TRIPLE CHOICE Dental Plan

TRIPLE CHOICE Dental Plan Employee Enrollment Packet (ADP/CDP/Delta) Beta Health Association, Inc. Dental Plan Specialists since 1990 303-744-3007 or 1-800-807-0706 (Corporate Office) www.betadental.com

Beta Health Association, Inc. Dental Plan Specialists Since 1990 WHAT IS THE TRIPLE CHOICE DENTAL PLAN? The Triple Choice Dental Plan allows each employee the choice of enrolling in the Alpha Dental Plan (ADP), Choice Dental Plan (CDP) or the Delta Dental Insurance Plan. There are over 650 contracted providers in Colorado who participate in either the Alpha or Choice Dental Plan. There are many advantages to this flexible arrangement. Triple Choice Option #1 Option #2 Option #3 Alpha Dental (ADP) Network Plan Discount, fee-for-service Choice Dental (CDP) Network Plan Discount, fee-for-service Delta Dental Plan See any dentist Indemnity Plan See Network Dentist Only No Deductibles to Satisfy Lower Co-Pays No Claim Forms to Complete Unlimited Services Orthodontics (Child & Adult) No Waiting Periods No Pre-authorizations Cosmetic Dentistry Included Low Monthly Cost Immediate Coverage for all services Save approximately 65% overall See Network Dentist Only No Deductibles to Satisfy Slightly Higher Co-Pays No Claim Forms to Complete Unlimited Services Orthodontics (Child & Adult) No Waiting Periods No Pre-authorizations Cosmetic Dentistry Included Low Monthly Cost Immediate Coverage for all Services Save approximately 48% overall Select Any Dentist Deductibles to satisfy $1,000 calendar year max. Waiting periods may apply Takeover credit also available Orthodontics (if available) Cosmetic dentistry included Higher monthly cost

Beta Health Association, Inc. Dental Plan Specialists Since 1990 Option #1 and #2 Plan Highlights Cosmetic Dentistry Included No Waiting Periods on any services Orthodontics (braces) covered for Children and Adults No Deductibles to satisfy No Claim Forms to complete No Age limits for members No Limit on Visits No Exclusions for Pre-Existing Conditions No Yearly Maximum Benefit Level (Use as much as you like each year) Guaranteed Acceptance The following fee schedule represents the prenegotiated discounts we have been arranged in advance with the General Dentists who are participating in the plan. Simply pay these amounts directly to your participating dentist at the time services are rendered it s that easy! There are no claim forms to complete.

Beta Health Association, Inc. Dental Fee Schedule Alpha Plan #19 Form 7109 ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE ALPHA PLAN #19 YOU SAVE Diagnostic Services (Exams and X-rays) 999 ROUTINE OFFICE VISIT $ 35 $ 5 86% 120 PERIODIC ORAL EVALUATION $ 53 NO COST 100% 140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED $ 79 $ 15 81% 150 COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED PATIENT $ 97 $ 12 88% 210 X-RAY INTRAORAL COMPLETE SERIES INC. BITEWINGS $ 134 $ 29 78% 220 X-RAY INTRAORAL-PERIAPICAL-FIRST FILM $ 31 $ 6 81% 230 X-RAY INTRAORAL PERIAPICAL EACH ADDITIONAL FILM $ 26 $ 5 81% 240 X-RAY INTRA ORAL-OCCLUSAL FILM $ 48 $ 5 90% 250 X-RAY EXTRAORAL-FIRST FILM $ 75 $ 5 93% 260 X-RAY EXTRAORAL-EACH ADDITIONAL FILM $ 63 $ 5 92% 270 X-RAY BITEWING-SINGLE FILM $ 31 NO COST 100% 272 X-RAY BITEWING-2 FILMS $ 48 NO COST 100% 274 X-RAY BITEWING-4 FILMS $ 68 NO COST 100% 330 X-RAY PANORAMIC FILM $ 116 $ 49 58% 340 CEPHALOMETRIC FILM $ 137 $ 60 56% 460 PULP VITALITY TEST $ 61 NO COST 100% 470 DIAGNOSTIC CASTS $ 122 $ 49 60% 999 EMERGENCY VISIT (SAME DAY) $ 90 $ 25 72% Preventive Services (Cleanings) 1110 PROPHYLAXIS-ADULT CLEANING (EVERY 6 MONTHS) $ 96 $ 15 84% 1120 PROPHYLAXIS-CHILD CLEANING (EVERY 6 MONTHS) $ 72 $ 15 79% 1203 TOPICAL APPLICATION OF FLUORIDE NOT INCL/PROPHY-CHILD $ 39 $ 11 72% 1330 ORAL HYGIENE INSTRUCTIONS $ 63 NO COST 100% 1351 SEALANT PER TOOTH $ 58 $ 12 79% 1510 SPACE MAINTAINER FIXED UNILATERAL $ 338 $ 173 49% 1515 SPACE MAINTAINER FIXED BILATERAL $ 461 $ 250 46% 1520 SPACE MAINTAINER-REMOVABLE-UNILATERAL $ 418 $ 213 49% 1525 SPACE MAINTAINER-REMOVABLE-BILATERAL $ 522 $ 246 53% 1550 RE-CEMENTATION OF SPACE MAINTAINER $ 90 $ 17 81% 1999 ADDITIONAL PROPHY (FOR PERIO MAINTENANCE) $ 96 $ 41 57% Restorative Services (Fillings, Crowns, Inlays and Onlays) 2140 AMALGAM-1 SURFACE (PRIMARY OR PERMANENT) $ 150 $ 33 78% 2150 AMALGAM-2 SURFACES (PRIMARY OR PERMANENT) $ 195 $ 44 77% 2160 AMALGAM-3 SURFACES (PRIMARY OR PERMANENT) $ 232 $ 54 77% 2161 AMALGAM-4 OR MORE SURFACES (PRIMARY OR PERMANENT) $ 272 $ 63 77% 2330 RESIN BASED COMPOSITE 1 SURFACE (ANTERIOR) $ 169 $ 45 73% 2331 RESIN BASED COMPOSITE 2 SURFACES (ANTERIOR) $ 212 $ 58 73% 2332 RESIN BASED COMPOSITE 3 SURFACES (ANTERIOR) $ 264 $ 77 71% 2335 RESIN 4 OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR) $ 328 $ 124 62% 2390 RESIN BASED COMPOSITE CROWN ( ANTERIOR) $ 476 $ 262 45% 2391 RESIN BASED COMPOSITE ONE SURFACE (POSTERIOR) $ 188 $ 98 48% 2392 RESIN BASED COMPOSITE TWO SURFACE (POSTERIOR) $ 243 $ 135 44% 2393 RESIN BASED COMPOSITE THREE SURFACE (POSTERIOR) $ 305 $ 172 44% 2394 RESIN BASED COMPOSITE FOUR OR MORE SURFACES (POSTERIOR) $ 364 $ 188 48% *2510 INLAY-METALLIC-ONE SURFACE $ 906 $ 299 67% *2520 INLAY-METALLIC-TWO SURFACE $ 936 $ 309 67% *2530 INLAY-METALLIC-THREE OR MORE SURFACES $ 991 $ 327 67% *2542 ONLAY-METALLIC-TWO SURFACES $ 1,005 $ 332 67% *2543 ONLAY-METALLIC-THREE SURFACES $ 1,037 $ 343 67% *2544 ONLAY-METALLIC-FOUR OR MORE SURFACES $ 1,069 $ 352 67% *2610 INLAY-PORCELAIN/CERAMIC-ONE SURFACE $ 965 $ 318 67% *2650 INLAY-RESIN BASED COMPOSITE-ONE SURFACE $ 927 $ 306 67% *2651 INLAY-RESIN BASED COMPOSITE-TWO SURFACES $ 952 $ 314 67% *2652 INLAY-RESIN BASED COMPOSITE-THREE OR MORE SURFACES $ 993 $ 328 67% *2710 CROWN-RESIN BASED COMPOSITE (INDIRECT) $ 963 $ 319 67% *2720 CROWN-RESIN WITH HIGH NOBLE METAL $ 1,139 $ 375 67% *2721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL $ 1,032 $ 340 67% *2722 CROWN RESIN WITH NOBLE METAL $ 1,048 $ 346 67% *2740 CROWN PORCELAIN/CERAMIC SUBSTRATE $ 1,196 $ 395 67% *2750 CROWN PORCELAIN FUSED TO HIGH NOBLE METAL $ 1,164 $ 384 67% *2751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $ 1,054 $ 315 70% *2752 CROWN-PORCELAIN FUSED TO NOBLE METAL $ 1,091 $ 370 66% Current Dental Terminology American Dental Association Page 1

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE ALPHA PLAN #19 YOU SAVE Restorative Services (Fillings, Crowns, Inlays and Onlays) Con't *2790 CROWN FULL CAST HIGH NOBLE METAL $ 1,154 $ 366 68% *2791 CROWN FULL CAST PREDOMINANTLY BASE METAL $ 1,028 $ 318 69% *2792 CROWN FULL CAST NOBLE METAL $ 1,058 $ 345 67% 2910 RECEMENT INLAY, ONLAY, OR PARTIAL COVERAGE RESTORATION $ 116 $ 15 87% 2920 RECEMENT CROWN $ 116 $ 31 73% 2930 PREFAB. STAINLESS STEEL CROWN-PRIMARY $ 291 $ 101 65% 2931 PREFAB STAINLESS STEEL CROWN-PERMANENT $ 355 $ 123 65% 2932 PREFAB. RESIN CROWN $ 376 $ 157 58% 2933 PREFAB. STAINLESS STEEL CROWN WITH RESIN WINDOW $ 398 $ 179 55% 2940 SEDATIVE FILLING $ 132 $ 37 72% 2950 CORE BUILDUP INCLUDING ANY PINS $ 292 $ 82 72% 2951 PIN RETENTION PER TOOTH IN ADD. TO RESTORATION $ 81 $ 23 72% 2952 CAST POST & CORE IN ADDITION TO CROWN $ 456 $ 134 71% 2954 PREFAB POST & CORE IN ADDITION TO CROWN $ 365 $ 107 71% 2955 POST REMOVAL (NOT IN CONJUNCTION WITH ENDODONTIC THERAPY) $ 317 $ 139 56% 2960 LABIAL VENEER RESIN LAMINATE (CHAIRSIDE) $ 714 $ 187 74% 2999 BLEACHING (PER ARCH) $ 270 $ 162 40% 2999 $125 ADDTL.CHARGE P/UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION *These co-payments do not include an allowable $151 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fees. Temporary crowns are included with permanent crown preparation. Endodontic Services (Root Canals) 3110 PULP CAP DIRECT EXCLUDING FINAL RESTORATION $ 90 $ 26 71% 3120 PULP CAP INDIRECT EXCLUDING FINAL RESTORATION $ 93 $ 27 71% 3220 THERAPEUTIC PULPOTOMY EXCLUDING FINAL RESTORATION $ 218 $ 72 67% 3230 PULPAL THERAPY ANTERIOR, PRIMARY TOOTH EXCLUDING REST. $ 328 $ 102 69% 3240 PULPAL THERAPY POSTERIOR, PRIMARY TOOTH EXCLUDING REST $ 370 $ 113 69% 3310 ROOT CANAL THERAPY 1 CANAL (EXCLUDING FINAL RESTORATION) $ 778 $ 275 65% 3320 ROOT CANAL THERAPY 2 CANALS (EXCLUDING FINAL RESTORATION) $ 874 $ 320 63% 3330 ROOT CANAL THERAPY 3 CANALS OR MORE $ 1,058 $ 400 62% 3410 APICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR $ 741 $ 328 56% 3421 APICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT) $ 805 $ 366 55% 3425 APICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT) $ 950 $ 424 55% 3426 APICOECTOMY/PERIRADICULAR SURGERY-EACH ADDITIONAL ROOT $ 450 $ 161 64% 3430 RETROGRADE FILLING-PER ROOT $ 315 $ 116 63% 3910 SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM $ 279 $ 64 77% Periodontic Services (Gum Disease) 4210 GINGIVOPLASY OR GIGIVECTOMY- 4+ CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD $ 704 $ 333 53% 4211 GINGIVECTOMY OR GINGIVOPLASTY-1 TO 3 CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD $ 323 $ 178 45% 4240 GINGIVAL FLAP PROCEDURE, INCL.ROOT PLNG -4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD $ 820 $ 352 57% 4260 OSSEOUS SURG. INCL. FLAP ENTRY & CLOSURE-4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD $ 1,138 $ 521 54% 4320 PROVISIONAL SPLINTING-INTRACORNIAL $ 556 $ 260 53% 4321 PROVISIONAL SPLINTING-EXTRACORNIAL $ 527 $ 246 53% 4341 PERIODONTAL SCALING & ROOT PLNG- 4+ TEETH PER QUAD $ 265 $ 112 58% 4355 FULL MOUTH DEBRIDEMENT TO ENABLE COMP.EVAL. & DIAGNOSIS $ 197 $ 89 55% 4910 PERIODONTAL MAINTENANCE $ 146 $ 57 61% 4999 PERIO SCREENING AND SCORING $ 30 $ 10 67% Prosthodontics (Removable/Complete Dentures, etc.) 5110 COMPLETE DENTURE-MAXILLARY $ 1,799 $ 533 70% 5120 COMPLETE DENTURE-MANDIBULAR $ 1,799 $ 533 70% 5130 IMMEDIATE DENTURE-MAXILLARY $ 1,921 $ 764 60% 5140 IMMEDIATE DENTURE-MANDIBULAR $ 1,958 $ 778 60% 5211 MAXILLARY PART. DENTURE-RESIN BASE (INCL. CLASPS & TEETH) $ 1,474 $ 463 69% 5212 MANDIBULAR PARTIAL DENTURE-RESIN BASE (INCL. CLASPS & TEETH) $ 1,448 $ 442 69% 5213 MAXILLARY PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) $ 1,885 $ 547 71% 5214 MANDIBULAR PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) $ 1,889 $ 545 71% 5410 ADJUST COMPLETE DENTURE-MAXILLARY $ 96 $ 36 63% 5411 ADJUST COMPLETE DENTURE-MANDIBULAR $ 95 $ 36 62% 5421 ADJUST PARTIAL DENTURE-MAXILLARY $ 95 $ 36 62% 5422 ADJUST PARTIAL DENTURE-MANDIBULAR $ 95 $ 36 62% 5510 REPAIR BROKEN COMPLETE DENTURE BASE $ 231 $ 88 62% 5520 REPLACE MISSING OF BROKEN TEETH-COMP.DENTURE-EACH TOOTH $ 197 $ 62 69% 5610 REPAIR RESIN DENTURE BASE $ 225 $ 82 64% 5620 REPAIR CAST FRAMEWORK $ 313 $ 139 56% 5630 REPAIR OR REPLACE BROKEN CLASP $ 286 $ 105 63% 5640 REPLACE BROKEN TEETH-PER TOOTH $ 198 $ 68 66% 5650 ADD TOOTH TO EXISTING PARTIAL DENTURE $ 241 $ 93 61% 5660 ADD CLASP TO EXISTING PARTIAL DENTURE $ 292 $ 121 59% Current Dental Terminology American Dental Association Page 2

