PWU REPRESENTED EMPLOYEES - ODA CODES COVERED UNDER THE KINECTRICS DENTAL PLAN (DRAFT) PROCEDURE

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "PWU REPRESENTED EMPLOYEES - ODA CODES COVERED UNDER THE KINECTRICS DENTAL PLAN (DRAFT) PROCEDURE"

Transcription

1 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Initial examination of a new patient % Class A Initial examination of a new patient % Class A Initial examination of a new patient % (2 times/person/cal yr OR Class A Re-examination of a previous patient once/person every 6 months) % (2 times/person/cal yr OR Class A Periodontal examination once/person every 6 months) % Class A Specific examination % Class A Emergency Examination % (once/person every 3 cal yrs) Class A Intraoral radiographs complete % (once/person every 3 cal yrs) Class A Intraoral radiographs complete % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral, Occlusal radiographs % Class A Intraoral, Occlusal radiographs % Class A Intraoral, Occlusal radiographs % Class A Intraoral, occulsal radiographs % Class A Intraoral Occlusal radiographs % Class A Intraoral Occlusal Radiographs % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % Class A Extraoral Radiogrphas % Class A Extraoral Radiographs % Class A Extraoral Radiographs % Class A Extraoral Radiographs % Class A Extraoral Radiographs % Class A Sinus Examination % Class A Sialography

2 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Sialography % Class A Sialography % Class A Use of radiopaque dyes to demonstrate lesions % Class A Use of radioopaque dyes to demonstrate lesions % Class A Use of radioopaque dyes to demonstrate lesions % Class A Temporomandibular Joint radiographs % Class A Temporomandibular Joint radiographs % (once/person every 3 cal yrs) Class A Panoramic (full mouth) radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Tracing of radiographs % Class A Tracing of radiographs % Class A Tracing of radiographs % Class A Interpretation of radiographs from another source - per unit of time % Class A Interpretation of radiographs from another source - per unit of time % Class A Interpretation of radiographs from another source - per unit of time % Class A Hand and Wrist radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Treatment Planning % Class A Treatment Planning % Class A Treatment Planning % Class A Treatment Planning % Class A Treatment Planning % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % (once every 6 months) Class A Polishing % (once every 6 months) Class A Polishing % (once every 6 months) Class A Polishing % (once every 6 months) Class A Polishing % Class A Scaling limited to a maximum combined with periodontal root planing

3 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (2 times/year up to and Class A Fluoride treatment including age 18) % (2 times/year up to and Class A Fluoride treatment including age 18) % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Finishing Restorations % Class A Finishing Restorations % (once every 3 cal yrs, up to and including age 18 - permanent molars only) % (once every 3 cal yrs, up to and including age 18 - permanent molars only) Class A Class A Pit and Fissure sealant Pit and Fissure sealant

4 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Protective Mouth Guard % Class A Interproximal discing of teeth % Class A Interproximal discing of teeth % Class A Interproximal discing of teeth % Class A Interproximal discing of teeth % Class A Control of Oral Habits % Class A Control of Oral Habits % Class A Control of Oral Habits % Class A Control of Oral Habits % Class A Myofunctional Therapy % Class A Myofunctional Therapy % Class A Myofunctional Therapy % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent molars % Class A Permanent molars % Class A Permanent molars % Class A Permanent molars % Class A Permanent molars % Class B Other Restorative Services % Class A Retentive pin reinforcement % Class A Retentive Pin reinforcement % Class A Retentive Pin reinforcement

5 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Retentive Pin reinforcement % Class A Retentive Pin reinforcement % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations

6 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class B Other Restorative Services % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Metal inlay restorations % Class B Metal inlay restorations % Class B Metal inlay restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Metal inlay restorations % Class B Retentive pins % Class B Retentive pins % Class B Retentive pins % Class B Retentive pins % Class B Retentive pins % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % (once every 5 cal yrs) Class B Posts, attachment to endosseous integrated implants % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations

7 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Porcelain restorations % Class B Porcelain restorations % Class B Other Restorative Services % Class B Other Restorative Services % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class A Pulpotmoy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Pulpotmoy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Pulpotmoy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Apexification % Class A Apexification % Class A Apexification % Class A Apexification % Class A Re-insertion of Dentogenic Media % Class A Re-insertion of Dentogenic Media % Class A Re-insertion of Dentogenic Media % Class A Re-insertion of Dentogenic Media % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy

8 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures

9 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Desensitization % Class A Periodontal - Desensitization % Class A Periodontal - Desensitization % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services

10 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Post Surgical Treatment % Class A Post Surgical Treatment % Class A Post Surgical Treatment % Class A Post Surgical Treatment % Class A Periodontal abcess/periocoronitis % Class A Periodontal abcess/periocoronitis % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Antimicrobial Agents % Class A Anitmicrobial Agents % Class A Periodontal Appliances % Class A Periodontal Appliances % Class A Maintenance Appliances % Class A Maintenance Appliances

11 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Maintenance Appliances % Class A Maintenance Appliances % Class A Maintenance Appliances % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % (once every 3 cal yrs) Class B Complete maxillary denture % (once every 3 cal yrs) Class B Complete mandibular denture % (once every 3 cal yrs) Class B Complete maxillary and mandibular dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 3 cal yrs) Class B Transitional partial denture % (once every 3 cal yrs) Class B Transitional partial denture % (once every 3 cal yrs) Class B Transitional partial denture % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic

