Page 83 - Appendices to Donald Pender's Evaluation
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PART B DRUGS
These are drugs you usually get at a doctor's o ce or hospital outpatient setting, like the u shot,
chemotherapy, or other shots.
Chemotherapy drugs 20% coinsurance Limits apply
Other Part B drugs 20% coinsurance Limits apply
Extra bene ts
HEARING
Hearing exam $0 copay Limits apply
Fitting/evaluation $0 copay Limits apply
Hearing aids - all types $449-699 copay Limits apply
PREVENTIVE DENTAL
Care to prevent or nd problems with your teeth and gums.
Oral exam $5-16 copay
Cleaning $20 copay Limits apply
Fluoride treatment $5 copay Limits apply
Dental x-rays $0-10 copay Limits apply
