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Willamette Dental Plan
July
1, 2008 - July 1, 2009 |
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Information provided is in summary
format. Any difference between the summary provided and
actual contract will be settled in favor of the contract.
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Deductible |
No Deductible |
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Preventive |
$15 copay
per visit, then covered
at 100%
(Routine and emergency exams, x-rays, teeth
cleaning, fluoride treatment, sealants, head
and neck cancer screening, oral hygiene
instruction, periodontal charting,
periodontal evaluation) |
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Basic |
$15 copay
per visit, then covered
at 100%
(Fillings, endodotics, periodontics, lab
fees, oral surgery, extractions, root
canals, root planing, local anesthesia) |
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Major |
$15 copay
per visit, then covered
at 100%
(Bridges, dentures, permanent crowns) |
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Annual
Maximum |
No Annual
Maximum |
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Orthodontia |
$1,500 Fee
$150 copay (fee credited towards ortho copay
if patient accepts treatment plan) |
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