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE ALPHA PLAN #19 YOU SAVE Prosthodontics (Removable/ Complete Dentures, etc.) Con't 5710 REBASE COMPLETE MAXILLARY DENTURE $ 630 $ 276 56% 5711 REBASE COMPLETE MANDIBULAR DENTURE $ 629 $ 276 56% 5720 REBASE MAXILLARY PARTIAL DENTURE $ 609 $ 230 62% 5721 REBASE MANDIBULAR PARTIAL DENTURE $ 609 $ 231 62% 5730 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) $ 402 $ 175 56% 5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) $ 402 $ 175 56% 5740 RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) $ 397 $ 167 58% 5741 RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) $ 402 $ 167 58% 5750 RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) $ 503 $ 155 69% 5751 RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) $ 503 $ 155 69% 5760 RELINE MAXILLARY PARTIAL DENTURE (LABORATORY) $ 503 $ 158 69% 5761 RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY) $ 503 $ 157 69% 5850 TISSUE CONDITIONING MAXILLARY $ 231 $ 66 71% 5851 TISSUE CONDITIONING MANDIBULAR $ 233 $ 65 72% NOTE: In addition to the fees listed above in section 5000 thru 6000, additional fees may be charged for upgraded teeth and enhanced cosmetics, personalization beyond norm or techniques involving precision dentures. Prosthodontics (fixed/partial Dentures, etc.) *6210 PONTIC-CAST HIGH NOBLE METAL $ 1,133 $ 359 68% *6211 PONTIC-CAST PREDOMINANTLY BASE METAL $ 1,037 $ 303 71% *6212 PONTIC-CAST NOBLE METAL $ 1,075 $ 320 70% *6240 PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL $ 1,161 $ 383 67% *6241 PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $ 1,058 $ 312 71% *6242 PONTIC-PORCELAIN FUSED TO NOBLE METAL $ 1,084 $ 331 69% *6250 PONTIC-RESIN WITH HIGH NOBLE METAL $ 1,085 $ 345 68% *6251 PONTIC-RESIN WITH PREDOMINANTLY BASE METAL $ 1,042 $ 323 69% *6252 PONTIC-RESIN WITH NOBLE METAL $ 1,044 $ 325 69% *6720 CROWN-RESIN WITH HIGH NOBLE METAL $ 1,154 $ 380 67% *6721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL $ 1,042 $ 344 67% *6722 CROWN-RESIN WITH NOBLE METAL $ 1,067 $ 352 67% *6750 CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL $ 1,164 $ 384 67% *6751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $ 1,052 $ 315 70% *6752 CROWN-PORCELAIN FUSED TO NOBLE METAL $ 1,079 $ 335 69% *6790 CROWN-FULL CAST HIGH NOBLE METAL $ 1,133 $ 359 68% *6791 CROWN-FULL CAST PREDOMINANTLY BASE METAL $ 1,042 $ 323 69% *6792 CROWN-FULL CAST NOBLE METAL $ 1,084 $ 330 70% 6930 RECEMENT FIXED PARTIAL DENTURE $ 185 $ 69 63% *These co-payments do not include an allowable $151 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fee. Oral Surgery (Extractions, etc.) 7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) $ 185 $ 46 75% 7210 SURGICAL EXT. ERUPTED TOOTH WITH REMOVAL OF BONE $ 295 $ 81 73% 7220 REMOVAL OF IMPACTED TOOTH-SOFT TISSUE $ 345 $ 92 73% 7230 REMOVAL OF IMPACTED TOOTH PARTIALLY BONY $ 419 $ 163 61% 7240 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY $ 524 $ 210 60% 7241 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY W/ UNUSUAL SURG. COMPLICATION $ 635 $ 248 61% 7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) $ 322 $ 118 63% 7270 TOOTH REIMPL. AND/OR STAB. OF ACC.EVULSED OR DISPL. TOOTH $ 609 $ 243 60% 7280 SURGICAL ACCESS OF AN UNERUPTED TOOTH $ 540 $ 235 56% 7285 BIOPSY OF ORAL TISSUE-HARD (BONE-TOOTH) $ 497 $ 217 56% 7286 BIOPSY OF ORAL TISSUE-SOFT $ 344 $ 150 56% 7310 ALVEOPLASTY IN CONJ. WITH EXT.- PER QUAD $ 329 $ 126 62% 7320 ALVEOPLASTY NOT IN CONJ WITH EXT- PER QUAD $ 528 $ 195 63% 7510 INCISION AND DRAINAGE ABSCESS- INTRAORAL SOFT TISSUE $ 255 $ 99 61% 7910 SUTURE OF RECENT SMALL WOUNDS UP TO 5CM $ 341 NO COST 100% 7960 FRENULECTOMY (FRENECTOMY OR FRENOTOMY)- SEPARATE PROCEDURE $ 498 $ 128 74% 7970 EXCISION OF HYPERPLASTIC TISSUE- PER ARCH $ 582 $ 207 64% General Miscellaneous Services 9110 EMERGENCY PALATIVE TREATMENT OF DENTAL PAIN- MINOR PROCEDURE $ 138 $ 48 65% 9230 ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE - FIRST 30 MINUTES $ 95 $ 27 72% 9310 CONSULTATION (DIAG. SERV. PROV. BY DENTIST OR PHYSICIAN OTHER THAN PRACTIONER PROV. TREATMNT) $ 159 NO COST 100% 9910 APPLICATION OF DESENSITIZING MEDICAMENT $ 73 $ 6 92% 9941 FABRICATION OF ATHLETIC MOUTHGUARD $ 315 $ 107 66% 9951 OCCLUSAL ADJUSTMENT-LIMITED $ 212 $ 77 64% 9952 OCCLUSAL ADJUSTMENT-COMPLETE $ 770 $ 286 63% 9999 MISSED APPOINTMENT (WITHOUT 24 HOUR NOTICE) $ 54 $ 30 44% Current Dental Terminology American Dental Association Page 3

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE ALPHA PLAN #19 YOU SAVE Orthodontics (Braces) for Children & Adults Monthly Payment 13 MONTH TREATMENT PLAN ($137/MONTH) $ 3,114 $ 2,409 23% 16 MONTH TREATMENT PLAN ($137/MONTH) $ 3,625 $ 2,820 22% 19 MONTH TREATMENT PLAN ($137/MONTH) $ 4,135 $ 3,231 22% 22 MONTH TREATMENT PLAN ($137/MONTH) $ 4,606 $ 3,642 21% 25 MONTH TREATMENT PLAN ($137/MONTH) $ 5,158 $ 4,053 21% 28 MONTH TREATMENT PLAN ($137/MONTH) $ 5,669 $ 4,464 21% 31 MONTH TREATMENT PLAN ($137/MONTH) $ 6,179 $ 4,875 21% 34 MONTH TREATMENT PLAN ($137/MONTH) $ 6,690 $ 5,286 21% 36 MONTH TREATMENT PLAN ($137/MONTH) $ 6,951 $ 5,560 20% Other Orthodontic Guidelines 1. A $382 charge will apply at the end of treatment (included in the above amounts) to cover all retention office visits (unlimited). 2. Services not listed above will be discounted 30% off of the participating Orthodontist's Usual and Customary fees (except #5 listed below). 3. Services must only be provided by a contracted Orthodontic Specialist. 4. The amounts listed above also include an initial one-time $246 charge for all records, mold, x-rays, etc. to determine the Orthodontic Treatment for the patient. 5. Invisalign procedures are to be discounted 15% off the participating Orthodontist's Usual and Customary fees. All Plans General Limitations and Exclusions 1. All fees listed above do not include all appropriate lab fees. Member must agree (in writing) to all upgraded materials before treatment is started. See each section for specific details (if applicable). 2. All patients are responsible for paying all fees (as listed above) at the time services are rendered. 3. These fees are for General Dentists only. A participating specialist list is available by calling our office at 303-744-3007 or 1-800-807-0706. 4. Any procedures not listed will be discounted 20% off the participating General Dentists normal fees. 5. Medical costs associated with any dental procedures are not covered. 6. Dentures or appliances will be replaced only after 3 years have elapsed since such dentures or appliances were provided under any plan program, unless the denture or appliance becomes unserviceable due to illness or other causes not controlled by other means. Replacement of dentures, appliances, or bridgework due to loss or theft are not covered. 7. Any dental treatment started prior to the Member's eligibility to receive services under this plan or started after a Member's termination are not covered. 8. Failure to follow the prescribed treatment or accidents occurring during the course of treatment may result in additional charges by your plan provider. 9. Failure to pay scheduled fees at the time service is rendered may prevent future dental services from being received until all fees have been paid in full. 10. Services provided by non-participating dentists are not covered. 11. Services which, in the opinion of the attending dentist, are not necessary for the patient's dental health, or are contrary to established dental ethics are not covered. 12. Cosmetic dental procedures are covered only if the attending dentist and patient agree on the specific procedure. 13. Services which are compensable under Worker's Compensation or employer liability laws are not covered. 14. General anesthesia and IV sedation are not covered. 15. Myofunctional therapy procedure for training, treating or developing muscles in and around the jaw or mouth including TMJ are not covered except by participating plan specialists. 16. Any dental procedure or service that cannot be performed in the dental office due to general and/or physical limitations of a member are not covered. 17. Expenses incurred for dental procedures initiated prior to member's eligibility or after termination are not covered. 18. Any services that the Participating General Dentist recommends be performed by a specialist are covered only by a plan participating specialist. 19. The liability of Beta Health Association, Inc. is limited to the return of the membership fees paid for one year by the member. 20. Extractions for asymptomatic third molars (wisdom teeth) are not covered unless causing movement of the teeth. An example of symptomatic include severe decay, and ontogenic cysts, chronic pericoronitis, and infection. 21. The Beta Health Association, Inc. dental programs do not constitute dental insurance and are considered discount, fee-forservice dental plans. 22. Fees are subject to change on an as needed basis. Please contact Beta Health Association, Inc. for current fees. Current Dental Terminology American Dental Association Page 4

Beta Health Association, Inc. Dental Fee Schedule Choice Plan #20 Form 7109 ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE CHOICE PLAN #20 YOU SAVE Diagnostic Services (Exams and X-rays) 999 ROUTINE OFFICE VISIT $ 35 $ 5 86% 120 PERIODIC ORAL EVALUATION $ 53 $ 28 47% 140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED $ 79 $ 43 46% 150 COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED PATIENT $ 97 $ 45 54% 210 X-RAY INTRAORAL COMPLETE SERIES INC. BITEWINGS $ 134 $ 80 40% 220 X-RAY INTRAORAL-PERIAPICAL-FIRST FILM $ 31 $ 16 48% 230 X-RAY INTRAORAL PERIAPICAL EACH ADDITIONAL FILM $ 26 $ 14 46% 240 X-RAY INTRA ORAL-OCCLUSAL FILM $ 48 $ 23 52% 250 X-RAY EXTRAORAL-FIRST FILM $ 75 $ 32 57% 260 X-RAY EXTRAORAL-EACH ADDITIONAL FILM $ 63 $ 19 70% 270 X-RAY BITEWING-SINGLE FILM $ 31 $ 13 58% 272 X-RAY BITEWING-2 FILMS $ 48 $ 29 40% 274 X-RAY BITEWING-4 FILMS $ 68 $ 39 43% 330 X-RAY PANORAMIC FILM $ 116 $ 66 43% 340 CEPHALOMETRIC FILM $ 137 $ 58 58% 460 PULP VITALITY TEST $ 61 $ 31 49% 470 DIAGNOSTIC CASTS $ 122 $ 68 44% 999 EMERGENCY VISIT (SAME DAY) $ 90 $ 65 28% Preventive Services (Cleanings) 1110 PROPHYLAXIS-ADULT CLEANING (EVERY 6 MONTHS) $ 96 $ 61 36% 1120 PROPHYLAXIS-CHILD CLEANING (EVERY 6 MONTHS) $ 72 $ 43 40% 1203 TOPICAL APPLICATION OF FLUORIDE NOT INCL/PROPHY-CHILD $ 39 $ 21 46% 1330 ORAL HYGIENE INSTRUCTIONS $ 63 $ 26 59% 1351 SEALANT PER TOOTH $ 58 $ 34 41% 1510 SPACE MAINTAINER FIXED UNILATERAL $ 338 $ 204 40% 1515 SPACE MAINTAINER FIXED BILATERAL $ 461 $ 312 32% 1520 SPACE MAINTAINER-REMOVABLE-UNILATERAL $ 418 $ 165 61% 1525 SPACE MAINTAINER-REMOVABLE-BILATERAL $ 522 $ 275 47% 1550 RE-CEMENTATION OF SPACE MAINTAINER $ 90 $ 42 53% 1999 ADDITIONAL PROPHY (FOR PERIO MAINTENANCE) $ 96 $ 61 36% Restorative Services (Fillings, Crowns, Inlays and Onlays) 2140 AMALGAM-1 SURFACE (PRIMARY OR PERMANENT) $ 150 $ 97 35% 2150 AMALGAM-2 SURFACES (PRIMARY OR PERMANENT) $ 195 $ 127 35% 2160 AMALGAM-3 SURFACES (PRIMARY OR PERMANENT) $ 232 $ 146 37% 2161 AMALGAM-4 OR MORE SURFACES (PRIMARY OR PERMANENT) $ 272 $ 175 36% 2330 RESIN BASED COMPOSITE 1 SURFACE (ANTERIOR) $ 169 $ 99 41% 2331 RESIN BASED COMPOSITE 2 SURFACES (ANTERIOR) $ 212 $ 125 41% 2332 RESIN BASED COMPOSITE 3 SURFACES (ANTERIOR) $ 264 $ 151 43% 2335 RESIN 4 OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR) $ 328 $ 190 42% 2390 RESIN BASED COMPOSITE CROWN ( ANTERIOR) $ 476 $ 233 51% 2391 RESIN BASED COMPOSITE ONE SURFACE (POSTERIOR) $ 188 $ 113 40% 2392 RESIN BASED COMPOSITE TWO SURFACE (POSTERIOR) $ 243 $ 148 39% 2393 RESIN BASED COMPOSITE THREE SURFACE (POSTERIOR) $ 305 $ 188 38% 2394 RESIN BASED COMPOSITE FOUR OR MORE SURFACES (POSTERIOR) $ 364 $ 214 41% 2510 INLAY-METALLIC-ONE SURFACE $ 906 $ 422 53% 2520 INLAY-METALLIC-TWO SURFACE $ 936 $ 506 46% 2530 INLAY-METALLIC-THREE OR MORE SURFACES $ 991 $ 549 45% 2542 ONLAY-METALLIC-TWO SURFACES $ 1,005 $ 617 39% 2543 ONLAY-METALLIC-THREE SURFACES $ 1,037 $ 619 40% 2544 ONLAY-METALLIC-FOUR OR MORE SURFACES $ 1,069 $ 750 30% 2610 INLAY-PORCELAIN/CERAMIC-ONE SURFACE $ 965 $ 593 39% 2650 INLAY-RESIN BASED COMPOSITE-ONE SURFACE $ 927 $ 481 48% 2651 INLAY-RESIN BASED COMPOSITE-TWO SURFACES $ 952 $ 561 41% 2652 INLAY-RESIN BASED COMPOSITE-THREE OR MORE SURFACES $ 993 $ 572 42% 2710 CROWN-RESIN BASED COMPOSITE (INDIRECT) $ 963 $ 378 61% 2720 CROWN-RESIN WITH HIGH NOBLE METAL $ 1,139 $ 516 55% 2721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL $ 1,032 $ 333 68% 2722 CROWN RESIN WITH NOBLE METAL $ 1,048 $ 436 58% 2740 CROWN PORCELAIN/CERAMIC SUBSTRATE $ 1,196 $ 593 50% 2750 CROWN PORCELAIN FUSED TO HIGH NOBLE METAL $ 1,164 $ 460 60% 2751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $ 1,054 $ 458 57% 2752 CROWN-PORCELAIN FUSED TO NOBLE METAL $ 1,091 $ 519 52% Current Dental Terminology American Dental Association Page 1

