| ADA Service Code————————————————- | Usual Fee—- | Member Fee– | Discount % |
| D7111 Extraction-coronal remnants, primary teeth | $121.00 | $45.00 | 63 % |
| D7140 Extraction-erupted tooth | $173.00 | $95.00 | 45 % |
| D7210 Extraction-erupted tooth surgical | $245.00 | $150.00 | 39 % |
| D7220 Extraction-soft tissue impaction | $277.00 | $180.00 | 35 % |
| D7230 Extraction-partial bony impaction | $353.00 | $240.00 | 32 % |
| D7240 Extraction-comp bony impaction | $434.00 | $280.00 | 35 % |
| D7241 Extraction of impacted tooth complications | $544.00 | $325.00 | 40 % |
| D7250 Surgical removal of residual tooth roots | $285.00 | $185.00 | 35 % |
| D7270 Tooth reimplantation | $501.00 | $135.00 | 73 % |
| D7280 Surgical access of an unerupted tooth | $439.00 | $134.00 | 69 % |
| D7310 Alveoplasty with extraction per quadrant | $285.00 | $175.00 | 39 % |
| D7320 Alveoplasty with no extraction per quadrant | $396.00 | $210.00 | 47 % |