Dental Savings Plan
Individual
$299
Couple
$499
Children
$199
(Under 18 years old)
DIAGNOSTICS & X-RAYS
Comprehensive Exam ........100%
New patient initial visit
Periodic Exam .......100%
Twice annual
Emergency Exam......100%
Problem focus - unlimited
Intraoral X-rays...........100%
• Complete series or Panorex (1 every 3 years)
• Periapical first film
• Periapical each additional film
• Occlusal film
Bitewings................100%
PREVENTIVE CARE
Child Prophylaxis..................100%
Cleaning – twice annual
Adult Prophylaxis..................100%
Cleaning – twice annual
Fluoride..................50%
Sealants..................50%
OTHER PROCEDURES
Fillings ......................20%
Crowns ....................20%
Periodontics ...................20%
Deep cleanings (SRP), FMD
Implants ......................15%
Dentures & Partials ........10%
Root Canals.............20%
Oral Surgery ..............20%
Limited to extractions including 3rd molars
PLAN GUIDELINES
- Exclusive to LaBry Family Dentistry
- Premiums are due at time of enrollment and must be paid prior to scheduling treatment
- No refunds or premiums will be issued at any time if participant decides not to utilize dental plan
- Patient’s portion of the bill due the day of service, unless payment plans discussed prior to treatment
This is not a dental insurance plan. It cannot be used in conjunction with another dental plan or for service covered under workman’s compensation. This cannot be used for treatment which, in the sole opinion of the treating dentist, lies outside the realm of their capability. This plan cannot be used for referrals, hospitalizations, or hospital charges of any kind. It also cannot be used for cost of dental care which is covered under automobile medical.
