Main        About        News        Jobs        Members        Groups        Dentists        Contact       

  Jackson Memorial Hospital
  Dental Members
  ADP Dental Option
ADP Plan Overview
ADP Standard Plan Schedule
ADP Enriched Plan Schedule
ADP Questions and
Answers (FAQs)
ADP Standard Plan Providers
ADP Enriched Plan Providers
  OHS Dental Option
OHS Plan Overview
OHS Standard Plan Schedule
OHS Enriched Plan Schedule
OHS Questions and
Answers (FAQs)
OHS Standard Plan Providers
OHS Enriched Plan Providers
 
  Optix Plan Overview
  How It Works
  Optix Schedule
  Optix Lasik Information
  Optix Vision Directory
  Optix Certificate
  HIPAA Notice
 
 
HIPAA Notice
Contact Information
 


ADP Standard Plan Schedule of Benefits1

The co-payments listed below are the maximum fees that will be charged by the Participating General Dentist for the specified covered services.

1Select a service below
 
Services
bulletAppointments
bulletDiagnostics
bulletX-Rays
bulletPreventive
bulletSpace Maintainers
bulletRestorative
bulletCrowns and Bridges
bulletEndodontics
bulletPeriodontics
bulletProsthodontics
bulletRepairs to Prosthetics
bulletExtractions
bulletOral Surgery
bulletAnesthesia
bulletAdjunctive General Service
bulletOrthodontics
 

 

Anesthesia Services
 
Procedure

Member
Pays

Local anesthesia No Charge
Nitrous oxide (per visit) $10.00/
30 min.


Exclusions and Limitations
The co-payments listed are the maximum fees that will be charged by the Participating General Dentist for the specified covered services.
 
Should you need a specialist (i.e., Endodontist, Orthodontist, Oral Surgeon, Periodontist, Prosthodontist, Pediatric Dentist), you may refer yourself to any Participating Specialist from our directory, Upon identifying yourself as an American Dental Plan member, you will receive a 25% reduction from usual and customary fees for services performed.
 
All procedures listed may not be performed by the Participating General Dentist. Therefore, you are encouraged to discuss availability of the scheduled services with your Participating General Dentist.
 
Specialist services are available only in areas where American Dental plan has a Participating Specialist.
 

 

 

Current Dental Terminology © 2004 American Dental Association. All rights reserved

 

To submit comments or questions, please visit our Contact Center.

© Copyright CompBenefits 2002.