In House Dental Benefits Plan

Membership in our In-House Dental Benefits Plan is available to all patients. After payment of an annual fee, members will receive the following:

  • 2 Regular Dental Check- ups:
    Exam, Digital X-rays (as necessary), Dental Cleaning, Oral Cancer Screening, Oral Hygiene Instruction, Periodontal Evaluation, TMJ screening
  • 2 Emergency Visits:
    Problem focused exam, and single x-ray (if necessary)
  • 25% Discount off the Usual and Customary fee (Standard fee/UCR)
    A treatment plan(s) will be provided in writing for recommended treatment and show the Standard fee/ UCR fee. (* If using outside financing then 20% off the Standard fee/UCR).

NO Waiting Periods
NO Claim Forms
NO Restriction on Treatment
NO Pre-determination necessary
No Age Limitations
Prices : Adult: $350/ yr, Child (under 12yrs old): $300/ yr

Coverage is in effect for one calendar year. Coverage begins when membership has been paid in full. Appointment times are limited, and it is the responsibility of the member to schedule appropriate visits.
By signing below, I have had the opportunity to ask questions and fully understand and accept the terms of this policy.

Patient Name:
Patient Signature/ Legal Guardian:
Effective Date:
to:

Membership in our In House Dental Benefits Plan is available to all our patients. After payment of an annual fee, members will receive the following:

  • 2 regular dental check-ups:
    Exam, Digital X rays (as) that is necessary, dental cleaning, oral cancer screening, oral hygiene instruction, periodontal evaluation and TMJ screening
  • 2 Emergency Dental Visits:
    Problem-focused exam and single x-ray if necessary
  • 25% discount off the customary and usual fee.

A treatment plan will be provided in writing for treatment that is recommended and show the standard fee/UCR fee (If using outside financing, then 20% off the standard fee/UCR fee).

  • NO waiting periods
  • NO claim forms
  • NO restriction on treatment
  • NO predetermination necessary
  • NO age limitations
  • Price: Adults $300/year kids under twelve: $250/year Coverage is in effect for one calendar year.

Coverage begins when membership has been paid in full. Appointment times are actually limited and it’s the duty of the member to schedule appropriate visits.