12 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments

13 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining

14 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Pontics % Class B Pontics % Class B Pontics % Class B Pontics % Class B Pontics % Class B Pontics % Class B Repairs, Replacements % Class B Repairs, Replacements % Class B Repairs, Replacements % Class B Repairs, Replacements % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Porcelain repair % Class B Porcelain repair % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % (once every 5 cal yrs) Class B Retainers - Attached to implants % (once every 5 cal yrs) Class B Retainers - Attached to implants % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % (once every 5 cal yrs) Class B Retainers - Attached to implants % (once every 5 cal yrs) Class B Retainers - Attached to implants % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers, Metal % Class B Retainers, Metal % Class B Retainers, Metal % Class B Retainers, Metal % Class B Retainers - Crowns % Class B Retainers - Crowns % (once every 5 cal yrs) Class B Retainers - Attached to implants % Class B Splinting % Class B Retentive pins in fixed prosthetics % Class B Retentive pins in fixed prosthetics % Class B Retentive pins in fixed prosthetics

15 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Retentive pins in fixed prosthetics % Class B Retentive pins in fixed prosthetics % Class B Provisional coverage % Class B Provisional coverage % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % Class A Uncomplicated surgical removal of single erupted tooth % Class A Removal of each additional tooth in same quadrant - same appointment % Class A Removal of erupted tooth (complicated) % Class A Removal of erupted tooth (complicated) % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Enucleation % Class A Surgical Enucleation % Class A Alveoloplasy % Class A Alveoloplasy % Class A Excision of bone % Class A Excision of bone % Class A Excision of bone % Class A Removal of bone % Class A Gingivoplasty and/or stomatoplasty % Class A Gingivoplasty and/or stomatoplasty

16 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Vestibuloplasty % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Incision % Class A Surgical Incision % Class A Surgical Incision % Class A Surgical Incision % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Frenectomy % Class A Frenectomy % Class A Frenectomy % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures

17 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia

18 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % Class A Therapeutic Injections % Class A Therapeutic Injections % Class A In-office laboratory procedures

Alberta Blue Cross Usual and Customary dental fees

Alberta Blue Cross Usual and Customary dental fees Alberta Blue Cross Usual and Customary dental fees Why Usual and Customary dental fees? In Alberta, individual dental providers set their own prices. As a result, dental offices across the province charge

More information

Schedule B Indemnity plan People First Plan Code #4084

Schedule B Indemnity plan People First Plan Code #4084 : Calendar year deductible Waived for Type I preventive dental services Calendar year maximum Type I, II, III Waiting period Type I, II, III $50 individual $150 family (3 per family) $1,000 per covered

More information

2016 Buy Up Dental Care Plan Procedure List

2016 Buy Up Dental Care Plan Procedure List * This is in addition to the embedded Preventive Plan (see procedure list at deltadentalco.com/kp_preventive. BASIC SERVICES Minor Restorative Services D2140 Amalgam 1 surface, primary or permanent D2150

More information

Procedure Description. Prophylaxis - adult. Periodic oral evaluation - established patient. Resin-based composite - three surfaces, posterior

Procedure Description. Prophylaxis - adult. Periodic oral evaluation - established patient. Resin-based composite - three surfaces, posterior Top ADA Dental Procedure Codes - Pediatric Patients Ranked by Contribution to Total Pediatric Dental Claim Costs based on 15 Milliman Health Cost Guidelines-Dental 12 08 13 51 74 91 71 93 03 12 06 Procedure

More information

PROVIDER CHOICE Plan PC - 5

PROVIDER CHOICE Plan PC - 5 The Dental Network Suite 200, 7400 York Road Towson, Maryland 21204 Telephone: (410) 847-9060 Fax: (410) 847-9062 Toll Free: (888) 833-8464 Website: www.thedentalnet.org Email: service@thedentalnet.org

More information

SECURITY LIFE INSURANCE COMPANY OF AMERICA Minnetonka, Minnesota

SECURITY LIFE INSURANCE COMPANY OF AMERICA Minnetonka, Minnesota SECURITY LIFE INSURANCE COMPANY OF AMERICA Minnetonka, Minnesota COVERAGE SCHEDULE PREFERRED (In-Network) PROVIDER: WE WILL PAY BASED ON THE CONTRACTED FEE FOR SERVICE WITH THE PREFERRED PROVIDER ORGANIZATION

More information

Dentists. Schedule of Dental Services and Fees for Ontario Works Adults

Dentists. Schedule of Dental Services and Fees for Ontario Works Adults Dentists Schedule of Dental Services and Fees for Ontario Works Adults 2015 2015 Ontario Works Adults - Schedule of Dental Services and Fees PURPOSE OF THE PROGRAM Halton Region does not intend to provide

More information

Healthy Kids Evidence of Coverage (EOC) Errata Sheet

Healthy Kids Evidence of Coverage (EOC) Errata Sheet Healthy Kids Evidence of Coverage (EOC) Errata Sheet The information below is to replace the Section U.3. (Dental Services) of your current Handbook (EOC) for the benefit year from July 1, 2015 June 30,

More information

Humana Health Plans of Florida. Important:

Humana Health Plans of Florida. Important: Humana Health Plans of Florida Important: Dental discount membership in Florida is determined by viewing the member s ID card and verifying that the Humana Logo and Medicare name is listed with an effective

More information

Dental Benefits (866) 212-2743 A. Choice of Physician and Provider B. Scheduling Appointments C. Referrals to Specialists D. Changing Your Dentist

