Transcription of Restorative (Crowns-Single Restorations) - General …
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Restorative (Crowns-Single Restorations) - General …
Dental Source of MO & KS, Inc (866) 481-9473 SourceDental Health Care PlansSchedule of Benefits plan EThe American Dental Association (ADA) assigns code numbers toeach dental service. The Schedule of Services below providesyou with an easy reference to the coverage associated with theDental Source Program. All co payments are paid directly to yourselected participating General dentist and are due at the time ofservice. All dental services listed in this schedule are providedexclusivelyby Dental Source network General dentists. There isno coverage outside of the Dental Source network. If the servicesof a Specialist are required, the member will receive a 20%discount off the usual fees from a participating Specialist, and Preventive General Dentists Office**Consultation.
Dental Source of MO & KS, Inc (866) 481-9473 www.densource.com PlanEBen.1/08 Dental Source Dental Health Care Plans Schedule of Benefits – Plan E
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