| ADA Service Code—————————————————— | Usual Fee—- | Member Fee– | Discount % |
| D5410 Adjust compete denture – maxillary | $88.00 | $45.00 | 49 % |
| D5411 Adjust compete denture – mandibular | $88.00 | $45.00 | 49 % |
| D5421 Adjust partial denture – maxillary | $88.00 | $45.00 | 49 % |
| D5422 Adjust partial denture – mandibular | $88.00 | $45.00 | 49 % |