PREVENTIVE SERVICES

Member Discount

• Healthy Mouth Preventative Care Visit  100%
• Comprehensive Evaluation   100%
• Doctor Prescribed Radiographs   100%
• Sealants   $50 (permanent teeth only, no age limit)
• Fluoride  $30 (two per year, no age limit)

PERIODONTAL SERVICES

Member Discount

• Periodontal Gum Evaluation (one per year) 100%
• Periodontal Management (D4910) 3-4 per year 100%
• Active Gum Therapy
  – (per quadrant D4341)  $200
  – (1-3 teeth/quadrant D4342)  $125

15% off ADDITIONAL SERVICES

BENEFIT PREMIUMS

• Adult 18+   $399
• Child <18   $299
• Periodontal Program $200

Auto Renewal policy – 5% off

Sign up for auto-renewal of your discount plan and receive 5% off next year’s premium! Ask our front desk team members how to sign up for this great savings offer.

With your Dental Savings Plan there are:

• No yearly maximums
• No deductibles
• No claim forms
• No pre-authorization requirements
• No pre-existing condition limitations
• Immediate eligibility (no waiting periods)

Membership fees must be paid in full prior to receiving benefits. All co-payments must be paid at the time of service or the usual fees will apply.

May not be used in conjunction with Care Credit or Chase Health Advance third-party financing or special offers.

May not be used in conjunction with dental insurance plans. The plan is intended for those who do not have dental insurance. No refunds will be granted after the annual fee has been paid.

Offer is for one year of service from date of membership payment. Renewal rates may be subject to change. .

This plan is only honored at Northstar Family Dental

View our full Dental Savings Plan Brochure.