Page 69 - APPENDICES for Stephen Spero
P. 69
PREVENTIVE DENTAL
Oral exam
$0 copay
Limits apply
Cleaning
$0 copay
Limits apply
Fluoride treatment
$0 copay
Limits apply
Dental x-rays
$0 copay
Limits apply
COMPREHENSIVE DENTAL
Non-routine services
$0 copay
Limits apply
Diagnostic services
$0 copay
Limits apply
Restorative services
$0 copay
Limits apply
Endodontics
$0 copay