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE CHOICE PLAN #20 YOU SAVE Restorative Services (Fillings, Crowns, Inlays and Onlays) Con't 2790 CROWN FULL CAST HIGH NOBLE METAL $ 1,154 $ 575 50% 2791 CROWN FULL CAST PREDOMINANTLY BASE METAL $ 1,028 $ 438 57% 2792 CROWN FULL CAST NOBLE METAL $ 1,058 $ 512 52% 2910 RECEMENT INLAY, ONLAY, OR PARTIAL COVERAGE RESTORATION $ 116 $ 50 57% 2920 RECEMENT CROWN $ 116 $ 59 49% 2930 PREFAB. STAINLESS STEEL CROWN-PRIMARY $ 291 $ 177 39% 2931 PREFAB STAINLESS STEEL CROWN-PERMANENT $ 355 $ 190 46% 2932 PREFAB. RESIN CROWN $ 376 $ 189 50% 2933 PREFAB. STAINLESS STEEL CROWN WITH RESIN WINDOW $ 398 $ 240 40% 2940 SEDATIVE FILLING $ 132 $ 67 49% 2950 CORE BUILDUP INCLUDING ANY PINS $ 292 $ 165 43% 2951 PIN RETENTION PER TOOTH IN ADD. TO RESTORATION $ 81 $ 37 54% 2952 CAST POST & CORE IN ADDITION TO CROWN $ 456 $ 234 49% 2954 PREFAB POST & CORE IN ADDITION TO CROWN $ 365 $ 196 46% 2955 POST REMOVAL (NOT IN CONJUNCTION WITH ENDODONTIC THERAPY) $ 317 $ 124 61% 2960 LABIAL VENEER RESIN LAMINATE (CHAIRSIDE) $ 714 $ 398 44% 2999 BLEACHING (PER ARCH) $ 270 $ 177 34% 2999 $125 ADDTL.CHARGE P/UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fees. Temporary crowns are included with permanent crown preparation. Endodontic Services (Root Canals) 3110 PULP CAP DIRECT EXCLUDING FINAL RESTORATION $ 90 $ 36 60% 3120 PULP CAP INDIRECT EXCLUDING FINAL RESTORATION $ 93 $ 47 49% 3220 THERAPEUTIC PULPOTOMY EXCLUDING FINAL RESTORATION $ 218 $ 109 50% 3230 PULPAL THERAPY ANTERIOR, PRIMARY TOOTH EXCLUDING REST. $ 328 $ 179 45% 3240 PULPAL THERAPY POSTERIOR, PRIMARY TOOTH EXCLUDING REST $ 370 $ 196 47% 3310 ROOT CANAL THERAPY 1 CANAL (EXCLUDING FINAL RESTORATION) $ 778 $ 516 34% 3320 ROOT CANAL THERAPY 2 CANALS (EXCLUDING FINAL RESTORATION) $ 874 $ 575 34% 3330 ROOT CANAL THERAPY 3 CANALS OR MORE $ 1,058 $ 719 32% 3410 APICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR $ 741 $ 466 37% 3421 APICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT) $ 805 $ 522 35% 3425 APICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT) $ 950 $ 625 34% 3426 APICOECTOMY/PERIRADICULAR SURGERY-EACH ADDITIONAL ROOT $ 450 $ 163 64% 3430 RETROGRADE FILLING-PER ROOT $ 315 $ 132 58% 3910 SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM $ 279 $ 180 35% Periodontic Services (Gum Disease) 4210 GINGIVOPLASY OR GIGIVECTOMY- 4+ CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD $ 704 $ 259 63% 4211 GINGIVECTOMY OR GINGIVOPLASTY-1 TO 3 CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD $ 323 $ 95 71% 4240 GINGIVAL FLAP PROCEDURE, INCL.ROOT PLNG -4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD $ 820 $ 344 58% 4260 OSSEOUS SURG. INCL. FLAP ENTRY & CLOSURE-4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD $ 1,138 $ 736 35% 4320 PROVISIONAL SPLINTING-INTRACORNIAL $ 556 $ 151 73% 4321 PROVISIONAL SPLINTING-EXTRACORNIAL $ 527 $ 135 74% 4341 PERIODONTAL SCALING & ROOT PLNG- 4+ TEETH PER QUAD $ 265 $ 153 42% 4355 FULL MOUTH DEBRIDEMENT TO ENABLE COMP.EVAL. & DIAGNOSIS $ 197 $ 103 48% 4910 PERIODONTAL MAINTENANCE $ 146 $ 85 42% 4999 PERIO SCREENING AND SCORING $ 30 $ 15 50% Prosthodontics (Removable/Complete Dentures, etc.) 5110 COMPLETE DENTURE-MAXILLARY $ 1,799 $ 1,040 42% 5120 COMPLETE DENTURE-MANDIBULAR $ 1,799 $ 1,002 44% 5130 IMMEDIATE DENTURE-MAXILLARY $ 1,921 $ 1,048 45% 5140 IMMEDIATE DENTURE-MANDIBULAR $ 1,958 $ 1,064 46% 5211 MAXILLARY PART. DENTURE-RESIN BASE (INCL. CLASPS & TEETH) $ 1,474 $ 724 51% 5212 MANDIBULAR PARTIAL DENTURE-RESIN BASE (INCL. CLASPS & TEETH) $ 1,448 $ 683 53% 5213 MAXILLARY PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) $ 1,885 $ 997 47% 5214 MANDIBULAR PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) $ 1,889 $ 999 47% 5410 ADJUST COMPLETE DENTURE-MAXILLARY $ 96 $ 58 40% 5411 ADJUST COMPLETE DENTURE-MANDIBULAR $ 95 $ 41 57% 5421 ADJUST PARTIAL DENTURE-MAXILLARY $ 95 $ 41 57% 5422 ADJUST PARTIAL DENTURE-MANDIBULAR $ 95 $ 41 57% 5510 REPAIR BROKEN COMPLETE DENTURE BASE $ 231 $ 122 47% 5520 REPLACE MISSING OF BROKEN TEETH-COMP.DENTURE-EACH TOOTH $ 197 $ 99 50% 5610 REPAIR RESIN DENTURE BASE $ 225 $ 97 57% 5620 REPAIR CAST FRAMEWORK $ 313 $ 131 58% 5630 REPAIR OR REPLACE BROKEN CLASP $ 286 $ 140 51% 5640 REPLACE BROKEN TEETH-PER TOOTH $ 198 $ 98 51% 5650 ADD TOOTH TO EXISTING PARTIAL DENTURE $ 241 $ 103 57% 5660 ADD CLASP TO EXISTING PARTIAL DENTURE $ 292 $ 127 57% Current Dental Terminology American Dental Association Page 2

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE CHOICE PLAN #20 YOU SAVE Prosthodontics (Removable/ Complete Dentures, etc.) Con't 5710 REBASE COMPLETE MAXILLARY DENTURE $ 630 $ 312 50% 5711 REBASE COMPLETE MANDIBULAR DENTURE $ 629 $ 312 50% 5720 REBASE MAXILLARY PARTIAL DENTURE $ 609 $ 300 51% 5721 REBASE MANDIBULAR PARTIAL DENTURE $ 609 $ 298 51% 5730 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) $ 402 $ 140 65% 5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) $ 402 $ 140 65% 5740 RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) $ 397 $ 149 62% 5741 RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) $ 402 $ 150 63% 5750 RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) $ 503 $ 249 50% 5751 RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) $ 503 $ 249 50% 5760 RELINE MAXILLARY PARTIAL DENTURE (LABORATORY) $ 503 $ 241 52% 5761 RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY) $ 503 $ 241 52% 5850 TISSUE CONDITIONING MAXILLARY $ 231 $ 88 62% 5851 TISSUE CONDITIONING MANDIBULAR $ 233 $ 88 62% NOTE: In addition to the fees listed above in section 5000 thru 6000, additional fees may be charged for upgraded teeth and enhanced cosmetics, personalization beyond norm or techniques involving precision dentures. Prosthodontics (fixed/partialdentures, etc.) 6210 PONTIC-CAST HIGH NOBLE METAL $ 1,133 $ 525 54% 6211 PONTIC-CAST PREDOMINANTLY BASE METAL $ 1,037 $ 425 59% 6212 PONTIC-CAST NOBLE METAL $ 1,075 $ 447 58% 6240 PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL $ 1,161 $ 542 53% 6241 PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $ 1,058 $ 465 56% 6242 PONTIC-PORCELAIN FUSED TO NOBLE METAL $ 1,084 $ 492 55% 6250 PONTIC-RESIN WITH HIGH NOBLE METAL $ 1,085 $ 497 54% 6251 PONTIC-RESIN WITH PREDOMINANTLY BASE METAL $ 1,042 $ 541 48% 6252 PONTIC-RESIN WITH NOBLE METAL $ 1,044 $ 476 54% 6720 CROWN-RESIN WITH HIGH NOBLE METAL $ 1,154 $ 499 57% 6721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL $ 1,042 $ 300 71% 6722 CROWN-RESIN WITH NOBLE METAL $ 1,067 $ 384 64% 6750 CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL $ 1,164 $ 546 53% 6751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $ 1,052 $ 465 56% 6752 CROWN-PORCELAIN FUSED TO NOBLE METAL $ 1,079 $ 495 54% 6790 CROWN-FULL CAST HIGH NOBLE METAL $ 1,133 $ 539 52% 6791 CROWN-FULL CAST PREDOMINANTLY BASE METAL $ 1,042 $ 443 57% 6792 CROWN-FULL CAST NOBLE METAL $ 1,084 $ 505 53% 6930 RECEMENT FIXED PARTIAL DENTURE $ 185 $ 84 55% Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fee. Oral Surgery (Extractions, etc.) 7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) $ 185 $ 90 51% 7210 SURGICAL EXT. ERUPTED TOOTH WITH REMOVAL OF BONE $ 295 $ 166 44% 7220 REMOVAL OF IMPACTED TOOTH-SOFT TISSUE $ 345 $ 197 43% 7230 REMOVAL OF IMPACTED TOOTH PARTIALLY BONY $ 419 $ 232 45% 7240 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY $ 524 $ 281 46% 7241 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY W/ UNUSUAL SURG. COMPLICATION $ 635 $ 339 47% 7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) $ 322 $ 172 47% 7270 TOOTH REIMPL. AND/OR STAB. OF ACC.EVULSED OR DISPL. TOOTH $ 609 $ 242 60% 7280 SURGICAL ACCESS OF AN UNERUPTED TOOTH $ 540 $ 360 33% 7285 BIOPSY OF ORAL TISSUE-HARD (BONE-TOOTH) $ 497 $ 265 47% 7286 BIOPSY OF ORAL TISSUE-SOFT $ 344 $ 139 60% 7310 ALVEOPLASTY IN CONJ. WITH EXT.- PER QUAD $ 329 $ 143 57% 7320 ALVEOPLASTY NOT IN CONJ WITH EXT- PER QUAD $ 528 $ 196 63% 7510 INCISION AND DRAINAGE ABSCESS- INTRAORAL SOFT TISSUE $ 255 $ 110 57% 7910 SUTURE OF RECENT SMALL WOUNDS UP TO 5CM $ 341 $ 87 74% 7960 FRENULECTOMY (FRENECTOMY OR FRENOTOMY)- SEPARATE PROCEDURE $ 498 $ 216 57% 7970 EXCISION OF HYPERPLASTIC TISSUE- PER ARCH $ 582 $ 230 60% General Miscellaneous Services 9110 EMERGENCY PALATIVE TREATMENT OF DENTAL PAIN- MINOR PROCEDURE $ 138 $ 70 49% 9230 ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE - FIRST 30 MINUTES $ 95 $ 37 61% 9310 CONSULTATION (DIAG. SERV. PROV. BY DENTIST OR PHYSICIAN OTHER THAN PRACTIONER PROV. TREATMNT) $ 159 $ 62 61% 9910 APPLICATION OF DESENSITIZING MEDICAMENT $ 73 $ 43 41% 9941 FABRICATION OF ATHLETIC MOUTHGUARD $ 315 $ 93 70% 9951 OCCLUSAL ADJUSTMENT-LIMITED $ 212 $ 100 53% 9952 OCCLUSAL ADJUSTMENT-COMPLETE $ 770 $ 693 10% 9999 MISSED APPOINTMENT (WITHOUT 24 HOUR NOTICE) $ 54 $ 35 35% Current Dental Terminology American Dental Association Page 3

