PLAN Tooth Existing ADA* Office Pt. Pays ADA* Office Patient Pays ADA Patient Pays ADA* No. Condition Code Description UCR**-A Plan Copay-B Code Description C (C … ...
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Code Description Member Copayment Diagnostic Services Office Visit (includes infection control) $5.00 D0120 Periodic oral evaluation $0.00 D0140 Limited oral ... ...
Bradley A. Blair, DDS Comprehensive Dentistry—Esthetic, Restorative & Preventive 1101 Norton Rd, Galloway, Ohio 43119 614-878-8303 e-mail: bblairdds@rrohio.com ...
GC-DENT-FP-CA (2002) DPA (2006) Dear Insured: Thank you for choosing Kaiser Permanente Insurance Company’s (KPIC) Dental Assistance Insurance ...
OPTIONAL DENTAL, VISION AND HEARING BENEFITS COVERAGE OPTIONAL DENTAL, VISION AND HEARING BENEFITS COVERAGE At SecureHorizons® we … ...
Ca p D e n t N Y Broadest Managed Care Network in the New York Metropolitan Area Group & Individual Plans B-3290-NY Print 1/13 Rev 2/12 GCDIY / GCDCY ...
Los Angeles Tenth District PTSA Gloria Gomez-DentalReferral Coordinator: (213) 745-7066 Phone # for Nurses: (213) 249-8271 RESOURCE FOR LOW-COSTAND FREE DENTAL ... ...