Dental Benefits (866) 212-2743 A. Choice of Physician and Provider B. Scheduling Appointments C. Referrals to Specialists D. Changing Your Dentist Dental Benefits Dental Benefits are provided through Delta Dental of California. Upon enrollment you will receive a dental provider directory that lists Delta Dental dentists participating in the Healthy

More information

A Dental Benefit Summary for Rice University

A Dental Benefit Summary for Rice University Aetna Dental presents A Dental Benefit Summary for Rice University CODE CODE Office Visit Copay $5 DIAGNOSTIC CROWNS/BRIDGES D0120 Exam-Periodic No Charge D2510 Inlay, Metallic, One surface $225 D0150

More information

ONTARIO WORKS. Dentist Fee Schedule. Adult Emergency Dental Services (Age 18 and over) District of Muskoka

ONTARIO WORKS. Dentist Fee Schedule. Adult Emergency Dental Services (Age 18 and over) District of Muskoka ONTARIO WORKS Dentist Fee Schedule Adult Emergency Dental Services (Age 18 and over) District of Muskoka May 2012 The Canadian Dental Association is the owner of the copyright and other intellectual property

More information

Staywell FL Child Medicaid Plan Benefits

Staywell FL Child Medicaid Plan Benefits The following is a complete list of the dental procedures for which benefits are payable under this Plan. on-listed procedures are not covered. This Plan does not allow alternate benefits. Members must

More information

DISCOUNT DENTAL PLAN COMPLETE LISTING OF MEMBER COPAYMENTS

DISCOUNT DENTAL PLAN COMPLETE LISTING OF MEMBER COPAYMENTS DISCOUNT DENTAL PLAN COMPLETE LISTING OF MEMBER COPAYMENTS 0120 PERIODIC ORAL EXAMINATION - ESTABLISHED PATIENT 20 0140 LIMITED ORAL EVALUATION - PROBLEM FOCUSED 33 0150 COMPREHENSIVE ORAL EVALUATION -

More information

LIST OF DENTAL PROCEDURES (LOW PLAN) PREVENTIVE PROCEDURES

LIST OF DENTAL PROCEDURES (LOW PLAN) PREVENTIVE PROCEDURES LIST OF DENTAL PROCEDURES (LOW PLAN) The following is a complete list of the dental procedures for which benefits are payable under this section. No benefits are payable for a procedure that is not listed.

More information

deltadentalins.com/usc

deltadentalins.com/usc Plan Benefit Highlights for: UNIVERSITY OF SOUTHERN CALIFORNIA STUDENT PLAN Group No: 05008 The Delta Dental PPO table plan provides you great dental benefits at a reasonable cost. With a table of allowance

More information

Alberta Dental Fee Guide 2014 - General Practioners and Specialists

Alberta Dental Fee Guide 2014 - General Practioners and Specialists Alberta Dental Fee Guide 2014 - General Practioners and s Note: the below information has been developed by Manulife Financial by using actual Manulife dental claims experience in Alberta. Manulife is

More information

Active. Comparison of Dental Benefits

Active. Comparison of Dental Benefits Carpenters Southwest Administrative Corporation ADMINISTRATIVE OFFICE: 533 S. Fremont Ave. Los Angeles, CA 90071-1706 Tel: (213) 386-8590 Toll Free (800) 293-1370 www.carpenterssw.org Active Comparison

More information

CCPOA PRIMARY DENTAL. CCPOA s Fee-for-Service. Procedure Code List

CCPOA PRIMARY DENTAL. CCPOA s Fee-for-Service. Procedure Code List CCPOA PRIMARY DENTAL CCPOA s Fee-for-Service Procedure Code List Effective May 2016 We have provided these payment allowances for informational purposes only and not as a guarantee of payment. All claims

More information

DEPARTMENT OF MEDICINE

DEPARTMENT OF MEDICINE DEPARTMENT OF MEDICINE Great-West Life is a leading Canadian life and health insurer. Great- West Life's financial security advisors work with our clients from coast to coast to help them secure their

More information

2015 Dental Procedures Chart for Basic Dental Benefits

2015 Dental Procedures Chart for Basic Dental Benefits The dental procedures chart provides you with a list of the covered procedures and copayments for the Basic Dental benefits you receive as part of your CareMore Health Plan. Note: None of the procedures

More information

TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS.

TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. The attached is a list of dental procedures for which benefits are payable under

More information

OVERVIEW The MetLife Dental Plan for Retirees

OVERVIEW The MetLife Dental Plan for Retirees OVERVIEW The MetLife Dental Plan for Retirees IN NETWORK: Staying in network saves you money. 1 Participating dentists have agreed to MetLife s negotiated fees which are typically 15% to 45% below the

More information

Dental Supplement. Dentist

Dental Supplement. Dentist Dental Supplement Dentist MINISTRY OF SOCIAL DEVELOPMENT TABLE OF CONTENTS Part A - Preamble - Dental Supplements - Dentist pages i - vi The Preamble - Dental Supplements - Dentist provides details on

More information

SMALL GROUP PLANS FOR FAMILIES AND ADULTS WITH COMPREHENSIVE COVERAGE Page 1 of 9 Features & Benefit Details

