Page 51 - APPENDICES for Stephen Spero
P. 51
PREVENTIVE DENTAL
Oral exam
$0 copay
Limits apply
Cleaning
$0 copay
Limits apply
Fluoride treatment
Not covered
Dental x-rays
Not covered
COMPREHENSIVE DENTAL
Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