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION NORMAL FEE CHOICE PLAN #20 YOU SAVE Orthodontics (Braces) for Children & Adults Monthly Payment 13 MONTH TREATMENT PLAN ($137/MONTH) $ 3,114 $ 2,409 23% 16 MONTH TREATMENT PLAN ($137/MONTH) $ 3,625 $ 2,820 22% 19 MONTH TREATMENT PLAN ($137/MONTH) $ 4,135 $ 3,231 22% 22 MONTH TREATMENT PLAN ($137/MONTH) $ 4,606 $ 3,642 21% 25 MONTH TREATMENT PLAN ($137/MONTH) $ 5,158 $ 4,053 21% 28 MONTH TREATMENT PLAN ($137/MONTH) $ 5,669 $ 4,464 21% 31 MONTH TREATMENT PLAN ($137/MONTH) $ 6,179 $ 4,875 21% 34 MONTH TREATMENT PLAN ($137/MONTH) $ 6,690 $ 5,286 21% 36 MONTH TREATMENT PLAN ($137/MONTH) $ 6,951 $ 5,560 20% Other Orthodontic Guidelines 1. A $382 charge will apply at the end of treatment (included in the above amounts) to cover all retention office visits (unlimited). 2. Services not listed above will be discounted 30% off of the participating Orthodontist's Usual and Customary fees (except #5 listed below). 3. Services must only be provided by a contracted Orthodontic Specialist. 4. The amounts listed above also include an initial one-time $246 charge for all records, mold, x-rays, etc. to determine the Orthodontic Treatment for the patient. 5. Invisalign procedures are to be discounted 15% off the participating Orthodontist's Usual and Customary fees. All Plans General Limitations and Exclusions 1. All fees listed above do not include all appropriate lab fees. Member must agree (in writing) to all upgraded materials before treatment is started. See each section for specific details (if applicable). 2. All patients are responsible for paying all fees (as listed above) at the time services are rendered. 3. These fees are for General Dentists only. A participating specialist list is available by calling our office at 303-744-3007 or 1-800-807-0706. 4. Any procedures not listed will be discounted 20% off the participating General Dentists normal fees. 5. Medical costs associated with any dental procedures are not covered. 6. Dentures or appliances will be replaced only after 3 years have elapsed since such dentures or appliances were provided under any plan program, unless the denture or appliance becomes unserviceable due to illness or other causes not controlled by other means. Replacement of dentures, appliances, or bridgework due to loss or theft are not covered. 7. Any dental treatment started prior to the Member's eligibility to receive services under this plan or started after a Member's termination are not covered. 8. Failure to follow the prescribed treatment or accidents occurring during the course of treatment may result in additional charges by your plan provider. 9. Failure to pay scheduled fees at the time service is rendered may prevent future dental services from being received until all fees have been paid in full. 10. Services provided by non-participating dentists are not covered. 11. Services which, in the opinion of the attending dentist, are not necessary for the patient's dental health, or are contrary to established dental ethics are not covered. 12. Cosmetic dental procedures are covered only if the attending dentist and patient agree on the specific procedure. 13. Services which are compensable under Worker's Compensation or employer liability laws are not covered. 14. General anesthesia and IV sedation are not covered. 15. Myofunctional therapy procedure for training, treating or developing muscles in and around the jaw or mouth including TMJ are not covered except by participating plan specialists. 16. Any dental procedure or service that cannot be performed in the dental office due to general and/or physical limitations of a member are not covered. 17. Expenses incurred for dental procedures initiated prior to member's eligibility or after termination are not covered. 18. Any services that the Participating General Dentist recommends be performed by a specialist are covered only by a plan participating specialist. 19. The liability of Beta Health Association, Inc. is limited to the return of the membership fees paid for one year by the member. 20. Extractions for asymptomatic third molars (wisdom teeth) are not covered unless causing movement of the teeth. An example of symptomatic include severe decay, and ontogenic cysts, chronic pericoronitis, and infection. 21. The Beta Health Association, Inc. dental programs do not constitute dental insurance and are considered discount, fee-forservice dental plans. 22. Fees are subject to change on an as needed basis. Please contact Beta Health Association, Inc. for current fees. Current Dental Terminology American Dental Association Page 4

