Say goodbye to deductibles, annual maximums, and frustrating insurance paperwork. Premier Plans is your modern dental membership, offering clear, predictable access to the high-quality care you need.
No Hidden Fees • No Limits • No Late Fees • No Waiting Periods • No Deductibles
(Ages 14+)
(13 & Under)
(3 Visit)
1-time Processing Fee: $30
Additional Benefits:
Oral Cancer Screening at every visit
Perio Exam once per year
No Hidden Fees • No Limits • No Late Fees • No Waiting Periods • No Deductibles
| Code | Service |
Adult – MDC (Qty)
(Ages 14+) |
Child – MDC (Qty)
(13 & Under) |
Perio (Qty)
(3 Visit) |
|---|---|---|---|---|
| D1110 | Adult Cleaning | 2 | -- | -- |
| D1120 | Child Cleaning | -- | 2 | -- |
| D4910 | Perio Maintenance | -- | -- | 3 |
| D0120 | Periodic Exams | 2 | 2 | 2 |
| D0140 | Limited Exam | 1 | 1 | 1 |
| D1206 | Fluoride | 2 | 2 | 3 |
| D0274 | BWX (x4) | 1 | -- | 1 |
| D0272 | BWX (x2) | -- | 1 | -- |
| D0220 | PA - First | 2 | 2 | 2 |
| D0230 | PA - Additional | 1 | 1 | 1 |
| D0210 | FMX | 1 (every 5 years) | 1 (every 5 years) | 1 (every 5 years) |
| D0330 | Panoramic X-ray | 1 (every 5 years) | 1 (every 5 years) | 1 (every 5 years) |
| CPT Code | Procedure Description | Adult Plan (14 & Over) |
Child Plan(13 & Under) | Perio Plan |
|---|---|---|---|---|
| Preventive & Diagnostic | D0000-D0999 | |||
| D0120 | Periodic Exam | No Charge | No Charge | No Charge |
| D1110 | Adult Cleaning | No Charge | -- | -- |
| D1120 | Child Cleaning | -- | No Charge | -- |
| D0210 | Full Mouth X-Rays | No Charge | No Charge | No Charge |
| D0150 | Comprehensive Exam | No Charge | No Charge | No Charge |
| D0140 | Emergency Exam | No Charge | No Charge | No Charge |
| D1206 | Fluoride Treatment with Varnish | No Charge | No Charge | No Charge |
| D1208 | Topical Fluoride | No Charge | No Charge | No Charge |
| D4910 | Periodontal Maintenance | -- | -- | No Charge |
| D0220 | PA First | No Charge | No Charge | No Charge |
| D0230 | PA Additional | No Charge | No Charge | No Charge |
| D0330 | Panoramic X-Ray | No Charge | No Charge | No Charge |
| D0274 | Bitewings (4) | No Charge | -- | No Charge |
| D0272 | Bitewings (2) | -- | No Charge | -- |
| D0277 | Vertical Bitewings | No Charge | No Charge | No Charge |
| D1351 | Sealant Per Tooth | 15% off | 15% off | 15% off |
| Restorative | D2000-D2999 | |||
| D2391 | Filling - 1 Surface, Posterior | 15% off | 15% off | 15% off |
| D2392 | Filling - 2 Surface, Posterior | 15% off | 15% off | 15% off |
| D2393 | Filling - 3 Surface, Posterior | 15% off | 15% off | 15% off |
| D2740 | Crown - Porcelain/Ceramic | 15% off | 15% off | 15% off |
| D2950 | Core Buildup Including Any Pins | 15% off | 15% off | 15% off |
| Endodontics | D3000-D3999 | |||
| D3330 | Root Canal - Molar | 15% off | 15% off | 15% off |
| Periodontics | D4000-D4999 | |||
| D4341 | Perio Scaling and Root Planing - 4+ Teeth | 15% off | 15% off | 15% off |
| D4342 | Perio Scaling and Root Planing - 1 to 3 Teeth | 15% off | 15% off | 15% off |
| Implants | D6000-D6999 | |||
| D6010 | Surgical Placement of an Endosteal Implant | 15% off | 15% off | 15% off |
| Oral and Maxillofacial Surgery | D7000-D7999 | |||
| D7140 | Simple Extraction | 15% off | 15% off | 15% off |
| D7210 | Surgical Extraction | 15% off | 15% off | 15% off |
| D7240 | Removal of Impacted Teeth | 15% off | 15% off | 15% off |
| D7953 | Bone Replacement Graft | 15% off | 15% off | 15% off |
| Orthodontics | D8000-D8999 | No discount | No discount | No discount |
| D8080 | Comprehensive Orthodontics - Adolescent | No discount | No discount | No discount |
| D8090 | Comprehensive Orthodontics - Adult | No discount | No discount | No discount |
