Savings to Smile About
Below is a list of common dental services and what you’ll pay with Vivid 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 |
| D0220 | Intraoral - First Film | NO CHARGE |
| D0230 | Intraoral - Additional Films | NO CHARGE |
| D0272 | Bitewings - Two Films | NO CHARGE |
| D0274 | Bitewings - 4 Films | NO CHARGE |
| D0330 | Panoramic X-Rays | NO CHARGE |
| D1110 | Adult Cleaning | $66.00 |
| D1120 | Child Cleaning | $55.00 |
| D1206 | Fluoride - Including Varnish | $25.00 |
| D1208 | Fluoride - Excluding Varnish | 15% OFF |
| Restorative - Fillings | ||
| D2330 | Filling - 1 Surface, Anterior | 15% OFF |
| D2331 | Filling - 2 Surfaces, Anterior | 15% OFF |
| D2332 | Filling - 3 Surfaces, Anterior | 15% OFF |
| D2391 | Filling - 1 Surface, Posterior | 15% OFF |
| D2392 | Filling - 2 Surfaces, Posterior | 15% OFF |
| D2393 | Filling - 3 Surfaces, Posterior | 15% OFF |
| Restorative - Crowns | ||
| D2740 | Crown - Porcelain/Ceramic | 15% OFF |
| D2750 | Crown - Porcelain/High Noble Metal | 15% OFF |
| D2954 | Prefab - Post & Core | 15% OFF |
| Endodontics | ||
| D3310 | Root Canal - Anterior | 15% OFF |
| D3320 | Root Canal - Bicuspid | 15% OFF |
| D3330 | Root Canal - Molar | 15% OFF |
| D4341 | Perio Scaling & Root Planing - 4+ Teeth (Per Quad) | 15% OFF |
| D4342 | Perio Scaling & Root Planing - 1-3 Teeth (Per Quad) | 15% OFF |
| D4355 | Full Mouth Debridement | 15% OFF |
| D4381 | Localized Delivery of Antimicrobial Agents | 15% OFF |
| D4910 | Periodontal Maintenance - Single Visit | 15% OFF |
| Prosthodontics - Removable | ||
| D5110 | Complete Denture - Maxillary (Upper) | 15% OFF |
| D5120 | Complete Denture - Mandibular (Lower) | 15% OFF |
| D5130 | Immediate Denture - Maxillary (Upper) | 15% OFF |
| D5140 | Immediate Denture - Mandibular (Lower) | 15% OFF |
| D5213 | Partial Denture - Maxillary (Upper) | 15% OFF |
| D5214 | Partial Denture - Mandibular (Lower) | 15% OFF |
| Prosthodontics - Fixed | ||
| D6058 | Abutment Supported Crown - Porcelain/Ceramic | 15% OFF |
| D6059 | Abutment Supported Crown - Porcelain/High Noble Metal | 15% OFF |
| D6240 | Pontic - Porcelain/High Noble Metal | 15% OFF |
| D6245 | Pontic - Porcelain/Ceramic | 15% OFF |
| D6740 | Crown - Porcelain/Ceramic | 15% OFF |
| D6750 | Crown - Porcelain/High Noble Metal | 15% OFF |
| Oral Surgery - Extractions | ||
| D7140 | Simple Extraction | 15% OFF |
| D7210 | Surgical Extraction | 15% OFF |
| D7220 | Impacted Tooth - Soft Tissue | 15% OFF |
| D7230 | Impacted Tooth - Partial Bony | 15% OFF |
| D7953 | Bone Replacement Graft (Per Site) | 15% OFF |
*Member savings may vary by location. Free exams and x-rays limited to 2x per member/per annual membership term.