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 Complete Participating Provider Directory ( Alpha and Choice Dental Plan including Orthodontists) Plan providers are listed in alphabetical order according to city. The most up to date provider listings can be found at www.betadental.com. You can also call 303-744-3007 or 1-800-807-0706 for assistance. All dentists listed are excepting new patients. Contact the office directly if you wish to verify. NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES General Dentists Dr. Richard Williams Dr. Richard Williams ADP #56 315 Edison 719-589-3686 Alamosa General Dentist *, **, C, E1-2, E3-4, N Dr. Frank Welch Welch Dental, LLC CDP #440 206 Crestone Ave. 719-589-6629 Alamosa General Dentist *, E1-2 Dr. Christopher Welch Welch Dental, LLC CDP #440 206 Crestone Ave. 719-589-6629 Alamosa General Dentist *, E1-2 Dr. Shayna Bahr Comfort Dental - North Arvada ADP #36 8390 W. 80th Ave. 303-425-6419 Arvada General Dentist *, **, C, E1-2, E3-4 Dr. Kathy Tomlinson Comfort Dental - North Arvada ADP #36 8390 W. 80th Ave. 303-425-6419 Arvada General Dentist *, **, C, E1-2, E3-4 Dr. Juan Materon Comfort Dental - North Arvada ADP #36 8390 W. 80th Ave. 303-425-6419 Arvada General Dentist *, **, C, E1-2, E3-4 Dr. Anita Vedi New Impressions Dental ADP #39 9122 W. 88th Ave. 303-422-0836 0836 Arvada General Dentist t **, C, E1-2 Dr. Alan Bueltel Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4 Dr. Mark Dean Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4 Dr. Neil Zimmet Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4 Dr. James R. Mayo Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4 Dr. Roy Theriot Dr. Roy Theriot ADP #10 941 S. Havana, #200 303-341-5313 Aurora General Dentist *, C Dr. Tiffany Fritz Bright Now Dental - Smoky Hill ADP #107 23963 Prospect Ave., Ste. #hv2be 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4 Dr. Chelsea Deutscher Bright Now Dental - Smoky Hill ADP #107 23963 Prospect Ave., Ste. #hv2be 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Smoky Hill ADP #107 23963 Prospect Ave., Ste. #hv2be 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4 Dr. Mona Omran Bright Now Dental - Smoky Hill ADP #107 23963 Prospect Ave., Ste. #hv2be 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4 Dr. Bob Allen Comfort Dental - Iliff & Tower Rd. ADP #110 18690 E. Iliff Ave., Suite 15 303-751-5010 Aurora General Dentist *, **, C, E1-2, E3-4 Dr. Ekapoj Thongin Comfort Dental - Iliff & Tower Rd. ADP #110 18690 E. Iliff Ave., Suite 15 303-751-5010 Aurora General Dentist *, **, C, E1-2, E3-4 Dr. Clyde A. Bowden Clyde A. Bowden ADP #133 14591 E. Alameda Ave. 303-343-7072 343 Aurora General Dentist C, E1-2, N Dr. Kris Komanduri Hanu Dental Care ADP #163 12343 E. Cornell Ave. #-17 720-748-7902 Aurora General Dentist *, **, C, E1-2, E3-4 Dr. Gerald Edwards Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Matthew Rowan Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Zachary D. Bergeson Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Jeffrey Gilliam Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Michael Millward Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. 303-680-9990 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Jeffrey Hamilton Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. 303-680-9990 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Asha Chinni Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. 303-680-9990 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Mark Lawson Village Park Dental ADP #191 11085 E. Mississippi Ave. 303-364-6455 Aurora General Dentist *, C, E1-2, E3-4 Dr. Christopher Bentley Grandview Dental ADP #201 6830 S. Liverpool St. #-A 303-400-3483 Aurora General Dentist **, C, E1-2, E3-4 Dr. Zachary D. Bergeson Comfort Dental-Havana ADP #202 10401 E. Colfax Ave. #150 303-344-2273 Aurora General Dentist *, **, C, E1-2, E3-4 Dr. Jeffrey Gilliam Comfort Dental-Havana ADP #202 10401 E. Colfax Ave. #150 303-344-2273 Aurora General Dentist *, **, C,E1-2, E3-4 Dr. Jeffrey A. Varner Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Jim Parfitt Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N Page 1 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. Richard Doerhoff Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N Dr. Barry Wohlgemuth Wohlgemuth & Rush, DDS ADP #41 1450 S. Havana, #200 303-755-8388 Aurora General Dentist C, N Dr. Steven Rush Wohlgemuth & Rush, DDS ADP #41 1450 S. Havana, #200 303-755-8388 Aurora General Dentist C, N Dr. Thomas E. Daniel Dr. Thomas E. Daniel ADP #46 1101 Havana 303-366-3577 Aurora General Dentist C Dr. Marc W. Reissner Blue Mesa Dental - S. Chambers Rd. ADP #70 1700 S. Chambers Rd. 303-337-0789 Aurora General Dentist **, C, E1-2, E3-4 Dr. Dwayne A. Moore Blue Mesa Dental - S. Chambers Rd. ADP #70 1700 S. Chambers Rd. 303-337-0789 Aurora General Dentist **, C, E1-2, E3-4 Dr. Richard Handelman Blue Mesa Dental - S. Chambers Rd. ADP #70 1700 S. Chambers Rd. 303-337-0789 Aurora General Dentist **, C, E1-2, E3-4 Dr. Craig A. Mellor Bright Now Dental - S. Tower Rd. ADP #74 3551 S. Tower Rd., #c 303-400-3669 Aurora General Dentist *, **, C, E1-2 Dr. Thomas Mulheran Bright Now Dental - S. Tower Rd. ADP #74 3551 S. Tower Rd., #c 303-400-3669 Aurora General Dentist *, **, C, E1-2 Dr. Traver L. Maxwell Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2 Dr. Nicole Ward Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2 Dr. Camillo Dilizia Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2 Dr. James Liu Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2 Dr. John W. Thousand, Iii Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2 Dr. Nelson S. Joo Nelson S. Joo, DMD CDP #352 2222 S. Fraser St. #3 303-671-0305 Aurora General Dentist *, C, E1-2, E3-4 Dr. Sharon Fahmy Sharon Fahmy, DDS CDP #427 13741 E. Rice Place #100 303-617-5212 Aurora General Dentist C Dr. Farhad Farbod Farhad Farbod, DMD, PC CDP #428 14991 E. Hampden Ave., #270 303-699-9880 Aurora General Dentist *, C, E1-2, E3-4 Dr. Falona Glenn Falona Glenn, DDS, PC CDP #450 1732 S. Chambers Rd. 303-751-6916 Aurora General Dentist *, **, C, E1-2, E3-4 Dr. Gerald Glenn Falona Glenn, DDS, PC CDP #450 1732 S. Chambers Rd. 303-751-6916 Aurora General Dentist *, **, C, E1-2, E3-4 Dr. Davood Manshadi Kids Choice Dental CDP #462 15159 E. Colfax Ave., B 303-341-5437 Aurora General Dentist *, C, E1-2, E3-4 Dr. Mario Montanez Kids Choice Dental CDP #462 15159 E. Colfax Ave., B 303-341-5437 Aurora General Dentist *, C, E1-2, E3-4 Dr. Lisa Sheldon Comfort Dental - Boulder ADP #112 3400 Arapahoe Rd. 303-444-2129 Boulder General Dentist *, C, E1-2, E3-4 Dr. Mark Cannon Comfort Dental - Boulder ADP #112 3400 Arapahoe Rd. 303-444-2129 Boulder General Dentist *, C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Boulder ADP #136 1840 Folsom St. 303-417-9401 Boulder General Dentist *, C, E1-2, E3-4 Dr. Chelsea Deutscher Bright Now Dental - Boulder ADP #136 1840 Folsom St. 303-417-9401 Boulder General Dentist *, C, E1-2, E3-4 Dr. Pasco Scarpella Platte River Family Dental, PC CDP #472 965 Platte River Blvd., Unit E 303-659-8200 Brighton General Dentist *, **, C, E1-2 Dr. Lyndon Mata Mata Dental ADP #58 6363 W. 120th Ave., #230 303-635-0100 Broomfield General Dentist *, C, E1-2, N Dr. Hani Marogil Hani Marogil DMD, PC CDP #471 340 E. 1st Ave., #202 303-466-4646 Broomfield General Dentist C, E1-2 Dr. Vikash Kanchanlal Shadow Rock Dentistry ADP #197 734 Wilcox St. #-200 303-257-8237 Castle Rock General Dentist *, **, C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Castle Rock ADP #49 1001 S. Perry St., #105-A 303-688-0252 Castle Rock General Dentist None Dr. Malgorzata R. Korosciel Bright Now Dental - Castle Rock ADP #49 1001 S. Perry St., #105-A 303-688-0252 Castle Rock General Dentist None Dr. Margarita Aleksanyan Guaranteed Smiles - Southglenn ADP #116 2001 E. Easter Ave., #200 303-703-4544 Centennial General Dentist C, E1-2, E3-4 Dr. Sarah J. Meyer Sarah J. Meyer DDS ADP #141 6650 S. Vine St. 303-794-2456 Centennial General Dentist *, C Dr. Adam Mcveigh Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4 Dr. Derrick Q. Price Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4 Dr. Murray Jacobs Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial i l General l Dentist t *, * C, E1-2, E3-4 Dr. Jeanette Berner Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4 Dr. Kevin Marshall Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4 Dr. William Case Dr. William Case ADP #71 7180 E. Orchard Rd., #302 720-488-6600 Centennial General Dentist *, C Dr. Neal Wilsted Neal K. Wilsted, DDS CDP #426 7920 S. University Blvd. #200 720-489-0797 Centennial General Dentist *, C Dr. Luis J. Bravo Luis J. Bravo, DMD CDP #467 6650 S. Vine St., #120 303-805-9256 Centennial General Dentist *, **, C, E1-2 Dr. Richard H. Wiedey Dr. Richard H. Wiedey ADP #106 1819 North Circle #6 719-520-5884 5884 Colorado Springs General Dentist **, E1-2, E3-4, N Dr. Michael Stoor Comfort Dental - Citadel Crossing ADP #108 509 N. Academy Blvd. 719-591-7599 Colorado Springs General Dentist *, C, E1-2 Dr. Travis Probst Comfort Dental - Citadel Crossing ADP #108 509 N. Academy Blvd. 719-591-7599 Colorado Springs General Dentist *, C, E1-2 Page 2 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. Scott Probst Comfort Dental - Citadel Crossing ADP #108 509 N. Academy Blvd. 719-591-7599 Colorado Springs General Dentist *, C, E1-2 Dr. Christian Lovejoy Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Dustin B. Dial Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Jamison Miller Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Dwight Douglas Olson Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Patrick Hudson Comfort Dental - Austin Bluffs ADP #158 3952 A North Academy 719-591-1811 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Dan Kingsford Comfort Dental - Austin Bluffs ADP #158 3952 A North Academy 719-591-1811 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Jeremy Bullock Comfort Dental - Austin Bluffs ADP #158 3952 A North Academy 719-591-1811 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Parkmoor Village ADP #159 3208 N. Academy Blvd., #140 719-596-7000 Colorado Springs General Dentist C, E1-2, E3-4 Dr. Paul Hennegan Bright Now Dental - Parkmoor Village ADP #159 3208 N. Academy Blvd., #140 719-596-7000 Colorado Springs General Dentist C, E1-2, E3-4 Dr. Paul Rygg Jade/erindale Dental ADP #164 6020 Erin Park Dr. 719-266-9393 Colorado Springs General Dentist C, E1-2, E3-4 Dr. Kathleen Brower Jade/erindale Dental ADP #164 6020 Erin Park Dr. 719-266-9393 Colorado Springs General Dentist C, E1-2, E3-4 Dr. Joseph A. Woods Blue Mesa Citadel Dental, PC ADP #175 825 Citadel Dr. East #200 719-380-7100 Colorado Springs General Dentist C, E1-2 Dr. Oliver M. Spaeth Broadmoor Valley Dental Care ADP #195 2965 Broadmoor Valley Rd. 719-632-7636 Colorado Springs General Dentist C, E1-2 Dr. Jay Johnson Comfort Dental-South Powers ADP #200 1580 Space Center Dr. #107 719-574-8922 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Benjamin Weir Comfort Dental-South Powers ADP #200 1580 Space Center Dr. #107 719-574-8922 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Kathleen Brower Rigby Dental PC ADP #206 1304 N. Academy Blvd. #104 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Ted L. Rigby Rigby Dental PC ADP #206 1304 N. Academy Blvd. #104 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Leopoldo Rodríguez Rigby Dental PC ADP #206 1304 N. Academy Blvd. #104 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Paul Rygg Rigby Dental PC ADP #206 1304 N. Academy Blvd. #104 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4 Dr. Angelo M. Camerino North Summit Dental Care ADP #212 1720 Jet Stream Dr. #110 719-481-8373 Colorado Springs General Dentist *, C, E1-2, E3-4 Dr. Carolyn T. Camerino Centennial Dental Care PC. ADP #213 5731 Silverstone Terr. #-200 719-632-7778 Colorado Springs General Dentist *, C, E1-2, E3-4 Dr. David R. Baer Stafford Dental Group ADP #25 559 E. Pikes Peak Ave., #208 719-636-3311 Colorado Springs General Dentist **, E1-2, E3-4 Dr. Jay D. Tippets Stafford Dental Group ADP #25 559 E. Pikes Peak Ave., #208 719-636-3311 Colorado Springs General Dentist **, E1-2, E3-4 Dr. Christopher Bentley Bright Now Dental - Citadel Dr. ADP #50 701 Citadel Dr. East 719-574-7288 Colorado Springs General Dentist **, C, E1-2, E3-4, N Dr. Thomas Mulheran Bright Now Dental - Citadel Dr. ADP #50 701 Citadel Dr. East 719-574-7288 Colorado Springs General Dentist **, C, E1-2, E3-4, N Dr. Julia Arnold Interquest Dental Group, Inc. ADP #75 1310 United Heights Dr. #220 719-266-5150 Colorado Springs General Dentist C Dr. Paul Rodríguez Dr. Paul Rodríguez ADP #77 703 N. Tejon St., #d 719-633-5501 Colorado Springs General Dentist **, C, E1-2, E3-4 Dr. Paul Rygg Jade Dental Associates ADP #89 703 N. Tejon St., #a 719-633-0770 Colorado Springs General Dentist C, E1-2, E3-4 Dr. Colleen Jenson Jade Dental Associates ADP #89 703 N. Tejon St., #a 719-633-0770 Colorado Springs General Dentist C, E1-2, E3-4 Dr. Natalie Jones Comfort Dental - North Academy ADP #9 1634 York Rd. 719-522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4 Dr. Steve Carter Comfort Dental - North Academy ADP #9 1634 York Rd. 719-522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4 Dr. Christopher Hasselback Comfort Dental - North Academy ADP #9 1634 York Rd. 719-522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4 Dr. Peter Lovejoy Comfort Dental - North Academy ADP #9 1634 York Rd. 719-522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4 Dr. Michael Gilbert Aspen Dental Associates CDP #332 559 E. Pikes Peak Ave., #203 719-473-9222 Colorado Springs General Dentist *, **, E1-2 Dr. Gregory D. Mock Aspen Dental Associates CDP #332 559 E. Pikes Peak Ave., #203 719-473-9222 9222 Colorado Springs General Dentist t *, **, E1-2 Dr. Arnold Cullum Lowell District Dental, PC CDP #412 251 E. Fountain #100 719-473-4300 Colorado Springs General Dentist *, E1-2, E3-4 Dr. Gregory Moore Gregory B. Moore, DDS CDP #424 5859 E. Pikes Peak Ave., #319 719-633-4028 Colorado Springs General Dentist C, E1-2 Dr. Stephen G. Sosdian Uptown Dental Associates CDP #448 523 N. Nevada Ave. 719-635-5815 Colorado Springs General Dentist C, E1-2 Dr. Quynh Dung Vo Sosdian Uptown Dental Associates CDP #448 523 N. Nevada Ave. 719-635-5815 Colorado Springs General Dentist C, E1-2 Dr. Glenn Thompson Glenn D. Thompson, DMD CDP #475 1711 N. Murray Blvd. 719-574-2211 Colorado Springs General Dentist E1-2 Dr. Jackson Anderson Jackson L. Anderson, DDS CDP #477 6459 Omaha Blvd. 719-597-9057 9057 Colorado Springs General Dentist *, * C, E1-2 Dr. Nicolas Porter Comfort Dental -Commerce City ADP #192 7201 Monaco St. 303-287-2755 Commerce City General Dentist *, **, C, E1-2, E3-4 Dr. Ramsey Warner Comfort Dental -Commerce City ADP #192 7201 Monaco St. 303-287-2755 Commerce City General Dentist *, **, C, E1-2, E3-4 Page 3 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. Owen Eames Comfort Dental -Commerce City ADP #192 7201 Monaco St. 303-287-2755 Commerce City General Dentist *, **, C, E1-2, E3-4 Dr. Jason Mahoney Comfort Dental-Conifer ADP #101 25597 Conifer Rd. 303-838-2811 Conifer General Dentist *, **, C, E1-2, E3-4 Dr. Jacqueline Blasko Comfort Dental-Conifer ADP #101 25597 Conifer Rd. 303-838-2811 Conifer General Dentist *, **, C, E1-2, E3-4 Dr. Teniel Seifert Comfort Dental-Conifer ADP #101 25597 Conifer Rd. 303-838-2811 Conifer General Dentist *, **, C, E1-2, E3-4 Dr. Robert Unrath Comfort Dental - North Denver ADP #113 4450 W. 38th Ave. #-110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Gary Saddler Comfort Dental - North Denver ADP #113 4450 W. 38th Ave. #-110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4 Dr. John Adams Comfort Dental - North Denver ADP #113 4450 W. 38th Ave. #-110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Lyda Martinez Comfort Dental - North Denver ADP #113 4450 W. 38th Ave. #-110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Alan Coombs Alpha Dental Ii, PC ADP #12 1660 S. Albion, #715 303-758-4287 Denver General Dentist ** Dr. Jason Ray Hampden Family Dental ADP #124 7090 E. Hampden Ave. #-A 303-758-1113 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Thomas Sniegowski Dr. Thomas Sniegowski ADP #151 7475 Dakin St., Ste. #309 303-429-2727 Denver General Dentist *, E3-4, N Dr. Todd Light Comfort Dental - Cherry Creek ADP #183 201 University Blvd., #101 303-321-2233 Denver General Dentist *, C, E1-2, E3-4 Dr. David Dinsmore Comfort Dental - Cherry Creek ADP #183 201 University Blvd., #101 303-321-2233 Denver General Dentist *, C, E1-2, E3-4 Dr. Mark Jolsted Comfort Dental - Cherry Creek ADP #183 201 University Blvd., #101 303-321-2233 Denver General Dentist *, C, E1-2, E3-4 Dr. Saul Escala Escala Family Dentistry ADP #199 677 S. Federal Blvd. 303-936-6188 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Sergio M. Lopez Sergio M. Lopez D.D.S. ADP #203 3865 Cherry Creek N. Dr. #230 303-329-3030 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Douglas R. Koch Greentree Dental ADP #204 10101 E. Hampden Ave. #100 303-671-0101 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Richard H. Koch Greentree Dental ADP #204 10101 E. Hampden Ave. #100 303-671-0101 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Chad Welch Southeast Denver Dental Associates ADP #211 2660 S. Monaco Pkwy. 303-757-7175 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Janice Jones Southeast Denver Dental Associates ADP #211 2660 S. Monaco Pkwy. 303-757-7175 Denver General Dentist *, **, C, E1-2, E3-4 Dr. Donald Mardis Comfort Dental - East Colfax ADP #26 5200 E. Colfax Ave. 303-377-3876 Denver General Dentist *, **, C, E1-2 Dr. Gary Rotolo Comfort Dental - East Colfax ADP #26 5200 E. Colfax Ave. 303-377-3876 Denver General Dentist *, **, C, E1-2 Dr. Thomas Pyne Dr. Thomas Pyne ADP #29 12075 E. 45th Ave., #333 303-371-9131 Denver General Dentist *, C, E1-2, E3-4 Dr. Lindsey I Graf Bright Now Dental - Denver Downtown ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Denver Downtown ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Cherry Creek ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N Dr. David Koo Bright Now Dental - Cherry Creek ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N Dr. Lindsey I Graf Bright Now Dental - Cherry Creek ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N Dr. Christopher Bentley Bright Now Dental - Cherry Creek ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N Dr. David R. Huskey David R. Huskey, DDS ADP #51 2465 S. Downing, #104 A 303-722-0204 Denver General Dentist C, E1-2, N Dr. Timothy Wachuta Dr. Timothy Wachuta ADP #53 2709 S. Colorado Blvd. 303-756-2770 Denver General Dentist C, E1-2, E3-4 Dr. Ekatrina Butkevich Dr. Timothy Wachuta ADP #53 2709 S. Colorado Blvd. 303-756-2770 Denver General Dentist C, E1-2, E3-4 Dr. Kenneth Chernoff Dr. Timothy Wachuta ADP #53 2709 S. Colorado Blvd. 303-756-2770 Denver General Dentist C, E1-2, E3-4 Dr. Kelly White Auraria Dental Centre ADP #96 1050 W. Colfax, Ste. G 303-573-5533 Denver General Dentist **, E1-2, E3-4 Dr. Arnold Cullum Blake Street Dental, PC CDP #411 1732 Blake St. 303-814-2200 Denver General Dentist *, E1-2, E3-4 Dr. Shih Chien Shih M. Chien, DDS CDP #423 500 E. 84th Ave., #e-3 303-288-0888 0888 Denver General Dentist t C, E1-2 Dr. Preet Clair Quebec Square Family Dentistry CDP #451 7505 E. 35th Ave., #304 303-322-2081 Denver General Dentist *, C, E1-2 Dr. Jason Ray Dentistry At Lincoln Center ADP #126 12624 Washington Lane #-102 303-768-8137 Englewood General Dentist **, C, E1-2, E3-4 Dr. Neil Cowen Dr. Neil Cowen ADP #33 3535 S. Lafayette, Suite 108 303-761-8688 Englewood General Dentist *, C, E1-2 Dr. David Rebber Comfort Dental - Englewood ADP #45 2780 S. Broadway 303-783-0100 Englewood General Dentist *, C, E1-2, E3-4, N Dr. Larry Nessel Comfort Dental - Englewood ADP #45 2780 S. Broadway 303-783-0100 Englewood General Dentist *, C, E1-2, E3-4, N Dr. James M. Brown Comfort Dental - Englewood ADP #45 2780 S. Broadway a 303-783-0100 0100 Englewood General Dentist *, C, E1-2, E3-4, N Dr. Brigitte Steeghs Brigitte Steeghs, DDS CDP #459 8000 E. Prentice Ave., Suite A-5 303-756-0723 Englewood General Dentist *, C, E1-2 Dr. Hiba Kellow Comfort Dental-Westminster ADP #125 9462 N. Federal Blvd. 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4 Page 4 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. Cory S. Higginbotham Comfort Dental-Westminster ADP #125 9462 N. Federal Blvd. 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4 Dr. Helen Stella Comfort Dental-Westminster ADP #125 9462 N. Federal Blvd. 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4 Dr. David Yeats Comfort Dental-Westminster ADP #125 9462 N. Federal Blvd. 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4 Dr. Ciaran Finbar Murphy Harbor Dental Clinic ADP #123 2608 S. Timberline Rd.