographic image No Charge
  • D0270 bitewing – single radiographic image $15.00
  • D0272 bitewings - two radiographic images $20.00
  • D0274 bitewings - four radiographic images $30.00
  • D0330 Panoramic radiographic image $55.00
  • D1110 Prophylaxis (Cleaning) Adult $70.00
  • D1120 Prophylaxis (Cleaning) Child $45.00
  • D1206 Topical application of fluoride varnish $28.00
  • D1208 Topical application of fluoride $25.00

Restorative

  • ADA Code Services Member
  • Resin-based composite-anterior
  • D2330 One surface $105.00
  • D2331 Two surfaces $115.00
  • Resin-based composite-posterior
  • D2391 One surface $120.00
  • D2392 Two surfaces $150.00

Periodontics

  • ADA Code Services Member
  • D4341 Periodontal scaling and root planing (four or more teeth per quadrant) $160.00
  • D4342 periodontal scaling and root planing - one to three teeth per quadrant $98.00
  • D4910 Periodontal maintenance $95.00

Oral Surgery

  • ADA Code Services Member
  • D7140 Extraction, erupted tooth or exposed root $110.00
  • D7210 Surgical removal of erupted tooth $198.00

25% Savings

On Gold Dental Plans

*Participating dental providers have agreed to discount their usual and customary fees by 25% for services not listed on the summary of discount fees above, provided those ADA code services are offered in office.