No Waiting Periods, Deductibles or Annual Maximums!
- 2 regular exams (D0150 or D0120) and 2 cleanings (D1110 or D4910) each year from the date of the
signed and paid contract
- 20% courtesy on periodontal cleanings (D4910 or D4345 or D4341) including laser therapy
- All x-rays are included with your cleaning visits (D0272, D0273, D0274, D0330) except 3-D imaging
- Annual fluoride treatment (D1208)
- Annual oral cancer screening
- 20% courtesy on all crowns, bridges, implants, fillings, dentures, emergency exams (D0140),
extractions, bleaching and laser treatment
- Benefits of plan are only available in our office - this plan is not part of any other insurance or discount
- Services cannot be filed to dental insurance
- Plan benefits not available with any other discount offer or products
This Dental Savings Plan offers significant discounts on dental services. I understand the benefits,
limitations, exclusions and requirements of this plan and agree to the following:
Any fees for dental services are due when the services are rendered. Fees for prosthodontic (dentures)
and indirect restorations (crowns, bridges, veneers, inlays, onlays) are due on the
preparation/impression appointment. Fees for single appointment CAD/CAM restorations are due on
the date of service. Member benefits may not be used with any other offers or insurance plans.
Members must remain in the plan a minimum of 12 months.