Smile Easy Dental Plan

Enjoy 2 Free Cleanings Per Year & Discounts Up To 30%

We offer an easy way for patients to receive comfortable, convenient care with the help of our in-house Smile Easy Dental Plan. It’s easy to get started – just fill out the application below and one of our associates will be in touch to finalize your membership!

Annual Premiums

$249 for first member
$179 each additional

Annual Benefits

2 Regular Cleanings (absence of periodontal disease)
If you receive periodontal therapy, you will receive one periodontal cleaning annually at no charge.(D4910/D4346/D4355)
2 Periodic Dental Exams
1 set of Check Up X-Rays & any individual X-rays needed throughout the year
30% Savings on Implant Placement (implants, abutments, attachments, bone grafts)
15% Savings on Invisalign
30% Savings on products – some exclusions may apply, call for details.
30% Savings on Fillings, Crowns, Veneers, Root Canals, Extractions, Dentures/Partials, Periodontal Treatment
30% Savings on in-office Boost Teeth Whitening

How much can you save?

Georgia Pricing – PDF Download
Michigan Pricing – PDF Download

Effective Date*
Date Format: MM slash DD slash YYYY
Preferred Office Location*
Member Name*
First Last
Address*
Street Address City State ZIP Code
Date of Birth*
Date Format: MM slash DD slash YYYY
Email*
Home Phone*
Cell Phone*
Gender*
Number of Eligible Dependents*
Please enter a number from 0 to 6.
Have more than 6 eligible dependents? Please contact us for assistance.
Dependent 1 Name*
Dependent 1 Gender*
Dependent 1 Date of Birth*
Date Format: MM slash DD slash YYYY
Dependent 2 Name*
Dependent 2 Gender*
Dependent 2 Date of Birth*
Date Format: MM slash DD slash YYYY
Dependent 3 Name*
Dependent 3 Gender*
Dependent 3 Date of Birth*
Date Format: MM slash DD slash YYYY
Dependent 4 Name*
Dependent 4 Gender*
Dependent 4 Date of Birth*
Date Format: MM slash DD slash YYYY
Dependent 5 Name*
Dependent 5 Gender*
Dependent 5 Date of Birth*
Date Format: MM slash DD slash YYYY
Dependent 6 Name*
Dependent 6 Gender*
Dependent 6 Date of Birth*
Date Format: MM slash DD slash YYYY
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Summary of Savings and Discounted Fees

Diagnostic & Preventative

ADA Code

Description of Services

Member Pays

Regular Price

Savings

0120

Periodic Oral Evaluation - Established Patient

No Charge

$0.00

0140

Limited oral evaluation- problem focused

No Charge

$0.00

0150

Comprehensive Oral Evaluation- new or established patient

No Charge

$0.00

0210

Full mouth x-rays

No Charge

$0.00

0220

First film

No Charge

$0.00

0230

Each additional film

No Charge

$0.00

0272

Bitewings- two films

No Charge

$0.00

0274

Bitewings - four films

No Charge

$0.00

0330

Panoramic Film

No Charge

$0.00

1110

Prophylaxis (cleaning) adult

No Charge

$0.00

1120

Prophylaxis (cleaning) child

No Charge

$0.00

1206

Topical application of fluoride varnish

No Charge

$0.00

1208

Topical application of fluoride

No Charge

$0.00

1351

Sealant- per tooth

No Charge

$0.00

Restorative - Fillings

ADA Code

Description of Services

Member Pays

Regular Price

Savings

2330

Composite- one surface, anterior

No Charge

$0.00

2331

Composite- two surfaces, anterior

No Charge

$0.00

2332

Composite- three surfaces, anterior

No Charge

$0.00

2391

Composite- one surface, posterior

No Charge

$0.00

2392

Composite- two surfaces, posterior

No Charge

$0.00

2393

Composite- three surfaces, posterior

No Charge

$0.00

Restorative - Crowns

ADA Code

Description of Services

Member Pays

Regular Price

Savings

2740

Crown-porcelain/ceramic substrate

No Charge

$0.00

2750

Crown-porcelain fused to high noble metal

No Charge

$0.00

2751

Crown-porcelain fused to base metal

No Charge

$0.00

2920

Recementation - crown

No Charge

$0.00

2950

Core Buildup

No Charge

$0.00

2954

Prefabricated post and core

No Charge

$0.00

Endodontics - Root Canals

ADA Code

Description of Services

Member Pays

Regular Price

Savings

3310

Root Canal (anterior)

No Charge

$0.00

3320

Root Canal (bicuspid)

No Charge

$0.00

3330

Root Canal (molar)

No Charge

$0.00

Periodontics

ADA Code

Description of Services

Member Pays

Regular Price

Savings

4341

Periodontal scaling and root planing- 4 or more teeth per quadrant

No Charge

$0.00

4355

Full mouth debridement

No Charge

$0.00

4381

Localized delivery of antimicrobial agents

No Charge

$0.00

4910

Periodontal maintenance

No Charge

$0.00

Prosthodontics - Dentures & Bridges

ADA Code

Description of Services

Member Pays

Regular Price

Savings

5110

Complete denture - maxillary (upper)

No Charge

$0.00

5120

Complete denture- mandibular (lower)

No Charge

$0.00

5213

Partial denture - maxillary (upper)

No Charge

$0.00

5214

Partial denture - mandibular (lower)

No Charge

$0.00

5225

Partial denture - flexible base- maxillary (upper)

No Charge

$0.00

5226

Partial denture - flexible base- mandibular (upper)

No Charge

$0.00

Bridge - Fixed

ADA Code

Description of Services

Member Pays

Regular Price

Savings

6240

Pontic-porcelain fused to high noble metal

No Charge

$0.00

6241

Pontic-porcelain fused to base metal

No Charge

$0.00

6245

Pontic-porcelain/ceramic

No Charge

$0.00

6740

Crown-porcelain/ceramic

No Charge

$0.00

6750

Crown-porcelain fused to high noble metal

No Charge

$0.00

Oral - Surgery

ADA Code

Description of Services

Member Pays

Regular Price

Savings

7140

Extraction, erupted tooth

No Charge

$0.00

7210

Surgical removal of erupted tooth

No Charge

$0.00

7220

Removal of impacted tooth- soft tissue

No Charge

$0.00

7230

Removal of impacted tooth- partially bony

No Charge

$0.00

7240

Removal of impacted tooth- completely bony

No Charge

$0.00

Orthodontics

ADA Code

Description of Services

Member Pays

Regular Price

Savings

8090

Invisalign

No Charge

$0.00

Other Services

ADA Code

Description of Services

Member Pays

Regular Price

Savings

9910

Application of desensitizing resin

No Charge

$0.00

9944/9945

Occlusal guard by report

No Charge

$0.00