Savings to Smile About
Below is a list of common dental services and what you’ll pay with SmileWorks Membership.
Saving Summary
| ADA Code | Procedure Description | Member Pays* |
|---|---|---|
| Preventive & Diagnostic | ||
| D0120 | Periodic Exam | NO CHARGE |
| D0140 | Periodic 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 | $65.00 |
| D1120 | Child Cleaning | $55.00 |
| D1206 | Fluoride – Including Varnish | $25.00 |
| Restorative | ||
| D2330 | Filling – 1 Surface, Anterior | $145.00 |
| D2391 | Filling – 1 Surface, Posterior | $150.00 |
| D2740 | Crown – Porcelain/Ceramic | $950.00 |
| D2950 | Core Buildup – Including Pins | $210.00 |
| Endodontics & Periodontics | ||
| D3330 | Root Canal – Molar | $925.00 |
| D4341 | Perio Scaling/Root Planing – 4+ Teeth | $195.00 |
| D4910 | Periodontal Maintenance | $110.00 |
| Prosthodontics & Oral Surgery | ||
| D5110 | Complete Denture (Upper or Lower) | 15% OFF |
| D5213 | Partial Denture (Upper or Lower) | 15% OFF |
| 7140 | Simple Extraction | $135.00 |
| D7210 | Surgical Extraction | $210.00 |
*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.
SmileWorks Membership is NOT INSURANCE, but rather a licensed dental savings plan offered through your local dental office. Members in good standing with their annual membership fee are eligible to receive transparent, member-only discounts from the normal retail fees that participating offices typically charge self-pay patients for dental services rendered. Plan details and member savings are exclusive to participating offices and may vary by location. Membersy does not make payments directly to dental providers for services rendered to plan members. Members are obligated to pay for all dental services but will receive a discount on services rendered by participating dental providers. The plan is not a qualified health plan under the Affordable Care Act. The plan does not meet the minimum creditable coverage requirements under MGLC.111M and 956 CMR 5.00. Discount Medical Plan Organization (“DMPO”) and plan administrator: Membersy LLC, 811 Barton Springs Rd. Ste. 750, Austin, TX 78704.
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