AQUARIUS DENTAL
In-House Dental Plan for 2019
Examinations/Xrays/ cleanings
Includes your initial and six month recall prophy package of xrays, prophylaxis, exam and fluoride fully covered.
Everything Else
All minor treatments are given a 20% discount. Most major treatments are given a 15%. Major treatments include crowns, partials, dentures and anything over $500. 10% off Implants and orthodontic treatments.
- Periodontal Therapy/Scaling & Root Planning Procedures
- Fillings
- Crowns, Bridges
- Cosmetic Dentistry
- Root Canals
- Extractions
- Dentures & Partials
- Scaling and Root Planing (deep cleaning)
- Emergency exam
MEMBERSHIP DUES:
- Prices are figured at a yearly rate, and are as follows:
- Adult family member over 21 years old: $300.00 each
- Member under 21 years old: $ 250.00 each
BENEFITS OF MEMBERSHIP
- No preauthorization required
- No annual maximum. No deductible
- No waiting periods or pre-existing exclusions
- Cosmetic dentistry is included
- Free consults on orthodontic treatment and implants
TERMS AND LIMITATIONS OF THE PLAN:
Your effective date is the day you sign up and your renewal date is the same date every year.
Cleanings must be performed before the end coverage date. The cleaning included with the discount plan is the regular prophylaxis in the absence of gum disease. More serious conditions require deep cleanings with a 20% discount.
This is a dental discount plan and is NOT dental insurance. It cannot be combined with any other dental insurance
Co-payment is due at time of service for any work received
Rates are subject to change annually
Must remain a member during entire duration of orthodontic treatment
Membership dues are not refundable
Discount is only valid at Aquarius Dental
In House Dental Consent Form
Patient Name ______________
Date ____________
Signature _________