SMALL GROUP PLANS FOR FAMILIES AND ADULTS WITH COMPREHENSIVE COVERAGE Page 1 of 9 Features & Benefit Details SMALL GROUP PLANS FOR FAMILIES AND ADULTS WITH COMPREHENSIVE COVERAGE Page 1 of 9 PLAN NETWORK Premium range child under age 19* Sample premium range typical family of 4* Is this a smaller network? Is

More information

Handbook. Your guide to the Alberta Blue Cross. Dental Schedule

Handbook. Your guide to the Alberta Blue Cross. Dental Schedule Dental Handbook 2016 Your guide to the Alberta Blue Cross Dental Alberta Blue Cross Dental : 2016 Helping you keep your healthy smile About the schedule January 2016 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

More information

General Dentist Fees

General Dentist Fees General Dentist Fees January 1, 2015 Not all codes are covered benefits. Please check the member s plan for verification and limitations. There are no fee increases for 2015, but new CDT codes have been

More information

Coverage with HMO Off-Marketplace Health Plans

Coverage with HMO Off-Marketplace Health Plans Adult Dental and Vision Coverage with HMO Off-Marketplace Health Plans Pam White We are your Health Net. Optional adult dental and vision coverage (ages 19 and older) with Health Net HMO Plus is available

More information

CALIFORNIA ASSOCIATION OF REALTORS

CALIFORNIA ASSOCIATION OF REALTORS CALIFORNIA ASSOCIATION OF REALTORS Summary of Benefits MetLife Dental Insurance Plan benefits effective 1/1/16 BENEFITS Plans at a glance CHOICE PLAN SELECT PLAN VALUE PLAN Reimbursement In-Network Out-of-

More information

An Overview of Your Dental Benefits

An Overview of Your Dental Benefits An Overview of Your Dental Benefits Educators Health Alliance ii \ DENTAL BENEFITS PPO Dental Plan Options OPTION 1 Maintenance Dentistry OPTION 2 (STANDARD PLAN) IN-NETWORK OUT-OF-NETWORK Maintenance

More information

PATIENT CHARGE SCHEDULE

PATIENT CHARGE SCHEDULE B1-05 Important Highlights PATIENT CHARGE SCHEDULE This Schedule lists the benefits of the Dental Plan including covered procedures and patient charges. This Schedule applies only when covered dental services

More information

EmblemHealth Preferred Dental

EmblemHealth Preferred Dental EmblemHealth Preferred Dental Unique coverage levels at affordable group rates. Here s how EmblemHealth Preferred Dental will deliver for you: Complete your benefits package with paid-infull* in-network

More information

FORD DENTAL COVERAGE

FORD DENTAL COVERAGE FORD DENTAL COVERAGE HOW DENTAL COVERAGE WORKS The Trust provides dental coverage to you and your eligible Dependents. A Dental Benefits Manager, Delta Dental of Michigan, whose contact information is

More information

Out-of- Network** $50 $50 Deductible (waived for Class I) $50 $50 Annual Maximum $1,500 Annual Maximum $1,500 Waiting Period

Out-of- Network** $50 $50 Deductible (waived for Class I) $50 $50 Annual Maximum $1,500 Annual Maximum $1,500 Waiting Period This summary of benefits, along with the exclusions and limitations describe the benefits of the Family Dental PPO Plan in California. Please review closely to understand all benefits, exclusions and limitations.

More information

Individual Incentive Dental 10 Insurance for Oregon Individuals and Families

Individual Incentive Dental 10 Insurance for Oregon Individuals and Families LifeMap Assurance Company TM 100 SW Market Street P.O. Box 1271 E-3A Portland, OR 97207-1271 (800) 756-4105 Individual Incentive Dental 10 Insurance for Oregon Individuals and Families This Outline of

More information

Dental Services Rider Harbor Choice Plus, a product of Harbor Health Plan, Inc.

Dental Services Rider Harbor Choice Plus, a product of Harbor Health Plan, Inc. Your Agreement gives You important information about Your health care benefits. This Dental Services Rider ( Rider ) is issued to You with Your Agreement because the plan you selected includes Other Dental

More information

Code Dental Procedure Description Pays CLINICAL ORAL EVALUATIONS

Code Dental Procedure Description Pays CLINICAL ORAL EVALUATIONS Schedule of Benefits SCHEDULE OF BENEFITS ADA Member Code Dental Procedure Description Pays CLINICAL ORAL EVALUATIONS D0120 Periodic oral evaluation...$0 D0140 Limited oral evaluation - problem focused...$0

More information

Summary of Benefits. Mount Holyoke College

Summary of Benefits. Mount Holyoke College Dental Blue Program 2 Summary of Benefits Mount Holyoke College Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association Dental Blue Program 2 Preventive

More information

Aetna Life Insurance Company Hartford, Connecticut 06156

Aetna Life Insurance Company Hartford, Connecticut 06156 Aetna Life Insurance Company Hartford, Connecticut 06156 Extraterritorial Certificate Rider (GR-9N-CR1) Policyholder: Choctaw Enterprises Group Policy No.: GP-819977 Rider: Florida ET Dental (PPO) Issue

More information

DENTAL FOR EVERYONE SUMMARY OF BENEFITS, LIMITATIONS AND EXCLUSIONS

DENTAL FOR EVERYONE SUMMARY OF BENEFITS, LIMITATIONS AND EXCLUSIONS DENTAL FOR EVERYONE SUMMARY OF BENEFITS, LIMITATIONS AND EXCLUSIONS DEDUCTIBLE The dental plan features a deductible. This is an amount the Enrollee must pay out-of-pocket before Benefits are paid. The

