KEY BENEFITS
BENEFITS INCLUDE:
| Examination: | Coverage: |
|---|---|
| New Patient Comprehensive Exam | 100% |
| Periodic Exam (Two/Year) | 100% |
| Limited Exam (Emergency-One/Year) | 100% |
| Radiographs: | Coverage: |
|---|---|
| Full Mouth X-Rays (One/3 Years) Pano 6yrs-14yrs | 100% |
| Bitewings (One/Year) | 100% |
| Periapical (First Film + 2 Add'l/Year) | 100% |
| Preventitive: | Coverage: |
|---|---|
| Adult Prophylaxis (Two/Year) | 100% |
| Child Prophylaxis (Two/Year) | 100% |
| Fluoride for Children up to 18 yrs of age | 100% |
| Perio Maintenance (Four/Year) | 100% |
| On Periodontal Plan | |
| Conebeam(3D X-Ray) 15yrs and up (Free upgrade from a 2D x-ray at no additional charge.) | 50% |
| Sealants | 50% |
| Everything Else: | Coverage: |
|---|---|
| Periodontal Therapy | 15% |
| Fillings | 15% |
| Crowns, Bridges | 15% |
| Root Canals, Extractions | 15% |
| Dentures & Partials | 15% |
| Wisdom Teeth | 15% |
| Implants | 15% |
| Veneers | 15% |
| SureSmile Aligners | 15% |
TERMS & LIMITATIONS
- This is a dental discount plan and is not dental insurance. It cannot be combined with any other dental insurance.
- It is good only for Leavitt Dentistry. Therefore, if you are referred to a specialist, they will not offer this discount.
- This plan is non-transferrable- Family members cannot be substituted in for another family member.
- It is non-refundable – No refunds given if patient chooses not to use their dental plan.
- Rates are subject to change.
- Payments for services are due at the time of service. Any service not paid at the time of service will be billed at usual and customary fees.
- This offer cannot be combined with any other offers or used with insurance.
- Financing is limited to 3rd party 6 month promotions.
- SureSmile payments are half down and the remaining balance divided over treatment time.
- Dental services only, products are not included.
- Benefits apply for one calendar year from anniversary date.
- Membership must be paid in full to begin plan.
- Based on current fees when treatment is delivered.
- This is an automatic annual renewal plan. A written request is required at a minimum of 30 days prior to renewal to cancel.
- Should there be dental treatment needed following any type of injury where a lawsuit and therefore outside medical care, disability, or workman’s comp type insurances are involved, this discounted plan cannot be used.