Comprehensive Exam (new patient, initial visit) Periodic Exam (2 per year) Limited Oral Exam (problem focused (1 per year) Complete Series & Panorex (1 every 5 years) Periapical, First film Periapical, Each additional film Bitewings (2 per year)
Child Prophylaxis (cleaning) (2 per year) Adult Prophylaxis (cleaning) (2 per year) Additional cleanings per year - Discounted Fluoride (2 per year, no age limit) Sealants (No age limit)
NO yearly maximums NO deductibles NO claim forms NO pre-authorization NO pre-existing condition limitations IMMEDIATE eligibility (NO waiting) FREE consultations
Plan
Total Annual Cost
Single
$ 269.00
Double*
$ 499.00
Family (3)**
$ 687.00
Family (4)**
$ 898.00
Additional members
$ 129.00/each
*The Double Plan is for Parent/Child or Husband/Wife only.
**The family plan includes family members and children who are enrolled full time in college until the age of 23 or children who are not enrolled full time in college until the age of 18.
Program Limitations & Exclusions
This program is a discount plan, NOT a dental insurance plan. It cannot be used:
In conjunction with another dental plan.
For services for injuries covered under workman's compensation, automobile, medical or homeowners insurance.
For treatment, which, in sole opinion of the treating dentist or doctor, lies outside the realm of their capability.
For referrals to specialists.
For hospitalization or hospital charges of any kind.
Plan is subject to change upon renewal.
There is a $ 50.00 charge for broken appointments that are not cancelled within 48 hours.
THIS PLAN IS ONLY HONORED AT TYRER DENTAL CARE.
Program Guidelines
Payment for savings plan must be paid before services are rendered.
Premiums are non-refundable.
No refunds will be given if participant decides not to utilize the dental savings program.
There is a charge for broken appointments that are not cancelled within 48 hours.
There will be a reinstatement fee if your plan lapses.
Patient’s portion of bill is due at time of service.