#-110 970-377-2456 Fort Collins General Dentist C, E1-2, E3-4 Dr. Jamie Fillmore Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N Dr. Alois Tripam Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N Dr. Douglas Haschke Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N Dr. Katerina Sorensen Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N Dr. Thomas Mulheran Bright Now Dental - Fort Collins ADP #38 1217 E. Elizabeth St., #5 970-498-8706 Fort Collins General Dentist C, E1-2 Dr. Scott Bares Bright Now Dental - Fort Collins ADP #38 1217 E. Elizabeth St., #5 970-498-8706 Fort Collins General Dentist C, E1-2 Dr. James Fischer Fischer Dental CDP #303 1331 E. Prospect Rd., #b2 970-482-6333 Fort Collins General Dentist *, C, E1-2, E3-4 Dr. Rich Wuerker Boardwalk Dental CDP #468 140 E. Boardwalk Dr. #g 970-407-8080 Fort Collins General Dentist *, C, E1-2, E3-4 Dr. Leon Green Boardwalk Dental CDP #468 140 E. Boardwalk Dr. #g 970-407-8080 Fort Collins General Dentist *, C, E1-2, E3-4 Dr. Zachery Green Boardwalk Dental CDP #468 140 E. Boardwalk Dr. #g 970-407-8080 Fort Collins General Dentist *, C, E1-2, E3-4 Dr. George V. Ranta Mesa Ridge Dental Center CDP #483 6980 Mesa Ridge Pkwy. 719-392-4231 Fountain General Dentist *, **, C, E1-2, E3-4 Dr. Candace Pfister Mesa Ridge Dental Center CDP #483 6980 Mesa Ridge Pkwy. 719-392-4231 Fountain General Dentist *, **, C, E1-2, E3-4 Dr. Kajsa Novembre Mesa Ridge Dental Center CDP #483 6980 Mesa Ridge Pkwy. 719-392-4231 Fountain General Dentist *, **, C, E1-2, E3-4 Dr. Ryan Reposa Mesa Ridge Dental Center CDP #483 6980 Mesa Ridge Pkwy. 719-392-4231 Fountain General Dentist *, **, C, E1-2, E3-4 Dr. Thomas L. Losacco Dr. Thomas L. Losacco ADP #8 801 6th St. 303-569-3141 Georgetown General Dentist *, C, E1-2, E3-4, N Dr. Benjamin D. Coon Glenwood Meadows Dental ADP #178 40 - A Market Street 970-947-1717 Glenwood Springs General Dentist **, C, E1-2, E3-4 Dr. Brian Talley Comfort Dental - Glenwood Springs ADP #91 1512 Grand Ave. 970-947-1273 Glenwood Springs General Dentist *, **, C, E1-2, E3-4 Dr. Michael Shea Comfort Dental - Glenwood Springs ADP #91 1512 Grand Ave. 970-947-1273 Glenwood Springs General Dentist *, **, C, E1-2, E3-4 Dr. Ekatrina Butkevich Dr. Timothy Wachuta ADP #128 2305 Jackson St. 303-278-2800 Golden General Dentist C, E1-2, E3-4 Dr. Timothy Wachuta Dr. Timothy Wachuta ADP #128 2305 Jackson St. 303-278-2800 Golden General Dentist C, E1-2, E3-4 Dr. Kenneth Chernoff Dr. Timothy Wachuta ADP #128 2305 Jackson St. 303-278-2800 Golden General Dentist C, E1-2, E3-4 Dr. Scott Welch Golden View Dental ADP #210 727 Simms St., #e 303-232-3636 Golden General Dentist *, **, C, E1-2, E3-4 Dr. Heath Colledge Comfort Dental - Golden ADP #90 17531 S. Golden Rd. 303-278-6953 Golden General Dentist *, **, C, E1-2, E3-4 Dr. Paulette Dilizia Comfort Dental - Golden ADP #90 17531 S. Golden Rd. 303-278-6953 Golden General Dentist *, **, C, E1-2, E3-4 Dr. Nicholas L. Groneman Comfort Dental - Golden ADP #90 17531 S. Golden Rd. 303-278-6953 Golden General Dentist *, **, C, E1-2, E3-4 Dr. Jason Noah Comfort Dental - Golden ADP #90 17531 S. Golden Rd. 303-278-6953 Golden General Dentist *, **, C, E1-2, E3-4 Dr. John Burchfield J.R. Burchfield, DDS CDP #443 2007 Jackson St. 303-279-3992 Golden General Dentist C, E1-2 Dr. James M. Tarr Dr. James M. Tarr ADP #102 2531 W. Pinyon Ave. 970-242-5367 Grand Junction General Dentist C, E1-2 Dr. Robert R. Harmen Robert Harmen ADP #122 1119 N. 1st St., Unit D 970-245-5040 Grand Junction General Dentist *, C Dr. Matthew Hudson Hudson Family Dental ADP #208 132 Walnut Ave. #-6 970-242-5151 Grand Junction General Dentist *, C, E1-2, E3-4 Dr. Thomas Sorensen Comfort Dental-Grand Junction ADP #61 2650 North Ave. 970-255-1222 Grand Junction General Dentist *, **, C, E1-2, E3-4 Dr. James Bradley Comfort Dental-Grand Junction ADP #61 2650 North Ave. 970-255-1222 Grand Junction General Dentist t *, **, C, E1-2, E3-4 Dr. Michael Shea Comfort Dental-Grand Junction ADP #61 2650 North Ave. 970-255-1222 Grand Junction General Dentist *, **, C, E1-2, E3-4 Dr. Stephen Brown Dr. Stephen Brown ADP #65 3400 W. 16th St., Bldg. 3, Ste. S 970-356-8118 Greeley General Dentist **, E1-2 Dr. Patrick Rinaldis Comfort Dental - Greeley ADP #67 3766 West 10th St. 970-304-1273 Greeley General Dentist **, C, E1-2, E3-4 Dr. Courtney Stevens Comfort Dental - Greeley ADP #67 3766 West 10th St. 970-304-1273 Greeley General Dentist **, C, E1-2, E3-4 Dr. Andrey A. Kondratenko Comfort Dental - Greeley ADP #67 3766 West 10th St. 970-304-1273 Greeley General Dentist **, C, E1-2, E3-4 Dr. Alex Knecht Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 0048 Greeley General Dentist *, **, C, E1-2, E3-4 Dr. Dinorah Moya Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4 Dr. Kent Day Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4 Page 5 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. Patrick Harrison Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4 Dr. Shivaun Mcartor Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4 Dr. Nicholas Jimison Nicholas A. Jamison, Ii DDS CDP #433 4669 W. 20th Street Rd., Ste. A 970 506-1122 Greeley General Dentist *, C Dr. Michael Love Comfort Dental - Highlands Ranch ADP #40 129 W. County Line Rd. 303-738-9499 Highlands Ranch General Dentist *, **, C, E1-2, E3-4 Dr. Khiem Hoang Comfort Dental - Highlands Ranch ADP #40 129 W. County Line Rd. 303-738-9499 Highlands Ranch General Dentist *, **, C, E1-2, E3-4 Dr. Michael Vetowich Comfort Dental - Highlands Ranch ADP #40 129 W. County Line Rd. 303-738-9499 Highlands Ranch General Dentist *, **, C, E1-2, E3-4 Dr. Mark Jolsted Comfort Dental - Highlands Ranch ADP #40 129 W. County Line Rd. 303-738-9499 Highlands Ranch General Dentist *, **, C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Highlands Ranch ADP #93 3626 Highlands Rnch. Pkwy #107 303-488-9922 Highlands Ranch General Dentist *, **, E1-2, E3-4, N Dr. Henry D. Ahn Bright Now Dental - Highlands Ranch ADP #93 3626 Highlands Rnch. Pkwy #107 303-488-9922 Highlands Ranch General Dentist *, **, E1-2, E3-4, N Dr. Hanaa Jebril Comfort Dental - Lafayette ADP #187 535 W. South Boulder Rd., #200 303-604-2804 Lafayette General Dentist *, **, C, E1-2, E3-4 Dr. Randal Silver Comfort Dental - Lafayette ADP #187 535 W. South Boulder Rd., #200 303-604-2804 Lafayette General Dentist *, **, C, E1-2, E3-4 Dr. Eric Rosengren Comfort Dental - Lafayette ADP #187 535 W. South Boulder Rd., #200 303-604-2804 Lafayette General Dentist *, **, C, E1-2, E3-4 Dr. Pamela Lerfald Comfort Dental - Lafayette ADP #187 535 W. South Boulder Rd., #200 303-604-2804 Lafayette General Dentist *, **, C, E1-2, E3-4 Dr. Efren Martinez Dr. Efren Martinez ADP #130 1200 S. Wadsworth 303-733-7533 Lakewood General Dentist **, E1-2, E3-4 Dr. Bruce H. Johnson Bruce H. Johnson ADP #140 9868 W. Girton Dr. 303-989-0577 Lakewood General Dentist *, **, C, E1-2 Dr. Richard Glucksman Alpha Dental Xx ADP #3 7373 W. Jefferson, #203 303-988-1530 Lakewood General Dentist *, N Dr. Jennifer K. Lee Bright Now Dental - Lakewood ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2 Dr. Thomas Mulheran Bright Now Dental - Lakewood ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2 Dr. Timothy Schroeder Timothy Schroeder, DDS CDP #420 6565 W. Jewell #3 303-937-6345 Lakewood General Dentist *, C, E1-2 Dr. Owen Crockett Owen C. Crockett, DDS CDP #458 1345 Wadsworth 303-238-1209 Lakewood General Dentist None Dr. James T. Kern James T. Kern, DDS CDP #465 10815 W. Jewell Ave., #l 303-988-6860 Lakewood General Dentist C Dr. Richard Nichols Cosmetic Complete Dentistry CDP #481 7625 W. Hampden Ave., #15 303-988-2150 Lakewood General Dentist *, **, C, E1-2 Dr. Ibraheem Ackall Highplains Community Health Center ADP #54 200 Kendall Drive 719-336-8445 Lamar General Dentist **, C, E1-2 Dr. Bill Bender Dr. Bill Bender ADP #23 202 2nd St. 970-284-7930 Lasalle General Dentist *, **, C, E1-2 Dr. Richard J. Birkel Comfort Dental- Littleton Blvd. ADP #132 209-B W. Littleton Blvd. 303-734-2273 Littleton General Dentist *, **, C, E1-2, E3-4, N Dr. Jeffrey Spiegel Comfort Dental- Littleton Blvd. ADP #132 209-B W. Littleton Blvd. 303-734-2273 Littleton General Dentist *, **, C, E1-2, E3-4, N Dr. David Kim Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4 Dr. Thomas Klumb Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4 Dr. Bill Oldershaw Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4 Dr. Brad Weekes Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4 Dr. Ellias Najjar Belleview Dental Associates ADP #69 10184 W. Belleview 303-932-1077 Littleton General Dentist * Dr. Margareta Pavel Dutch Creek Dental ADP #78 8370 W. Coal Mine Ave., #103 303-978-1522 Littleton General Dentist *, C, E1-2, E3-4 Dr. James Preston James M. Preston, DDS CDP #438 5950 Platte Canyon Rd. 303-797-2286 Littleton General Dentist *, C, E1-2 Dr. Jason Blanchard Blanchard & Richardson Family Dentistry CDP #442 8089 S. Lincoln St. #102 303-794-9271 Littleton General Dentist *, **, C, E1-2 Dr. Brian Richardson Blanchard & Richardson Family Dentistry CDP #442 8089 S. Lincoln St. #102 303-794-9271 Littleton General Dentist *, **, C, E1-2 Dr. Cindy Kempton Cindy Kempton, DDS CDP #444 7261 S. Broadway, #102 303-738-3888 3888 Littleton t General l Dentist t *, **, C, E1-2 Dr. Tram Tran Tram Tran, DDS, LLC CDP #454 9860 W. Belleview Ave. 303-933-9969 Littleton General Dentist *, C, E1-2 Dr. M. William Meyer Littleton Dental Associates CDP #470 6691 W. Ken Caryl Ave. 303-979-4994 Littleton General Dentist *, C, E1-2 Dr. Ramzi Matar Littleton Dental Associates CDP #470 6691 W. Ken Caryl Ave. 303-979-4994 Littleton General Dentist *, C, E1-2 Dr. David Gryzick Littleton Dental Associates CDP #470 6691 W. Ken Caryl Ave. 303-979-4994 Littleton General Dentist *, C, E1-2 Dr. Donald Hobbs Littleton Dental Associates CDP #470 6691 W. Ken Caryl Ave. 303-979-4994 Littleton General Dentist *, C, E1-2 Dr. Richard Handelman Dentistry At The Crest ADP #205 10047 Park Meadows Dr. #-B 303-768-8848 8848 Lone Tree General Dentist *, **, C, E1-2, E3-4 Dr. Daniel Larscheid Dentistry At The Crest ADP #205 10047 Park Meadows Dr. #-B 303-768-8848 Lone Tree General Dentist *, **, C, E1-2, E3-4 Dr. M. Shawn Lawler Four Seasons Dental CDP #464 9896 Rosemont Ave., #103 303-705-5700 Lone Tree General Dentist C, E1-2 Page 6 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. Jolly Johnson Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4 Dr. Stephen Sidwell Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4 Dr. Conrad Stutznegger Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4 Dr. Aaron D. Mortensen Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4 Dr. Stephen Brown Affordable Dental Clinic ADP #22 2051 Terry St. 303-678-7232 Longmont General Dentist *, E1-2 Dr. David R. Maki Bright Now Dental - Longmont ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4 Dr. Lauren Peterson Bright Now Dental - Longmont ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4 Dr. Thomas Mulheran Bright Now Dental - Longmont ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4 Dr. Mona Omran Bright Now Dental - Longmont ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4 Dr. Abraham Miller Comfort Dental - Louisville ADP #17 339 Mccaslin Blvd., #b 303-673-0500 Louisville General Dentist *, **, C, E1-2, E3-4 Dr. Stephen Spencer Comfort Dental - Louisville ADP #17 339 Mccaslin Blvd., #b 303-673-0500 Louisville General Dentist *, **, C, E1-2, E3-4 Dr. Doug Duey Comfort Dental - Louisville ADP #17 339 Mccaslin Blvd., #b 303-673-0500 Louisville General Dentist *, **, C, E1-2, E3-4 Dr. Susan Kutis Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2 Dr. James A. Fisher Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2 Dr. Thomas Mulheran Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2 Dr. Jeffery Bourne Comfort Dental- North Loveland ADP #193 274 W. 64th St. 970-667-0446 Loveland General Dentist **, C, E1-2, E3-4, N Dr. Mikal Lindman Comfort Dental- North Loveland ADP #193 274 W. 64th St. 970-667-0446 Loveland General Dentist **, C, E1-2, E3-4, N Dr. Patrick Harrison Loveland Community Health Center ADP #87 450 N. Cleveland Ave. 970-461-8942 Loveland General Dentist *, **, C, E1-2, E3-4 Dr. Christopher Hasselback Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4 Dr. Michael Gioia Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4 Dr. Victoria L. Driskill Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4 Dr. Steve Carter Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4 Dr. Stewart Moss Stuart Moss & Associates ADP #4 421 W. 104th Ave., #201 303-427-6462 Northglenn General Dentist *, **, C, E1-2 Dr. Ronald J. Freimuth Comfort Dental - Parker ADP #111 12870 Stroh Ranch Court 303-840-6543 Parker General Dentist *, C, E1-2, E3-4, N Dr. Scott Henderson Comfort Dental - Parker ADP #111 12870 Stroh Ranch Court 303-840-6543 Parker General Dentist *, C, E1-2, E3-4, N Dr. Trevor G. Johnson Comfort Dental - Parker ADP #111 12870 Stroh Ranch Court 303-840-6543 Parker General Dentist *, C, E1-2, E3-4, N Dr. Kathleen Cortese Parker Dental Center ADP #194 11031 S. Pikes Peak Dr. #103 303-841-4580 Parker General Dentist **, C, E1-2, E3-4 Dr. Michael Miller Foxfield Dental ADP #207 16350 E. Arapahoe Rd. #-114 720-870-0401 Parker General Dentist *, **, C, E1-2, E3-4 Dr. Michael G. Hale Dr. Michael G. Hale ADP #27 19751 E. Mainstreet #r16 303-841-3322 Parker General Dentist C, N Dr. Joel Stafford Comfort Dental-Falcon Hills ADP #127 11605 Meridian Market View #154 719-495-8989 Peyton General Dentist *, **, C, E1-2, E3-4 Dr. Jonathan Harvey Comfort Dental-Falcon Hills ADP #127 11605 Meridian Market View #154 719-495-8989 Peyton General Dentist *, **, C, E1-2, E3-4 Dr. Chad J. Murdock Comfort Dental-Falcon Hills ADP #127 11605 Meridian Market View #154 719-495-8989 Peyton General Dentist *, **, C, E1-2, E3-4 Dr. Vikash Kanchanlal Gentle Touch Family Dentistry ADP #198 3926 Sandalwood Lane 719-564-3900 Pueblo General Dentist *, **, C, E1-2, E3-4 Dr. Anthony Knowlton Sandalwood Dental Care Center ADP #42 3939 Sandalwood Lane 719-564-5833 Pueblo General Dentist *, C, E1-2, E3-4 Dr. Tony G. Oreskovich Oreskovich Dental ADP #5 1111 Pueblo Blvd. Way, #140 719-542-8182 Pueblo General Dentist E1-2, E3-4 Dr. Tony I. Oreskovich Oreskovich i Dentalt l ADP #5 1111 Pueblo Blvd. Way, #140 719-542-8182 Pueblo General Dentist t E1-2, E3-4 Dr. Richard C. Moreschini Dr. Richard C. Moreschini ADP #52 1000 W. 6th St. 719-542-7420 Pueblo General Dentist C, E1-2, N Dr. Karleen L. Trefil Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, Ste. A 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4 Dr. Phillip Holden Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, Ste. A 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4 Dr. Elden M. Rice Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, Ste. A 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4 Dr. Brady T. Smith Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, Ste. A 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4 Dr. Jeffery A. Moeller Comfort Dental - Pueblo - South ADP #80 1221 S. Pueblo Blvd. 719-565-2274 Pueblo General Dentist *, **, C, E1-2, E3-4 Dr. Bradley Michael Almond Comfort Dental - Pueblo - South ADP #80 1221 S. Pueblo Blvd. 719-565-2274 Pueblo General Dentist *, **, C, E1-2, E3-4 Dr. Ralph Downey Comfort Dental - Pueblo - South ADP #80 1221 S. Pueblo Blvd. 719-565-2274 Pueblo General Dentist *, **, C, E1-2, E3-4 Page 7 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. Gino Ortegon Dr. Gino Ortegon ADP #85 401 W.12th St. 719-583-0555 Pueblo General Dentist **, C, E1-2, N Dr. Gary Graves Dr. Gary Graves ADP #99 1345 S. Pueblo Blvd. 719-542-3595 Pueblo General Dentist *, **, C, E1-2 Dr. David Robinson David B. Robinson, DDS, PC CDP # 435 1560 Bonforte Blvd. 719-544-5340 Pueblo General Dentist *, C, E1-2 Dr. Tony Roberts Dr. Tony Roberts CDP #329 1225 N. Grand Ave. 719-542-6014 Pueblo General Dentist *, C, E1-2, E3-4 Dr. Duilio Stricca Duilio A. Stricca,, DDS CDP #432 753 W. Abriendo Ave. 719-543-5604 Pueblo General Dentist C, E1-2 Dr. Thomas W. Ready Gentle Dental CDP #445 643 S. Pueblo Blvd. 719-561-8170 Pueblo General Dentist * Dr. Greg Philson Dr. Greg A. Philson, PC CDP #473 830 W. Abriendo 719-545-6421 Pueblo General Dentist E1-2 Dr. Mark Hurd Mark D. Hurd, DDS CDP #476 3901 Outlook Blvd., Ste. C 719-544-7020 Pueblo General Dentist *, C, E1-2 Dr. Lorraine Mundy Comfort Dental- Summit County ADP #64 354 Blue River Pkwy #a 970-262-2273 Silverthorne General Dentist *, C, E1-2, E3-4 Dr. John Rollow, Iv Comfort Dental- Summit County ADP #64 354 Blue River Pkwy #a 970-262-2273 Silverthorne General Dentist *, C, E1-2, E3-4 Dr. Tim Townsend Tim F. Townsend, DDS CDP #418 501 Anglers Dr. #102 970-879-2290 Steamboat Springs General Dentist C, E1-2 Dr. Randall C. Jones Randall C. Jones ADP #15 1402 S. 3rd Ave. 970-522-6280 Sterling General Dentist *, C, E1-2, E3-4 Dr. Matthew Janda Matthew C. Janda, DDS CDP #431 801 Iris Dr. 970-522-4050 Sterling General Dentist *, **, C, E1-2, E3-4 Dr. Hanh H. Phi Kids And Family Dentistry And Orthodontics CDP #482 2300 E. 120th Ave. #104 303-254-8828 Thornton General Dentist *, **, C, E1-2, E3-4 Dr. Phillip K. Johnson Kids And Family Dentistry And Orthodontics CDP #482 2300 E. 120th Ave. #104 303-254-8828 Thornton General Dentist *, **, C, E1-2, E3-4 Dr. Christopher Welch Welch Dental CDP #441 209 E. Main St. 719-846-0870 Trinidad General Dentist *, E1-2 Dr. Frank Welch Welch Dental CDP #441 209 E. Main St. 719-846-0870 Trinidad General Dentist *, E1-2 Dr. Phil Warlick Phil Warlick, DDS, Inc. CDP #436 620 S. Albert Ave. 719-738-6446 Walsenberg General Dentist *, C, E1-2 Dr. Malgorzata R. Korosciel Bright Now Dental - Westminster ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2 Dr. Thomas Mulheran Bright Now Dental - Westminster ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2 Dr. Lindsey Schroepfer Bright Now Dental - Westminster ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2 Dr. Luan K. Tran Bright Now Dental - Westminster ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2 Dr. Travis Willey Bright Now Dental - Westminster ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2 Dr. Chelsea Deutscher Bright Now Dental - Westminster ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2 Dr. Alan Bueltel Kenneth J. Polke, DDS, PC CDP #446 12030 Melody Dr. 303-920-4900 Westminster General Dentist *, C, E1-2, E3-4 Dr. Kenneth Polke Kenneth J. Polke, DDS, PC CDP #446 12030 Melody Dr. 303-920-4900 Westminster General Dentist *, C, E1-2, E3-4 Dr. Claude Pareja Westminster Dental Associates CDP #466 4070 W. 72nd Ave. 303-429-7072 Westminster General Dentist *, **, C, E1-2, E3-4 Dr. William Mcglashan Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4 Dr. Sara Marchbanks Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4 Dr. Lewis Sherman Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4 Dr. Christopher Hasselback Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4 Dr. David R. Maki Aspen Hill Dental, PC ADP #209 7015 W. 38th Ave. 303-940-9755 Wheat Ridge General Dentist *, **, C, E1-2, E3-4 Dr. Alan Bernbaum Alan N. Bernbaum, DDS CDP #415 6654 W. 38th Ave. 303-424-1517 Wheat Ridge General Dentist *, C, E1-2 Dr. Bryan Dahler Bryan M. Dahler, DDS, PC CDP #310 3785 Kipling St. 303-421-8857 Wheat Ridge General Dentist *, C, E1-2, E3-4 Dr. Anthony Musella Wheatridge Oral Surgery Not Needed 7760 W. #38th. Ave., Ste 102 303-421-4010 Wheat Ridge General Dentist None Dr. Gregory E. Micheli Dental Associates At Eagles Nest ADP #196 150 Morning Sun Dr. 719-687-2000 Woodland d Park General l Dentist t *, C, E1-2, E3-4 Dr. Eric T. Helland Dental Associates At Eagles Nest ADP #196 150 Morning Sun Dr. 719-687-2000 Woodland Park General Dentist *, C, E1-2, E3-4 Orthodontists Dr. James H. Mason Colo Orthodontics Not Needed 6390 Gardenia St., #200 303-421-2616 Arvada Orthodontist N/A Dr. Galen L. Callender Galen L. Callender Not Needed 7207 Grandview Ave. 303-421-1984 Arvada Orthodontist N/A Dr. John Bailey Colo Orthodontics Not Needed 2993 S. Peoria St., #260 303-751-5700 Aurora Orthodontist N/A Dr. James H. Mason Colo Orthodontics Not Needed 2993 S. Peoria St., #260 303-751-5700 Aurora Orthodontist N/A Dr. Jack E. Duran Dr. Jack E. Duran Not Needed 13701 E. Mississippi Ave., # 360 303-789-9257 Aurora Orthodontist N/A Dr. Roy M. Lorenz Roy M. Lorenz, DMD, MS Not Needed 14991 E. Hampden Ave. #320 303-690-2333 Aurora Orthodontist N/A Page 8 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES Dr. John Walker Dr. John Walker Not Needed 350 Broadway #120 303-494-3535 Boulder Orthodontist N/A Dr. David E. Gold David E. Gold Jr. Not Needed 9025 E. Mineral Cir. #100 303-792-0345 Centennial Orthodontist N/A Dr. David Schroeder Apple Orthodontics Not Needed 1694 E. Cheyenne Mtn. Blvd. 719-538-4671 Colorado Springs Orthodontist N/A Dr. Louis Talmoumis Apple Orthodontics Not Needed 1694 E. Cheyenne Mtn. Blvd. 719-538-4671 Colorado Springs Orthodontist N/A Dr. Scott Suter Front Range Ortho Not Needed 3100 N. Academy Blvd., #200 719-550-0222 Colorado Springs Orthodontist N/A Dr. Voytek Bobak Dr. Voytek Bobak Not Needed 26697 Pleasant Park Rd., #b-120 303-816-5239 Conifer Orthodontist N/A Dr. Andrey Nazarov Allegro Orthodontics Not Needed 9450 E. Mississippi Ave. #a 303-751-0031 Denver Orthodontist N/A Dr. Damon C. Wilkerson Clear Choice Orthodontics Not Needed 2617 E. 3rd Ave. 303-225-0525 Denver Orthodontist N/A Dr. Michael D. Bellon Dr. Michael D. Bellon Not Needed 7200 E. Hampden, #203 303-692-9610 Denver Orthodontist N/A Dr. Eunice P. Lee Hampden Family Dentistry $ Orthodontics Not Needed 9250 E. Hampden Ave. 303-930-8828 Denver Orthodontist N/A Dr. Jack E. Duran Orthodontics Exlusively Not Needed 3601 S. Clarkson 303-789-9257 Englewood Orthodontist N/A Dr. T. Allan Hymas Mesa Orthodontics Not Needed 1190 Bookcliff, Ave., Ste. 202 970-245-8810 Grand Junction Orthodontist N/A Dr. Gary Barth Dr. Gary Barth Not Needed 1640 25th St. #a 970-353-4249 Greeley Orthodontist N/A Dr. David Richter Richter Orthodontics Not Needed 1813 61st Ave. 970-392-1733 Greeley Orthodontist N/A Dr. Shawn Murray Skyview Orthodontics Not Needed 1825 56th Ave. #a 970-330-5363 Greeley Orthodontist N/A Dr. Bradley E. Goings Skyview Orthodontics Not Needed 1825 56th Ave. #a 970-330-5363 Greeley Orthodontist N/A Dr. Paul A. Hamersky Douglas County Orthodontics Not Needed 4185 E. Wildcat Reserve Pkwy #300 720-344-2662 Highlands Ranch Orthodontist N/A Dr. Bryan Nelson Dr. Bryan Nelson Not Needed 9567 S.University Blvd., #c-1a 720-344-2662 Highlands Ranch Orthodontist N/A Dr. Paul Rocke Dr. Paul Rocke Not Needed 200 W. County Line Rd. #340 303-730-7002 Highlands Ranch Orthodontist N/A Dr. Shawn M. Murray Murray Orthodontics Not Needed 257 Johnstown Center Dr. #201 970-587-5228 Johnstown Orthodontist N/A Dr. Howard Stringert Dr. Howard Stringert Not Needed 313 W. 3rd St., #104 719-384-5583 La Junta Orthodontist N/A Dr. Jack Allen Jr. Dr. Jack M. Allen D.D.S. Not Needed 7373 W. Jefferson Ave. #302 303-988-9220 Lakewood Orthodontist N/A Dr. Voytek Bobak Dr. Voytek Bobak Not Needed 1840 S. Wadsworth Blvd. 303-988-0844 Lakewood Orthodontist N/A Dr. Michael D. Bellon Dr. Michael D. Bellon Not Needed 7325 S. Pierce St., #204 303-933-6830 Littleton Orthodontist N/A Dr. Paul Rocke Front Range Orthodontic Not Needed 200 West County Line Rd., #340 303-730-7002 Littleton Orthodontist N/A Dr. Amir R. Fereydouni Kids And Family Dentistry Not Needed 40 W. Littleton Blvd. 303-327-4091 Littleton Orthodontist N/A Dr. Kurt Niepraschk Niepraschk Orthodontics Not Needed 9878 W. Belleview Ave. 303-978-1316 Littleton Orthodontist N/A Dr. Eunice P. Lee Southpark Orthodontics Not Needed 8199 South Park Lane #150 303-738-8828 Littleton Orthodontist N/A Dr. Fazila Durkin Durkin Orthodontics Not Needed 7430 Park Meadows Dr. 303-799-8882 Lone Tree Orthodontist N/A Dr. Jonathan Weinbach Smile Zone Orthodontics Not Needed 1075 S. Boulder Rd., #235 303-604-0300 Louisville Orthodontist N/A Dr. Shawn Murray Skyview Orthodontics Not Needed 2555 E. 13th St. #-215 970-667-4245 Loveland Orthodontist N/A Dr. Bradley E. Goings Skyview Orthodontics Not Needed 2555 E. 13th St. #-215 970-667-4245 Loveland Orthodontist N/A Dr. Andrey Nazarov Allegro Orthodontics Not Needed 10450 S. Progress Way #100 720-842-4544 Parker Orthodontist N/A Dr. Howard Stringert Dr. Howard Stringert Not Needed 3955 Sandelwood Lane 719-564-3333 Pueblo Orthodontist N/A Dr. James H. Mason Colo Orthodontics Not Needed 3984 E. 120th Ave. 303-428-8800 Thornton Orthodontist N/A Dr. James H. Mason Colo Orthodontics ti Not Needed d 901 E. 120th Ave. #e 303-428-8800 8800 Thornton Orthodontist Oth ti t N/A Dr. John Bailey Colo Orthodontics Not Needed 3984 E. 120th Ave. 303-428-8800 Thornton Orthodontist N/A Dr. John Bailey Colo Orthodontics Not Needed 901 E. 120th Ave. #e 303-428-8800 Thornton Orthodontist N/A Dr. Eunice P. Lee Kids And Family Dentistry And Orthodontics Not Needed 2300 E. 120th Ave. #-104 303-254-8828 Thornton Orthodontist N/A Dr. Colin Gibson 1st Impressions Orthodontics Not Needed 1333 W. 120th Ave. #303 303-452-2277 Westminster Orthodontist N/A Dr. Jonathan Weinbach Smile Zone Orthodontics Not Needed 9910 Wadsworth Pkwy. 303-430-4200 Westminster Orthodontist N/A Dr. David Richter Richter Orthodontics Not Needed 1218 W. Ash St. 970-392-1744 Windsor Orthodontist N/A Page 9 of 10