More information

Aetna Dental Plan Organization (DPO) Plan. 2015 New Jersey SHBP Active Employees Covered Services

Aetna Dental Plan Organization (DPO) Plan. 2015 New Jersey SHBP Active Employees Covered Services Aetna Dental Plan Organization (DPO) Plan 2015 New Jersey SHBP Active Employees Covered Services The following is a list of covered services and, if applicable, required copayments. Copayments are your

More information

2015 Dental Plan 5000S Benefit Information BALTIMORE CITY PUBLIC SCHOOLS. Baltimore City Public Schools 2015 Dental Options C1

2015 Dental Plan 5000S Benefit Information BALTIMORE CITY PUBLIC SCHOOLS. Baltimore City Public Schools 2015 Dental Options C1 2015 Dental Plan 5000S Benefit Information BALTIMORE CITY PUBLIC SCHOOLS Baltimore City Public Schools 2015 Dental Options C1 Important Information for 2015 The State of Maryland legalized same sex marriage

More information

Dental Benefits Summary

Dental Benefits Summary PATIENT PAYS PATIENT PAYS CODE PROCEDURE CODE PROCEDURE Office Visit Copay $5 DIAGNOSTIC D0120-D0180 Oral Evaluations D0277 Vertical Bitewings - 7 to 8 Films D0210 Full mouth series Images D0330 Panoramic

More information

Delta Dental Patient Direct Schedule 19

Delta Dental Patient Direct Schedule 19 Delta Dental Patient Direct Schedule 19 ADA CODE DENTAL PROCEDURE /ADA CODE DESCRIPTION NORMAL FEE* MEMBER FEE YOU SAVE Diagnostic and Preventive Services (x-rays and cleanings) D0999 Routine office visit

More information

Dental Benefits Summary

Dental Benefits Summary CODE PROCEDURE Office Visit Copay PATIENT PAYS CODE $0 DIAGNOSTIC PROCEDURE PATIENT PAYS D0120-D0180 Oral Evaluations D0277 Vertical Bitewings - 7 to 8 Films D0210 Full mouth series Images D0330 Panoramic

More information

Dental Coverage Limitations By Program

Dental Coverage Limitations By Program Dental Coverage Limitations By Program Procedure or Service Common ADA Codes Program Coverage Periodic Oral Exam D0120 If you are less than 21 you may have an exam every 6 months. If you are 21 or older,

More information

Cigna Dental Care (*DHMO) Patient Charge Schedule

Cigna Dental Care (*DHMO) Patient Charge Schedule A3O08 Cigna Dental Care (*DHMO) Schedule This Schedule lists the benefits of the Dental Plan including covered procedures and patient charges. Important Highlights This Schedule applies only when covered

More information

Dental Benefits Summary

Dental Benefits Summary CODE Office Visit Copay PATIENT PAYS CODE DIAGNOSTIC PATIENT PAYS D0120-D0180 Oral Evaluations D0277 Vertical Bitewings - 7 to 8 Films D0210 Full mouth series X-rays D0330 Panoramic X-Ray D0220-D0230 Periapicals

More information

Network Plus Prepaid plan People First Plan Code #4004

Network Plus Prepaid plan People First Plan Code #4004 Selecting a dentist For participating dentist information you may visit our website at www.humanadental.com/custom/fl/ or call our dedicated Customer Care number at 1-800-943-6880. Once you become enrolled

More information

Dental Benefits Summary

Dental Benefits Summary PATIENT PAYS PATIENT PAYS CODE PROCEDURE CODE PROCEDURE Office Visit Copay $0 DIAGNOSTIC D0120-D0180 Oral Evaluations D0277 Vertical Bitewings - 7 to 8 Films D0210 Full mouth series X-rays D0330 Panoramic

More information

DIRECT REFERRAL DENTAL PLAN HN VALUE DHMO 150 SCHEDULE OF BENEFITS

DIRECT REFERRAL DENTAL PLAN HN VALUE DHMO 150 SCHEDULE OF BENEFITS DIRECT REFERRAL DENTAL PLAN HN VALUE DHMO 150 SCHEDULE OF BENEFITS Benefits provided by Dental Benefit Providers of California, Inc. This document describes the Covered Services of this Health Net of California

More information

Anthem Blue Dental PPO Plan

Anthem Blue Dental PPO Plan Anthem Blue Dental PPO Plan For Individuals and Families Anthem Blue Cross and Blue Shield 700 Broadway Denver, Colorado 80273 anthem.com An independent licensee of the Blue Cross and Blue Shield Association.

More information

You may receive dental services from any dentist practicing within the scope of his or her license.

You may receive dental services from any dentist practicing within the scope of his or her license. DENTAL PLAN Once you enroll in one of the Getty s medical plans, you and your covered dependents are automatically enrolled in the Dental Plan. The Dental Plan, which is offered through MetLife, allows

More information

ONTARIO WORKS DENTAL BENEFITS. Adult Ontario Works Recipients. Region of Durham Departments of Health and Social Services

ONTARIO WORKS DENTAL BENEFITS. Adult Ontario Works Recipients. Region of Durham Departments of Health and Social Services HEALTH DEPARTMENT ONTARIO WORKS DENTAL BENEFITS Adult Ontario Works Recipients Region of Durham Departments of Health and Social Services Effective for services provided after January 1, 2012. The fees

More information

CODING DENTAL CHARACTERISTICS Letter to Dentist

CODING DENTAL CHARACTERISTICS Letter to Dentist CODING DENTAL CHARACTERISTICS Letter to Dentist Dear Doctor: Because it is believed that you have treated the subject of this report, your assistance with the enclosed dental report is requested. Your

More information

DENTAL PLAN ADMINISTERED BY MEDBEN

DENTAL PLAN ADMINISTERED BY MEDBEN DENTAL PLAN ADMINISTERED BY MEDBEN 2.9 SCHEDULE OF DENTAL BENEFITS This Schedule of Dental Benefits is intended to provide only a general description of a Covered Person s dental benefits under this Plan.

