DIAGNOSTIC AND PREVENTIVE PROCEDURES
Code Procedure Description Retail Fee* Member Fee* Member Savings*
D0120 Periodic Oral Evaluation $71 FREE 100%
D0140 Limited Oral Evaluation - Problem Focused $105 FREE 100%
D0150 Comprehensive Oral Evaluation $122 FREE 100%
D0210 X-Rays - Intraoral Complete Series $187 FREE 100%
D0274 Bitewings - Four Images $92 FREE 100%
D0330 X-Rays - Panoramic $158 FREE 100%
D1110 Adult Cleaning $128 $64 50%
D1120 Child Cleaning $100 $50 50%
Note: any current dental services not listed above are discounted 20-50% off your participating dental office's retail fees.
BASIC, MAJOR AND OTHER PROCEDURES
Code Procedure Description Retail Fee* Member Fee* Member Savings*
D2330 Composite - One Surface, Anterior $238 $179 25%
D2331 Composite - Two Surfaces, Anterior $288 $216 25%
D2332 Composite - Three Surfaces, Anterior $354 $266 25%
D2335 Composite - Four/More Surfaces, Anterior $442 $332 25%
D2391 Composite - One Surface, Posterior $255 $191 25%
D2392 Composite - Two Surfaces, Posterior $326 $245 25%
D2393 Composite - Three Surfaces, Posterior $401 $301 25%
D2394 Composite - Four/More Surfaces, Posterior $480 $360 25%
D2720 Crown - Resin With High Noble Metal $1,606 $1,285 20%
D2740 Crown - Porcelain/Ceramic $1,606 $1,285 20%
D2750 Crown - Porcelain/High Noble Metal $1,587 $1,270 20%
D2950 Core Buildup $373 $298 20%
D3310 Endodontic Therapy - Anterior Tooth $1,067 $854 20%
D3320 Endodontic Therapy - Bicuspid Tooth $1,204 $963 20%
D3330 Endodontic Therapy - Molar Tooth $1,469 $1,174 20%
D5110 Complete Denture - Maxillary $2,453 $1,962 20%
D5120 Complete Denture - Mandibular $2,502 $2,002 20%
D5130 Immediate Denture - Maxillary $2,617 $2,094 20%
D5140 Immediate Denture - Mandibular $2,630 $2,104 20%
D7140 Extraction - Erupted Tooth/Exposed Root $262 $210 20%
Note: any current dental services not listed above are discounted 20-50% off your participating dental office's retail fees.

*Free exams and x-rays limited to 2x per member/per annual membership term. Member savings is defined as the amount members pay less participating offices’ normal retail fees typically charged to self-pay patients for dental services rendered. Exact member savings may vary by location. Please speak with your participating office prior to treatment.

Since Medicare doesn't cover dental we were looking for an affordable solution to save us money at the dentist. Sure Smile Dental Plan is perfect for seniors like us that don't have dental insurance. We love that Sure Smile Dental Plan keeps it simple with no waiting periods, maximums, or exclusions. Adnan & Kristy
Our employer offered dental insurance was expensive and lacked value. Our family needed a dental plan that's affordable, easy-to-use and has significant member savings. In exchange for a low annual membership fee, Sure Smile Dental Plan saves us hundreds of dollars each time we visit the dentist. Pete & Maggie