Alpha and Choice Dental Plan including Orthodontists 10/28/2010 NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES bottom page General Provisions: Code Definitions: All needed specialty care (except Orthodontics) that cannot be provided by your selected General Dentist can be provided by a plan participating specialist. These specialists have been contracted to offer plan members up to a 20% discount off of their normal full fee. You may see any of the contracted plan specialists as the needed without contacting your selected General Dentist. Call us at 303-744-3007 or 1800-807-0706 for a list of plan participating specialists or visit our web site at www.betadental.com. Orthodontic treatment discounts are listed on your plan schedule of benefits. All family members must see the same General Dentist for treatment. You may change your General Dentist selection at any time by contacting us at 303-744-3007 or 1800-807-0706. * - This office provides nitrous oxide. C - This office accepts most children over the age of 4 for routine care. Please check with your selected dental office for their specific guidelines. E1-2 - This office will provide most 1 and 2 canal root canal procedures depending on the complexity of the situation. E3-4 - This office will provide most 3 and 4 canal root canal procedures depending on the complexity of the situation. Some large dental offices with multiple locations list all contracted providers from all locations combined. They do this because some of the providers float between offices as needed. Please contact the dental office for the specific providers at that location. N - This office will only see members that are identified on the eligibility roster provided by the plan administrative office at the beginning of each month. ** - Estos consultorios tienen personal de habla hispana. Page 10 of 10

