| ADA Service Code—————————————————– | Usual Fee—- | Member Fee– | Discount % |
| D2510 Inlay-metallic 1-surface | $475.00 | $200.00 | 58 % |
| D2520 Inlay-metallic 2-surface | $500.00 | $300.00 | 40 % |
| D2530 Inlay-metallic 3-or more surfaces | $700.00 | $380.00 | 46 % |
| D2542 Onlay-metallic 2 surfaces | $550.00 | $245.00 | 55 % |
| D2543 Onlay-metallic 3 surfaces | $745.00 | $380.00 | 49 % |
| D2544 Onlay-metallic 4 or more surfaces | $910.00 | $430.00 | 53 % |
| D2610 Inlay-ceramic 1 surface | $445.00 | $270.00 | 39 % |
| D2620 Inlay-ceramic 2 surface | $645.00 | $343.00 | 47 % |
| D2630 Inlay-ceramic 3 or more surfaces | $710.00 | $363.00 | 49 % |
| D2642 Onlay, porcelain/ceramic 2 surface | $886.00 | $475.00 | 46 % |
| D2643 Onlay, porcelain/ceramic 3 surface | $917.00 | $500.00 | 45 % |
| D2644 Onlay, porcelain/ceramic 4 surface | $958.00 | $518.00 | 46 % |
| D2751 Crown, Porcelain fused to Metal | $920.00 | $514.00 | 44 % |
| D2752 Crown, Porcelain fused to noble Metal | $948.00 | $575.00 | 39 % |
| D2740 Crown, Porcelain/Ceramic | $997.00 | $575.00 | 42 % |
| D2750 Crown, Porcelain fused to high noble Metal | $968.00 | $575.00 | 41 % |
| D2790 Crown, full cast high noble | $959.00 | $540.00 | 44 % |
| D2791 Crown, full cast base metal | $866.00 | $450.00 | 48 % |
| D2792 Crown, full cast noble metal | $909.00 | $500.00 | 45 % |
| D2920 Re-cement Crown | $96.00 | $40.00 | 58 % |
| D2940 Sedative Filling | $98.00 | $65.00 | 34 % |
| D2930 Prefab stainless steel crown – primary | $245.00 | $150.00 | 39 % |
| D2931 Prefab stainless steel crown – permanent | $275.00 | $155.00 | 44 % |
| D2932 Prefabricated resin crown | $299.00 | $120.00 | 60 % |
| D2950 Core Build Up including any pins | $262.00 | $125.00 | 52 % |
| D2952 Cast Post and Core | $410.00 | $150.00 | 63 % |
| D2954 Prefab post & Core in addition to crown | $295.00 | $190.00 | 36 % |
| D2955 Post Removal | $85.00 | $35.00 | 59 % |
| D2960 Labial Veneer resin – chairside | $553.00 | $340.00 | 39 % |
| D2961 Labial Veneer resin – laboratory | $813.00 | $500.00 | 38 % |