How to Use your Card:

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2 Our team at Morgan Dental Associates, PLLC has designed a new way to access the dental benefits that will help maintain oral health and keep the healthy smile that you always desire. The Morgan Dental Associates, PLLC Dental Discount Card will provide you, the patient, with a discounted fee for all services in our office, including preventive services, periodontics, cosmetic dentistry, oral surgery and much more! For a fee of $299.00, patients will be able to access this plan for a full year from August 15 th -August 14 th yearly. Everyone is eligible to purchase the dental discount card. No previous health history or affiliation with Florida State University is required. Open enrollment for the plan will close on October 15, Notice: Patients under the age of 15 years are not eligible for services in our practice! How to Use your Card: Your Dental Discount Card is your personal identification for dental services. The discount card must be in your possession along with a form of photo identification e.g. driver s license or student ID. Patients must bring both the Dental Discount Card and photo ID to every appointment. The dental discount card fees will be applied to all services in our office at the time of your visit. Scheduling an Appointment: When scheduling an appointment via phone, , or in person, please notify our staff that you have the dental discount card. This ensures that our office will apply the appropriate fees to your account prior to your arrival. If you have been previously established with another office within the last four years, please notify our staff at the time of scheduling your appointment. When you arrive for your appointment, please be ready to fill out all necessary paperwork, including medical and dental history. We can be reached by at fsumorgandental@gmail.com or by phone (850) for appointments. Walk-in appointments can be made in the Dental Clinic on the 3 rd floor of the Wellness Center. Dental Discount Fee Schedule: All services provided in our office are at a discounted rate from % with a full list of discounted fees attached in this packet. A treatment plan will be made at the end of each appointment with outstanding/next visit treatment with the discount fees in place when services are provided.

3 Fee Schedule for the Dental Discount Plan Procedure Code Description Standard Fee Discount Card Fee D0140 Limited Exam $66.00 FREE! D0150 Comprehensive Exam $70.00 FREE! D0220 Intraoral X-ray $24.00 FREE! D0274 Bitewing X-rays $46.00 FREE! D0330 Panoramic X-ray $80.00 FREE! D1110 Dental Cleaning $80.00 $25.00 D Surface Anterior Filling $ $90.00 D Surface Anterior Filling $ $ D Surface Anterior Filling $ $ D Surface Anterior Filling $ $ D Surface Posterior Filling $ $97.00 D Surface Posterior Filling $ $ D Surface Posterior Filling $ $ D Surface Posterior Filling $ $ D2740 Porcelain Crown $1, $ D2950 Core Buildup with Crown $ $ D2954 Prefab Post and Core $ $ D2962 Labial Veneer (Porcelain) $1, $ D3221 Gross Pupal Debridement $ $84.00 D3310 Anterior Rootcanal $ $ D3320 Bicuspid Rootcanal $ $ D3330 Molar Rootcanal $1, $ D4341 D4342 Periodontal Scaling and Rootplaning (Per Quad) Periodontal Scaling and Rootplaning (1-3 Teeth) $ $ $ $122.00

4 D4910 Periodontal Maintenance $ $85.00 D5110 Complete Upper Denture $1, $ D5120 Complete Lower Denture $1, $ D5130 Immediate Upper Denture $1, $ D5140 Immediate Lower Denture $1, $ D7140 Basic/Simple Extraction $ $78.00 D7210 Surgical Extraction $ $ D7220 D7230 D7240 Removal of Impacted Tooth Soft Tissue Removal of Impacted Tooth Partially Boney Removal of Impacted Tooth Complete Boney $ $ $ $ $ $ D9230 Analgesia (Laughing Gas) $80.00 $45.00 D9248 Non-intravenous Conscious Sedation $ $ NOTE: ANY FEES NOT LISTED ARE ELIGIBLE FOR A 20% DISCOUNT!

5 Canceled/Missed Appointments: Each patient s time is very important to us. This is why we have established the following policy for patients who do not cancel in a timely manner. If patients need to cancel, there are options for notifying our office by either calling our main office line at (850) or ing the office at fsumorgandental@gmail.com. Failure to cancel at least 24-hours before your scheduled appointment time will result in a $25.00 rescheduling fee and require a deposit before your next appointment will be scheduled. Dental Discount Card Presentation: Present your dental discount card and another form of identification e.g. driver s license or a student ID at every appointment. Failure to do so will result in a $10.00 cancellation fee and the reschedule of your appointment. Misuse of the dental discount program will result in patient dismissal from the practice with no refund for the discount card purchase or services rendered. Payment for Services: All services must be paid for at the time services are rendered. Morgan Dental Associates, PLLC accepts all major credit cards, cash, check, and CareCredit for services. If the patient will be sedated for the appointment, all services must be paid before services are rendered.

6 Disclaimer: This card is not dental insurance! This card is not intended to replace dental or health insurance benefits. This plan does not qualify under the Affordable Care Act and is not a Medicare plan. This is a discount card that provides a variety of dental services at a discounted fee to help participants receive the dental work desired without having to pay monthly premiums and having the hassle with waiting periods that are associated with the majority of dental plans. The enrollee is obligated to pay for the dental services but will receive a discount from those dental providers who have contracted with the discount plan. This card has been designed with the patient s fiscal responsibilities in mind and has been marketed and sold though Morgan Dental Associates, PLLC that can be used for services only at Morgan Dental Associates, PLLC in the Tallahassee, FL location only. This card holds no value if presented at a specialist s office if the patient is to be referred. The one-time yearly fee of $ must be paid at the time of enrollment. Failure to do so will result in the enrollee s card not being valid. All fees for services must be paid for at the time of service. We accept all major credit cards, cash, check, PayPal and Care Credit. Purchasers are entitled to a full refund of the card purchase within the first 15 days from the purchase date ONLY if the card has NOT been used during that first 15- day period. For any questions regarding this discount plan, please refer to the following resources:

7 Morgan Dental Associates, PLLC 960 Learning Way Suite 3400 Tallahassee, FL Website: Phone: (850) Fax: (850)