OPTION #3 DENTAL INSURANCE PLAN To locate a Delta provider please visit: www.betadental.com and click on the Provider Locator link the quick links box. Then go to the Delta logo and click. Select either PPO or Premier, enter your zip code and search parameters, and then click search for a dentist. Benefits provided by:

Plan A - Delta Dental Calendar Year Deductible $25 Deductible applies to Basic and Major services. Family deductible amount is three times the individual deductible. Annual Maximum Benefit $1,000 Per member, per calendar year. Prevention First (for PPO dentists) Included Diagnostic and Preventive services from PPO dentist do not count against annual maximum benefit. Dependent Age for Dental Benefits Age 26 Orthodontics Included? Optional If included: 50% coverage to age 19;; 12-month waiting period Orthodontic Lifetime Maximum $1,000 if included Network Delta Dental PPO Dentist Delta Dental Premier Dentist Non-Participating Dentist Benefit Limitations Diagnostic & Preventive Services Oral Exams and Cleanings 100% 80% 80% Once each in a 6-month period Sealants 100% 80% 80% Once per tooth for permanent molars in children through age 14 in a 36-month period Bitewing 100% 80% 80% Once in a 12-month period Full Mouth X-Rays 100% 80% 80% Once in a 60-month period Fluoride 100% 80% 80% Once in a 12-month period, through age 15 Space Maintainers 100% 80% 80% Children through age 13 Basic Services Fillings 80% 80% 80% Once per tooth in a 24-month period, composite (white) fillings on front teeth only Simple Extractions 80% 80% 80% Major Services (12-month waiting period applies) Oral Surgery 50% 50% 50% Implants, Crowns (restorative phase) 50% 50% 50% Once per tooth in a 84-month period Dentures, Bridges 50% 50% 50% Only a benefit to replace a functioning, natural tooth that was extracted while the patient was covered under this plan Endodontics/Periodontics 50% 50% 50% Under the Delta Dental PPO plan, you may visit the dentist of your choice. There are three levels of dentists to choose from. PPO Dentist - Payment is based on the PPO dentist's allowable fee, or the actual fee charged, whichever is less. Premier Dentist - Payment is based on the PPO dentist's allowable fee, or the actual fee charged, whichever is less. Members are responsible for the difference between the PPO dentist's allowable fee and the Premier Maximum Plan Allowance fee. Non-Participating Dentist - Payment is based on the PPO dentist's allowable fee, or the actual fee charged, whichever is less. Members are responsible for the difference between the PPO dentist's allowable fee and the full fee charged by the dentist. You will receive the best benefit by choosing a PPO dentist. Enrollment type for these plans is Open Enrollment. Members can add dental coverage once per year. Benefit waiting periods apply, regardless of enrollment type. This is a brief description of services covered under your dental plan. Please refer to the Employee Benefit Booklet for full plan details. If differences exist between this summary and the Employee Benefit Booklet, the Employee Benefit Booklet will govern.

Delta Dental Premier, PPO Limitations and Exclusions - for Beta Health Plans The following is a brief summary of the benefit limitations and exclusions for the dental plan(s) quoted. Please refer to your dental contract for a complete list. Limitations on Type I Oral examinations and cleanings - once in any 6-month period Topical fluoride - once in 12 months under age 16. Bitewing x-rays once per 12 months. Sealants - once per tooth in any 36 consecutive month period under age 15. Full mouth x-rays - once per 60 months. Limitations on Type II Amalgam fillings - once per 24-month period. Limitations on Type IIIA Surgical Periodontic Services - once in any 36 month period. Non-Surgical Periodontic Services - once in any 24 month period. Periodontal cleanings are included in the cleaning limitations shown above. Reline or Rebase of a prosthodontic appliance will be once in any 36 month period. Limitations on Type IIIB Benefit for placement of Crowns and Onlays will not be provided more than once in any 84-month period involving restorations of the same tooth. Allowance for Crowns, Inlays, and Onlays posterior to the first molar will be limited to the allowance for a full metal restoration. The patient will be responsible for the portion of the Dentist's fee in excess of the Delta Dental allowance. Initial placement of full or partial Dentures is only a benefit to replace a natural tooth that was extracted while the patient was covered under this contract. Benefit for replacement is once per 60-month period if it cannot be repaired or made serviceab Initial placement of fixed bridges is only a benefit to replace a natural tooth that was extracted while the patient was covered under this contract. Benefit for replacement is once per 84-month period if it is not serviceable, and cannot be repaired. Limitations on Orthodontic Benefits (if covered) Replacement or repair of appliances is not covered. Orthodontic care provided in the treatment of periodontal cases or cases involving treatment or repositioning of the temporomandibular joint or related conditions is not covered. Periodic Orthodontic payments will end upon termination of treatment for any reason prior to completion of the case, or upon termination of the Covered Person s eligibility. For an Orthodontic treatment plan started prior to the eligibility date of the patient, Delta Dental will begin periodic payments with the first payment due following the patient eligibility date. The maximum benefit will be determined based upon the prio EXCLUSIONS The following Services are not Benefits: Any Covered Service Started when the person was not eligible for such Service under this Contract. Services for treatment of congenital (present at birth) or developmental (following birth) malformations, except intraoral dental Services for treatment of a condition which is related to, or developed as a result of, cleft lip and/or cleft palate. Services for cosmetic reasons. Services for restoring tooth structure lost from wear, erosion, attrition, abrasion or abfraction. Services related to protecting, altering, correcting, stabilizing, rebuilding or maintaining teeth due to improper alignment, occlusion or contour. Services related to periodontal stabilization of teeth. Habit appliances, night guards, occlusal guards, athletic mouth guards and gnathological (jaw function) Services, bite registration or analysis, or any related Services Charges for prescription drugs. Hospital costs and any additional fees charged by the Dentist or hospital for hospital services or visits, or charges for use of any facility. Any anesthesia service not specifically included in Covered Services. Orthodontic Services unless shown as covered on the Summary of Dental Plan Benefits. Myofunctional therapy or speech therapy. Services for the treatment of any disturbances of the temporomandibular joint (TMJ), facial pain or any related conditions. Oral hygiene instructions or dietary instructions. Replacement of lost, stolen or damaged appliances. Repair of appliances altered by someone other than a Dentist. Any Services including any associated Services or procedures not specifically included in Covered Services. Services for which charges would not have been made if this coverage had not existed, except for Services as provided under Medicaid.

Check out these Free National Discount Programs! All employees and dependents enrolling in one of the attached dental plans can use any of the attached programs free of charge. It is our thanks to you for using Beta Health as your dental provider! Simply follow the instructions on the attached discount program description sheets.it s that easy. You can photocopy these items and distribute to all of your dependents as well. If you have questions, please call Beta Health at 303-744- 3007 or 1-800-807-0706.

Introducing Discount Services for Dental Plan Members Free of Charge The Vision Discount Plan Beta Health Association, Inc. has teamed up with EyeMed Vision Care to offer easy access to over 43,000 national, conveniently located vision care providers including optometrists, ophthalmologists, opticians and many leading optical retailers, such as LensCrafters, Target Optical, and most Sears Optical and Pearl Vision locations. This benefit is free of charge for Beta Health Dental Plan members. Note that this is not insurance, only a discount plan to save you and your family members $ as needed! Vision Care Services Exam with Dilation (as necessary) Contact Lens Fit and Follow-up Standard Premium In Network Only $5 off exam $10 off exam $10 off exam Frames When a complete pair of glasses is purchased (frame, lenses and lens options purchased in the same transaction) a 35% discount will apply.* Standard Plastic Lenses Member Pays Single Vision $50 Bifocal $70 Trifocal $105 Lens Options Member Pays UV Coating $15 Tint (Solid and Gradient) $15 Standard Scratch Resistant Coating $15 Standard Polycarbonate $40 Standard Anti-Reflective Coating $45 Standard Progressive (Add-on to Bifocal) $65 Other Add-ons and Services 20% off retail Contact Lens Materials (Discount applied to materials only) Conventional 15% off retail price Disposable no discount Laser Vision Correction** Lasik or PRK Frequency Examination Frame Lenses or Contact Lenses 15% off retail price or 5% promotional price Unlimited Unlimited Unlimited * Items purchased separately will be discounted 20% off of the retail price. ** Since Lasik or PRK vision correction is an elective procedure, performed by specially trained providers, this discount may not always be available from a provider in your immediate location. For a location near you and the discount authorization, please call 1-877-5LASER6.

Introducing Discount Services for Dental Plan Members Free of Charge The Hearing Discount Plan This hearing care program combines unlimited choices with quality and value. It s provided free of charge to all employees and family members enrolled in a Beta Health Association, Inc. dental plan. Beta Health and EPIC Hearing Health Care give you easy access to a large national network of thousands of hearing care professionals primarily physicians and audiologists who can help you achieve your maximum hearing potential throughout your life. The prices you get from EPIC may be as much as 50% below the manufacturer s suggested retail price and up to 35% lower than most discount offers. EPIC can coordinate the coverage with your existing healthcare plan. Note that this is not insurance, only a discount plan to save you and your family members $ as needed! To activate your hearing discount plan, call EPIC Hearing Health at 1-866-956-5400. EPIC will send you a card with all the information you need to access your benefits, including referrals to providers near you and activation forms to access them. Tell them that you are a Beta Health member and you will be connected to a personal EPIC phone contact who can answer any questions you may have. A booklet that outlines the plan benefits (as well as pricing) will be mailed to your home. Then you will follow through with an appointment, examination and treatment. All payments should be made to EPIC HSP. No other billing or payments should occur. Contact EPIC at any time for assistance, advice and information. Check out these benefits and savings! The hearing discount plan benefits and savings are: Hearing tests Hearing aids, aid cleaning supplies, accessories and batteries Ear protection, swim and musician earplugs Assistive listening devices TV ears (amplifies and clarifies television) Alerting and signaling devices The Prescription Drug Discount Plan Do you want to SAVE an average of 10% to 85% on the cost of prescription medications? With the HealthTrans nationwide national discount prescription drug program this is easy! It s simply a great way to save money on prescription drugs! After working closely with pharmacies and drug manufacturers, HealthTrans has negotiated lower prices for thousands of medications, and have passed these savings on to all Beta Health Association members and their families. The average discounts range from up to 16% on brand name and up to 55% on generic drugs. There are no limits on quantities and no paperwork to complete. Discounts are available at over 55,000 pharmacies nationwide and are also available to the entire family on an as needed basis! To use your HealthTrans discount drug card: 1.) Write in your specific member I.D. number on the member I.D. cards (attached) for use at the pharmacy. 2.) Take your card and prescription(s) to a participating pharmacy. Pharmacy locations can be found at the web site below. 3.) Pay the pharmacy the negotiated reduced discount! Note that this is not insurance, only a discount plan to save you and your family members $ as needed! See how much you can save today by going to http://cashcard.lc.healthtrans.com

Thank you for choosing Beta Health Association, Inc. as your dental partner. We are proud to offer you, free of charge, the EyeMed Vision Discount Plan, the Epic Hearing Health Plan and the HealthTrans Prescription Discount Plan. Please use the ID cards provided below to access these Free of Charge benefits. Follow all instructions as identified on each set of cards. We appreciate our relationship! EyeMed Group Number: 9235409 Group Name: Beta Health Association, Inc. Member Name: EyeMed Group Number: 9235409 Group Name: Beta Health Association, Inc. Member Name: Call 1-866-723-0596 to locate the nearest EyeMed Provider. This is a discount program and not insurance. Call 1-866-723-0596 to locate the nearest EyeMed Provider. This is a discount program and not insurance. Epic Hearing: Call 1-866-956-5400 for ID card information. Group Name: Beta Health Association, Inc. Member Name: Epic Hearing: Call 1-866-956-5400 for ID card information. Group Name: Beta Health Association, Inc. Member Name: This is a discount program and not insurance. This is a discount program and not insurance. BIN #: 011867 Group ID: DDS01 Member ID: Please enter your initials & the last four digits of your phone #) Member Name: This is a discount program and not insurance. Visit http://cashcard.lc.healthtrans.com for more information or call 877-459-8474. BIN #: 011867 Group ID: DDS01 Member ID: Please enter your initials & the last four digits of your phone #) Member Name: This is a discount program and not insurance. Visit http://cashcard.lc.healthtrans.com for more information or call 877-459-8474.

COMBINED DENTAL EMPLOYEE ENROLLMENT FORM Please complete the form following this page and submit to personnel at your earliest convenience. Note that since this is an annual open enrollment, all employees must either enroll or waive for the next year. A REMINDER! You will not be allowed to enroll in any plans again until this time next year.