Dental Savings Plan
Benefit Premium:
| Plan | Total Annual Cost |
|---|---|
| Adult (12 & above) | $350.00 |
| Child (ages 2-11) | $299.00 |
Membership includes:
Diagnostic & X-rays
- Comprehensive Exam (new patients, initial visit) ------ 100%
- Periodic Exam (1 per year) (child under age of 18 2 per year) ------ 100%
- Limited Oral Exam problem focused (1 per year) ------ 100%
- Complete Series or Panorex (1 every 3-5years) ------ 100%
- Periapical, First Film ------ 100%
- Periapical, Additional Film ------ 100%
- Bitewings (1 time per year) ------ 100%
Preventive
- Child Prophylaxis (cleaning)(2 per year) ------ 100%
- Adult Prophylaxis (cleaning)(2 per year) ------ 100%
- Additional cleanings per year ------ 20%
- Fluoride (2 per year, no age limit, no copay) ------ 100%
- Sealants ------ 20%
All Other Procedures
- Bleaching (does not include whitening trays) ------ $325
- Fillings & Build-ups ------ 20%
- Crowns ------ 15%
- Veneers ------ 15%
- Periodontics ------ 15%
- Dentures and Partials ------ 15%
- Oral Surgery ------ 20%
- Root Canals ------ 20%
- Implants ------ 15%
- Periodontal (Deep) Cleanings ------ 15%
- Specialty Services* % discount off of Ivory Dental standard fees ------ 15%
Membership Plan Details
- Cannot be used in conjunction with another dental/ insurance plan
- NON-REFUNDABLE
- No refunds or premiums will be issued at any time if participant decides not to utilize dental plan
- Patient’s portion of any bill is due on the same day as service
- Plan will auto-renew on enrollment anniversary
- The plan is in effect once the premiums are paid in full
- Patients are responsible to schedule preventive cleanings and exams
- Credit card only, cannot use cash or check
