PURVI PATEL DDS P S DENTAL, INC.

2849 DULLES AVE
MISSOURI CITY, TX 77459

281-261-7721

Key Dental Plan Saves Members 20% to 60%

Description	Regular Cost*	Plan Cost**	Savings $	Savings %
Adult Cleaning	$118	$39	$79	67%
Child Cleaning	$83	$32	$51	62%
Routine Checkup	$69	$19	$50	73%
Four Bitewings X-rays	$80	$26	$54	67%
Composite (White) Filling Code	$188	$66	$122	65%
Crown (porcelain fused to high noble metal)	$1,332	$589	$743	56%
Complete Upper Denture	$1,911	$747	$1,164	61%
Molar Root Canal	$1,299	$508	$791	61%
Extraction (single tooth)	$221	$67	$154	70%

* Regular cost is based on the national average of the 80th percentile usual and customary rates as detailed in the 2014 FairHealth Report in the Los Angeles, Orlando, Chicago and New York City metropolitan statistical areas.
** These fees represent the average of the assigned Careington Care 500 Series fees in the Los Angeles, Orlando, Chicago and New York City metropolitan statistical areas.
Prices subject to change.

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Disclosures:
THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. THIS IS NOT A MEDICARE PRESCRIPTION DRUG PLAN.* The plan provides discounts at certain health care providers for medical services. The range of discounts will vary depending on the type of provider and service. The plan does not make payments directly to the providers of medical services. Plan members are obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount medical plan organization. You may access a list of participating health care providers on this website. Upon request the plan will make available a written list of participating health care providers. You have the right to cancel within the first 30 days after receipt of membership materials and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5, AR and TN resident will be refunded processing fee). Discount Medical Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034. This plan is not available in Vermont. This plan is not currently available in Washington. *Medicare statement applies to MD residents when pharmacy discounts are part of plan.

PURVI PATEL DDS P S DENTAL, INC.

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