| ADA Service Code————————————————— | Usual Fee—- | Member Fee– | Discount % |
| D5510 Repair broken complete denture base | $185.00 | $93.00 | 50 % |
| D5520 Replace missing/broken teeth, each tooth | $188.00 | $90.00 | 52 % |
| D5610 Repair resin denture base | $189.00 | $93.00 | 51 % |
| D5620 Repair cast framework | $259.00 | $95.00 | 63 % |
| D5630 Repair or replace broken clasp | $237.00 | $95.00 | 60 % |
| D5730 Reline complete maxillary denture, chairside | $338.00 | $190.00 | 44 % |
| D5731 Reline complete mandib denture, chairside | $338.00 | $190.00 | 44 % |
| D5740 Reline maxillary partial denture, chairside | $328.00 | $190.00 | 42 % |
| D5741 Reline mandibular partial denture, chairside | $333.00 | $190.00 | 43 % |
| D5750 Reline complete Maxillary denture – Lab | $419.00 | $230.00 | 45 % |
| D5751 Reline complete Mandibular denture – Lab | $423.00 | $230.00 | 46 % |
| D5760 Reline maxillary partial denture – Lab | $419.00 | $230.00 | 45 % |
| D5761 Reline mandibular partial denture – Lab | $423.00 | $230.00 | 46 % |
| D5850 Tissue conditioning, maxillary | $197.00 | $90.00 | 54 % |
| D5851 Tissue conditioning, mandibular | $198.00 | $90.00 | 55 % |