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Summary of Discounts

Your membership in the Resolution Dental Plan provides you access to instant savings and up-front pricing
so you will know what to expect when it comes to your dental care needs. After enrolling in the plan, just show
your member ID at a participating dental office to take advantage of plan savings.

Summary of Discounts and Fees

ADA Code Diagnostic & Preventative Member Pays
D0120 Periodic oral Evaluation $28
D0140 Limited oral evaluation - problem focused No Charge
D0150 Comprehensive oral evaluation No Charge
D0210 X-Rays - complete set $73
D0220 Intraoral - first film $16
D0230 Intraoral - each additional film $14
D0272 Bitewings - two films $24
D0274 Bitewings - four films $36
D0330 Panoramic x-ray $61
D1110 Cleaning - adult $50
D1120 Cleaning - child $39
D1206 Topical application of fluoride varnish $20
D1208 Topical application of fluoride $20
D1351 Sealant - per tooth $33
Restorative - Fillings
D2140 One surface $85
D2150 Two surfaces $100
D2160 Three surfaces $120
Resin-based composite-anterior (front teeth)
D2330 One surface $99
D2331 Two surfaces $118
D2332 Three surfaces $140
D2335 Four surfaces $170
Resin-based composite-posterior (back teeth)
D2391 One surface $100
D2392 Two surfaces $129
D2393 Three surfaces $162
D2394 Four surfaces $184
Restorative - Crowns
Restorative - Crowns Crown - porcelain/ceramic substrate $851
D2750 Crown - porcelain fused to high noble metal $799
D2751 Crown - porcelain fused to predominantly base metal $749
D2752 Crown - porcelain fused to noble metal $769
D2930 Prefabricated stainless steel crown - primary tooth $177
D2931 Prefabricated stainless steel crown - permanent tooth $184
D2934 Protective restoration $228
D2950 Core buildup (including pins) $155
D2954 Prefabricated post & core in addition to crown $217
D3220 Therapeutic pulpotomy (excluding final restoration) $115
D3310 Root canal - anterior $440
D3320 Root canal - bicuspid $581
D3330 Root canal - molar $817
D4341 Perio scaling & root planing - four or more teeth per quad $147
Prosthodontics - Removable
D5110 Complete denture - maxillary (upper) $949
D5120 Complete denture - mandibular (lower) $949
D5213 Partial denture - maxillary (upper) $999
D5214 Partial denture - mandibular (lower) $999
D5410 Adjust complete denture - (upper) $71
D5411 Adjust complete denture - (lower) $71
D5750 Reline complete maxillary denture (laboratory) $325
D5751 Reline complete mandibular denture (laboratory) $325
Oral Surgery - Extractions
D7111 Coronal remnants - deciduous tooth $74
D7140 Extraction, erupted tooth $99
D7210 Surgical removal of tooth $159
D7220 Impacted tooth - soft tissue $199
D7230 Impacted tooth - partial bony $228
D7240 Extraction - impacted tooth - full bony $295
Orthodontic Services
D8010-D8999 Orthodontic treatment $100 off Discounted pricing
Other Services
D9230 Inhalation of nitrous oxide/analgesia, anxiolysis $49
D9920 Behavior management $75
D9940 Occlusal night guard $331

Taking care of your oral health has never been easier!

Regular dental visits can contribute to a lifetime of oral health. Annual dental examinations and good oral hygiene can prevent most dental diseases. Don’t wait to see a dentist until you are in pain or think something is wrong. Resolution Dental Plan allows you to get the quality care you need at a price you can afford.

We love the Resolution Dental Plan!

I purchased the plan for my son and I. When my husband needed a tooth extraction, we decided to add him to the plan. Everything was so simple! We made his appointment, had the extraction, and paid the discounted fee, which we knew upfront. Now, we all can receive regular exams, x-rays, and cleanings at an affordable price. We love this hassle free plan.

I am relieved to have a Resolution membership!

As a single parent on a tight budget with two active teenagers, I need to be prepared for everything. Resolution gives me the confidence knowing that my kids can receive regular checkups and effective dental care at an affordable cost. I am always prepared if any unexpected dental expenses arise, not only for my kid’s, but myself too. Now that’s a relief!