More information

UFT WELFARE FUND DIRECT ACCESS DENTAL PLAN

UFT WELFARE FUND DIRECT ACCESS DENTAL PLAN ~ UFT WELFARE FUND DIRECT ACCESS DENTAL PLAN The United Federation of Teachers Welfare Fund is pleased to announce the Direct Access Dental Plan. The Direct Access Dental Plan was developed for the benefit

More information

TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS.

TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. The attached is a list of dental procedures for which benefits are payable under

More information

Plans for Families and Adults with Comprehensive Coverage Features & Benefit Details

Plans for Families and Adults with Comprehensive Coverage Features & Benefit Details Page 1 of 7 s for Families and Adults with Comprehensive Coverage Network Premier Altus Dental Participating Dentists Blue Cross PPO Dental Preferred Dentist Program Plus EPO Family EPO DentalGuard Preferred

More information

SCHEDULE OF BENEFITS Benefits provided by SafeGuard Health Plans, Inc., a MetLife company Self-Referral Dental Plan

SCHEDULE OF BENEFITS Benefits provided by SafeGuard Health Plans, Inc., a MetLife company Self-Referral Dental Plan SCHEDULE OF BENEFITS Benefits provided by SafeGuard Health Plans, Inc., a MetLife company Self-Referral Dental Plan Univ II This Schedule of Benefits lists the services available to you under your SafeGuard

More information

HEALTH SERVICES POLICY & PROCEDURE MANUAL. SUBJECT: Types of Dental Treatments Provided EFFECTIVE DATE: July 2014 SUPERCEDES DATE: January 2014

HEALTH SERVICES POLICY & PROCEDURE MANUAL. SUBJECT: Types of Dental Treatments Provided EFFECTIVE DATE: July 2014 SUPERCEDES DATE: January 2014 PAGE 1 of 5 References Related ACA Standards 4 th Edition Standards for Adult Correctional Institutions 4-4369, 4-4375 PURPOSE To provide guidelines for determining appropriate levels of care and types

More information

Contributory dental (2-9) Alaska 2016

Contributory dental (2-9) Alaska 2016 Contributory dental (2-9) Option 1 Indemnity 1500 Indemnity 100/80/50 Option 2 PPO 1000 Option 3 PPO 1500 Option 4 PPO 2000 PPO 100/80/50 PPO 100/80/50 PPO 100/80/50 $50; 3X Family Maximum $50; 3X Family

More information

2014 Dental Benefits Summary

2014 Dental Benefits Summary 2014 Dental Benefits Summary ICUBA Dental Benefit Options from HumanaDental The dental coverage is offered, so you and your family can receive the important dental care you need for good health. You can

More information

Quality, affordable dental insurance

Quality, affordable dental insurance Quality, affordable dental insurance Group association dental insurance under the IHC Dental plans is underwritten by Madison National Life Insurance Company, Inc. For residents of Texas. Your oral health

More information

DeltaCare Plan SCHEDULE OF DENTAL BENEFITS PATIENT

DeltaCare Plan SCHEDULE OF DENTAL BENEFITS PATIENT DeltaCare Plan SCHEDULE OF DENTAL BENEFITS CODE (D0100-D0999) DIAGNOSTIC Office visit, per visit (in addition to other services) No Cost D0120 Periodic oral evaluation No Cost D0140 Limited oral evaluation

More information

Residency Competency and Proficiency Statements

Residency Competency and Proficiency Statements Residency Competency and Proficiency Statements 1. REQUEST AND RESPOND TO REQUESTS FOR CONSULTATIONS Identify needs and make referrals to appropriate health care providers for the treatment of physiologic,

More information

Cigna Dental - Low Plan Schedule for Class II and III Procedures Payment Basis - Maximum Covered Expense Benefit Period - Calendar Year.

Cigna Dental - Low Plan Schedule for Class II and III Procedures Payment Basis - Maximum Covered Expense Benefit Period - Calendar Year. Cigna Dental - Low Plan Schedule for Class II and III Procedures Payment Basis - Maximum Covered Expense Benefit Period - Calendar Year ADA Code Class II Maximum Covered ORAL PATHOLOGY/LABORATORY Procedure

More information

The Full Dental Plan is designed to cover diagnostic, preventive and restorative procedures necessary for adequate dental health.

