Extreme Pinball consists of four different tables: Urban Chaos, which features riot lanes, a police station and a jail; Monkey Mayhem, which takes place on the forest world of Monkey Planet; Medieval Knights, where you battle dragons, bats, and trolls; and Rock-Makers, a world of night clubs, stages, and recording companies. Each table is filled with tunnels, targets, and bumpers that relate to its respective themes. At the bottom of each play field, a score board posts information on what to hit next for extra points, your current score, what ball you're on, and other helpful facts.
While the ball is in play, you can use a nudge button that gives the table a quick jolt, influencing the direction of the pinball's movement. The four tables also each have a unique soundtrack and more than 200 dotmation screens.