• Orthodontists - braces
• Periodontists - gums
• Oral Surgeons - wisdom tooth or major extractions
• Prosthodontists - bridges and dentures
• Pediatric Dentists - child treatment
• Endodontist - extensive root canals

• Your welcome letter and membership cards
• A complete fee schedule with discounted fees on nearly every dental procedures
• Instructions and tips for maximizing your savings
• Support and contact documentation

Special Notes:
There are no maximum benefits per year.
Routine cleanings include polishing and light coronal scaling, above gumline.
Dentist will explain level of calc/tartar deposits (possible periodontal problems).
Initial cleaning may be considered a difficult cleaning.
Payment is due at time of service. Office may require deposit prior to rendering services.
A fee will be charged for broken appointments w/o 24 hour notice.
All materials used are ADA approved.
Dentist may charge a higher fee for higher quality materials used.
Consult a participating Specialist for services not performed by a general dentist.
Dentist assumes full responsibility for all dental services provided to member.
Standards of Care suggest clinical exam, x-rays, diagnosis and treatment plan.
Some dentists may require a more extensive initial diagnosis which may includepano x-rays & perio charting.
This fee schedule effective September '06

ORTHODONTIC BENEFITS
Phase One: Interceptive Orthodontic Treatment
20% Discount off usual and customary charges.
Phase Two: Eruption of Permanent Teeth (pre & post)
$2895 for Class 1. adolescent only. 24 months of treatment (includes study models & records fee).Class 2,3,4, adult, surgical, or more complex cases will receive 20% discount off usual and customary charges.

The total costs of orthodontic services are based on the complexity and time involved moving the teeth.

Limitations
1. No benefits are available if orthodontic treatment began prior to membership in American Dental Plan.
2. Additional fees may be charged by the doctor for:
a. Surgical procedures and/or extraction cases
b. Care in excess of 24 months
c. Gold, ceramic or designer appliances
d. Broken metal bands
e. Complications occurring during treatment
3. If Membership expires before completion of treatment, member is responsible for usual and customary fees.
4. Choice of Orthodontists is limited to a list of participating orthodontists. Please refer to current listings.
5. No benefits qualify for work done outside doctor's office.

Additional Fees
Retainers...............................$115 (per arch)
Missed Appointments...............(ask receptionist)
All other orthodontic services.........20% discount

General Plan Information
American Dental Plan has quick activation, no health restrictions, no paperwork hassles, and there are no annual limits. Eligible dependents include children under 19 years of age or full-time students up to 23 years of age. Mentally or physically challenged children, living with parents, will continue as dependents indefinitely.

American Dental Plan promotes early detection and ongoing maintenance. Most dentists recommend a checkup twice every year. Members agree to hold American Dental Plan harmless from services performed by all participating dentists. Member is responsible for all payments to dentists. Members agree to all terms of membership. (Additional terms provided upon request).

You are entitled to choose any participating dentist on the ADP plan.   Dental offices are located throughout Arizona.  The dental provider listings on DentalPlans.com are provided directly from each dental network or dental plan, who are responsible for its accuracy and completeness. These listings are updated on a monthly basis, and every effort has been made to ensure that only participating active providers are listed. We strongly recommend that you confirm that a provider is currently participating before you receive any services from that provider. Please see Member's Agreement for more details.