The Full Dental Plan is designed to cover diagnostic, preventive and restorative procedures necessary for adequate dental health. Full Dental Plan The Full Dental Plan is designed to cover diagnostic, preventive and restorative procedures necessary for adequate dental health. Covered services include: Oral Examinations Periapical

More information

Individual Dental Plan

Individual Dental Plan Individual Dental Plan Your dental health affects more than just your smile... It can have a major impact on your overall health. That s why it s important to have solid dental benefits in place to complete

More information

P REMIER A CCESS TABLE OF CONTENTS

P REMIER A CCESS TABLE OF CONTENTS Important Contacts Questions Can Be Answered By: Premier Provider Relations Department (916) 920-2500 1-800-640-4466 Submit Claims To: Premier Access Insurance Company Claims Department P. O. Box 659010

More information

DentalBlue Network. DentalBlue Network Basics. Participating Dentists. Non-Participating Dentist. Predetermination of Benefits

DentalBlue Network. DentalBlue Network Basics. Participating Dentists. Non-Participating Dentist. Predetermination of Benefits With more than 2,000 dentist locations in Tennessee and its bordering counties, your DentalBlue plan has the largest dental PPO network (Preferred Provider Organization network) in Tennessee. And DentalBlue

More information

2007 Insurance Benefits Guide. Dental and Dental Plus. Dental and. Dental Plus. www.eip.sc.gov Employee Insurance Program 91

2007 Insurance Benefits Guide. Dental and Dental Plus. Dental and. Dental Plus. www.eip.sc.gov Employee Insurance Program 91 Dental and www.eip.sc.gov Employee Insurance Program 91 Table of Contents Introduction...93 Your Dental Benefits at a Glance...94 Claim Examples (using Class III procedure claims)...95 How to File a Dental

More information

The Alberta Blue Cross Dental Schedule Effective January 01, 2012

The Alberta Blue Cross Dental Schedule Effective January 01, 2012 The Alberta Blue Cross Dental Schedule Effective January 01, 2012 2005 ABC Benefits Corporation. All rights reserved. Alberta Blue Cross symbol and name and Alberta Blue Cross Dental Schedule name are

More information

Enroll in DeltaCare USA and you ll enjoy these features:

Enroll in DeltaCare USA and you ll enjoy these features: DeltaCare USA provided by Delta Dental of California We ll do whatever it takes and then some. Find a DeltaCare USA dentist Select from among the many conveniently located DeltaCare USA contracted general

More information

MEDICAL ASSISTANCE PROGRAM DENTAL FEE SCHEDULE

MEDICAL ASSISTANCE PROGRAM DENTAL FEE SCHEDULE Dental General Payment Policies Children under 21 years of age are eligible for all medically necessary dental services. For children under 21 years of age who require medically necessary dental services

More information

Prepaid Dental. Good news about dental benefits for employees of. UMB Financial - Texas

Prepaid Dental. Good news about dental benefits for employees of. UMB Financial - Texas Prepaid Dental Good news about dental benefits for employees of UMB Financial - Texas A Dental Plan Means Healthy Smiles Because you are a valued employee, we are pleased to offer you the opportunity to

More information

Diagnostic. 6-20 No One of (D0210, D0330) per 60 Month(s) Per patient. 0-20 No

Diagnostic. 6-20 No One of (D0210, D0330) per 60 Month(s) Per patient. 0-20 No Exhibit A Benefits Covered for OH Paramount Advantage Medicaid Children Diagnostic services include the oral examinations, and selected radiographs, needed to assess the oral health, diagnose oral pathology,

More information

TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS.

TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. The attached is a list of dental procedures for which benefits are payable under

More information

WMI Mutual Insurance Company

WMI Mutual Insurance Company Dental Policy WMI Mutual Insurance Company PO Box 572450 Salt Lake City, UT 84157 (801) 263-8000 & (800) 748-5340 Fax: (801) 263-1247 DENTAL POLICY A. Schedule of Benefits: Annual Maximum Dental Benefit

More information

AMS Premier Group Dental Insurance Plan

AMS Premier Group Dental Insurance Plan AMS Premier Group Dental Insurance Plan American Military Society Acceptance Guaranteed Comprehensive Coverage Economical Insurance Protection Choice of your own dentist You deserve more! AMS Premier Group

More information

Dental. Covered services and limitations module

Dental. Covered services and limitations module Dental Covered services and limitations module Dental Covered Services and Limitations Module Covered Dental Services for Patients Under the Age of 21...2 Examinations...2 Radiographs and Diagnostic Imaging...2

More information

SCHEDULE OF BENEFITS DIRECT REFERRAL DENTAL PLAN*

SCHEDULE OF BENEFITS DIRECT REFERRAL DENTAL PLAN* SCHEDULE OF BENEFITS DIRECT REFERRAL DENTAL PLAN* Nexus 150 This document describes the Covered Services of this dental plan, as well as Copayment requirements, Limitations of Benefits and Exclusions.

More information

Dental Plans. MetLife Dental Plan Delta Dental Plan. ACTIVE UT-B Dental Plans 3 1 1/1/2013

Dental Plans. MetLife Dental Plan Delta Dental Plan. ACTIVE UT-B Dental Plans 3 1 1/1/2013 Dental Plans There are two dental plans to choose from the Metropolitan Life Insurance Plan (MetLife) and the Delta Dental Plan of Ohio (Delta Dental). You may elect either plan, but not both. The dental

More information

Mature Decisions Dental Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations

Mature Decisions Dental Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations Dental Plan Summary Network: PDP/PDP Plus Mature Decisions Dental Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations 100% of Negotiated Fee* 100% of Negotiated Fee* Type B fillings

More information

Dental Plans. Montgomery County Public Schools Summary Plan Description

Dental Plans. Montgomery County Public Schools Summary Plan Description Montgomery County Public Schools Summary Plan Description Table of Contents Dental Plans At-A-Glance...2 The Preferred Provider Organization...5 How Benefit Amounts Are Determined...5 Annual Deductibles

More information

Alberta Dental Fee Guide General Practitioners and Specialists

Alberta Dental Fee Guide General Practitioners and Specialists Alberta Dental Fee Guide 2016 - General Practitioners and Specialists Note: The below information has been developed by Manulife Financial by using actual Manulife dental claims experience in Alberta.

