Summary of Discounts

OneSmile Dental Plan is a flexible alternative to insurance. Members pay a low yearly fee to receive FREE Exams & X-Rays and 20-40% discounts off all dental services. After enrolling in the plan, just show your member ID at a participating dental office to take advantage of plan discounts.

Summary Discount Fees!

ADA Code Description You
Pay
Diagnostic and Preventative
120Periodic Oral Evaluation (2 per year)Select Your State
140Limited Oral Evaluation - Problem Focused (unlimited)Select Your State
150Comprehensive Oral Evaluation (2 per year)Select Your State
210X-Ray - Intraoral - Complete SeriesSelect Your State
220X-Ray - Intraoral - Periapical - First ImageSelect Your State
230X-Ray - Intraoral - Periapical - Each Add'l ImageSelect Your State
270X-Ray - Bitewing - Single ImageSelect Your State
272X-Ray - Bitewing - Two ImagesSelect Your State
274X-Ray - Bitewing - Four ImagesSelect Your State
330X-Ray - Panoramic Image (if available)Select Your State
350Oral/Facial Photographic ImagesSelect Your State
1330Oral Hygiene InstructionsSelect Your State
431Adjunctive Oral Cancer ExamSelect Your State
1110Prophylaxis - Adult (basic cleaning & polishing)Select Your State
1120Prophylaxis - Child (basic cleaning & polishing)Select Your State
1106Topical Application Of Fluoride VarnishSelect Your State
1108Topical Application Of FluorideSelect Your State
1351Sealant - per toothSelect Your State
Restorative (Fillings)
2140Amalgam - Posterior - One SurfaceSelect Your State
2150Amalgam - Posterior - Two SurfaceSelect Your State
2160Amalgam - Posterior - Three Surface Select Your State
2330 Resin-Based Composite - Anterior - One SurfaceSelect Your State
2331Resin-Based Composite - Anterior - Two SurfacesSelect Your State
2332Resin-Based Composite - Anterior - Three SurfacesSelect Your State
2335Resin-Based Composite - Anterior - Four SurfacesSelect Your State
2391Resin-Based Composite - Posterior - One SurfaceSelect Your State
2392Resin-Based Composite - Posterior - Two SurfacesSelect Your State
2393Resin-Based Composite - Posterior - Three SurfacesSelect Your State
2394Resin-Based Composite - Posterior - Four SurfacesSelect Your State
Crowns & Bridges
2740/6740Crown - Full Porcelain/Ceramic SubstrateSelect Your State
2750/6750Crown - Porcelain Fused To High Noble MetalSelect Your State
2751/6751Crown - Porcelain Fused Predominantly Base MetalSelect Your State
2752Crown - Porcelain Fused To Noble MetalSelect Your State
6240Pontic - Porcelain Fused To High Noble MetalSelect Your State
6245Pontic - Porcelain/CeramicSelect Your State
2920Recementation, CrownSelect Your State
2950Core Buildup (including pins)Select Your State
2954Prefabricated post & core in addition to crownSelect Your State
2962Veneer - Standard (per tooth)Select Your State
ADA Code Description You
Pay
Endodontics (Performed by General Dentist)
3120Pulp Cap - IndirectSelect Your State
3310Root Canal (anterior)Select Your State
3320Root Canal (bicuspid)Select Your State
3330Root Canal (molar)Select Your State
Periodontics
4341Periodontal Scaling and Root Planning (4+ teeth per quad)Select Your State
4342Periodontal Scaling and Root Planning (1-3 teeth per quad)Select Your State
4346Gingival ScalingSelect Your State
4381Arestin (Per tooth)Select Your State
4910Periodontal MaintenanceSelect Your State
4921Gingival Irrigation - Per QuadSelect Your State
4999Gingival Irrigation - Full MouthSelect Your State
Prosthodontics - Removable
5110/5120Complete Denture - (upper or lower)Select Your State
5130/5140Immediate Denture - (upper or lower)Select Your State
5213/5214Partial Denture w/ Metal Frame - (upper or lower)Select Your State
5225/5226Partial Denture w/ Flexible Base - (upper or lower)Select Your State
5410/5411Adjusted Complete Denture - (upper or lower)Select Your State
5750/5751Reline Denture - in laboratory (upper or lower)Select Your State
5820/5821Interim Partial Denture - (upper or lower)Select Your State
Oral Surgery (Performed by General Dentist)
7140Extraction - Erupted Tooth Or Exposed RootSelect Your State
7210Surgical Removal Of Erupted ToothSelect Your State
7220Extraction - Impacted Tooth - Soft TissueSelect Your State
7230Extraction - Impacted Tooth - Partial BonySelect Your State
7240Extraction - Impacted Tooth - Full BonySelect Your State
7250Surgical Removal Of Residual RootsSelect Your State
7953Bone Replacement For Ridge Preservation (per site)Select Your State
Orthodontics
8660Orthodontic ConsultSelect Your State
8060Early Orthodontic Treatment (up to 12 months)Select Your State
8080/8090Comprehensive Orthodontic Treatment (up to 24 months)Select Your State
8080Invisalign (up to 24 months)Select Your State
8692Replacement Retainers (Essex)Select Your State
Other Services
9230Nitrous OxideSelect Your State
9910Application Of Desensitizing MedicamentSelect Your State
9940Occlusal Night GuardSelect Your State
9972Teeth Whitening - In Office (per arch)Select Your State
9975Take-Home Whitening Trays (10 Pack)Select Your State

Certain Limitations Apply. See onesmiledentalplan.com/support/ to view your state's Description of Service and Disclosure form.

Click here to view your state's General Dentist Fee Schedule.