More information

Performance Plus Dental Plan. Annual Deductible. Dental Benefit Maximums. Prior Authorization. Verification of Coverage. Eligible Dental Expenses

Performance Plus Dental Plan. Annual Deductible. Dental Benefit Maximums. Prior Authorization. Verification of Coverage. Eligible Dental Expenses Performance Plus Dental Plan The Trust provides a Dental Plan for Participants the Performance Plus Dental Plan. In-Network Services are available from dentists contracted on behalf of the Trust. Out-of-Network

More information

The Penn Dental Plan for Undergraduate and Graduate Students of the University of Pennsylvania

The Penn Dental Plan for Undergraduate and Graduate Students of the University of Pennsylvania The Penn Dental Plan for Undergraduate and Graduate Students of the University of Pennsylvania Effective August 1, 2015 Introduction The Penn Dental Plan of the University of Pennsylvania ( Penn Dental

More information

Your Dentist says you need a Crown, a Type C Service** Dentist s Usual Fee: $600.00 - R&C Fee: $500.00 - PDP Fee: $375.00

Your Dentist says you need a Crown, a Type C Service** Dentist s Usual Fee: $600.00 - R&C Fee: $500.00 - PDP Fee: $375.00 To help you enroll, the following pages outline your company s dental plan 1 and address any questions you may have. Coverage Type In-Network 2 Out-of-Network 2 Type A - Preventive 100% of PDP Fee 3 80%

More information

healthy teeth healthy body arkansas medicaid s dental care for adults

healthy teeth healthy body arkansas medicaid s dental care for adults healthy teeth healthy body arkansas medicaid s dental care for adults eeping your teeth healthy can help your whole body stay well. If your mouth and teeth are clean, you might not get sick as much. That

More information

Program Description. Services Covered

Program Description. Services Covered Provider Guide Program Description Delta Dental of Oregon (DDOR) and OEBB have partnered together to create a much needed program called The Children s Program. The program provides basic dental services

More information

CDT These changes take effect January 1, If you have questions, please feel free to contact:

CDT These changes take effect January 1, If you have questions, please feel free to contact: CDT 2016 Current Dental Terminology American Dental Association procedure codes (CDT codes) are the recognized dental codes set by the Federal Government. CDT codes are used for dental claim transactions

More information

Access PPO 1 Adults Maximum access, convenience and flexibility.

Access PPO 1 Adults Maximum access, convenience and flexibility. Access PPO 1 Adults Maximum access, convenience and flexibility. Benefit Features Deductibles: $50 ($150) per family Annual Maximum: $1,000 Waiting Periods: None Receive Care From: Any Dentist or Access

More information

Quality, affordable dental insurance

Quality, affordable dental insurance Quality, affordable dental insurance Group association dental insurance under the IHC Dental plans is underwritten by Madison National Life Insurance Company, Inc. in all states except Maine, New Hampshire

More information

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Purpose Use this guide to explain Federal Employee dental benefits to your patients if they

More information

Bonitas Medical Scheme Dental Benefit Table

Bonitas Medical Scheme Dental Benefit Table Bonitas Medical Dental Benefit Table 2015 PRIMARY DENTAL BENEFIT TABLE 2015 BONSAVE DENTAL BENEFIT TABLE 2015 STANDARD DENTAL BENEFIT TABLE 2015 BONCOM DENTAL BENEFIT TABLE 2015 Dental benefits are paid

More information

A DENTAL PLAN THAT BALANCES CHOICE & SAVINGS

A DENTAL PLAN THAT BALANCES CHOICE & SAVINGS A DENTAL PLAN THAT BALANCES CHOICE & SAVINGS GuideStone s Choice Dental Plan Cigna Total DPPO The Cigna Total Dental PPO (DPPO) network makes it easy to protect your health and your smile with the right

More information

PENSIONERS DENTAL SERVICES PLAN (PDSP) Member Booklet

PENSIONERS DENTAL SERVICES PLAN (PDSP) Member Booklet PENSIONERS DENTAL SERVICES PLAN (PDSP) Member Booklet The PDSP is administered by Sun Life Assurance Company of Canada, on behalf of the Government of Canada Contract Number 25555 Printed in Canada Revised

More information

Enroll in DeltaCare USA and you ll enjoy these features: you and your family. dentists, so you can enjoy a long-term relationship with your dentist

Enroll in DeltaCare USA and you ll enjoy these features: you and your family. dentists, so you can enjoy a long-term relationship with your dentist DeltaCare USA A Dental HMO Plan We ll do whatever it takes and then some. Welcome to DeltaCare USA - quality, convenience, predictable costs Find a DeltaCare USA dentist Select a conveniently located DeltaCare

More information

Choice, Service, Savings. To help you enroll, the following pages outline your company's dental plan and address any questions you may have.

Choice, Service, Savings. To help you enroll, the following pages outline your company's dental plan and address any questions you may have. Plan Design for: Unitarian Universalist Association of Congregations Effective Date: October 01, 2002 Amendment Effective Date ± : January 01, 2013 Date Prepared: January 01, 2015 Choice, Service, Savings.

More information