Signature Savings Plan

• NO yearly maximums
• NO deductibles
• NO claim forms
• NO pre-authorization requirements
• NO health questions

• NO pre-existing condition limitations
• NO one will be denied coverage
• NO waiting periods – immediate eligibility
• FREE consultations

There are several plans available to meet your needs:

Single Plan – $349/year

Benefits of this plan include:

• 1 comprehensive exam
• 1 annual exam
• 1 emergency exam (to be used at any time during the year)
• 2 dental cleanings (non-periodontal)
• 2 oral cancer screenings
• 2 fluoride tooth desensitizing treatments
• 4 bitewing X-rays

Parent/Child or Husband/Wife Only -$629/year

Benefits of this plan include:

• 2 comprehensive exams
• 2 annual exams
• 2 emergency exams (to be used at any time during the year)
• 4 dental cleanings (non-periodontal)
• 4 oral cancer screenings
• 4 fluoride tooth desensitizing treatments
• 8 bitewing X-rays

Family Plan of 3 – $879/year

Family Members and Children under 18

Benefits of this plan include:

• 3 comprehensive exams
• 3 annual exams
• 3 emergency exams (to be used at any time during the year)
• 6 dental cleanings (non-periodontal)
• 6 oral cancer screenings
• 6 fluoride tooth desensitizing treatments
• 12 bitewing X-rays

Family Plan of 4 – $1089/year

Family Members and Children under 18

Benefits of this plan include:

• 4 comprehensive exams
• 4 annual exams
• 4 emergency exams (to be used at any time during the year)
• 8 dental cleanings (non-periodontal)
• 8 oral cancer screenings
• 8 fluoride tooth desensitizing treatments
• 16 bitewing X-rays

*You will not have rate increases or cancellation fees. You will not receive a membership card. Your plans’ effective date will be on file with our office.

Diagnostics and X-Rays

• Comprehensive Exam (new patient/initial visit) – 100%
• 1 Annual Exam (children under 18 = 2 per year) – 100%
• 1 Emergency Exam (problem focused, 1 per year) – 100%
• 4 Bitewing X-Rays (1 per year) – 100%
• Periapical, First Film – 100%
• Periapical, Each Additional Film – 100%
• Complete Series X-rays or Panorex – 50%

Preventive Care

• Child Cleaning (2 per year) – 100%
• Adult Cleaning* (2 per year) – 100%
• Additional cleanings per year – 20%
• Oral Cancer Screenings (2 per year) – 100%
• Dental Sealants – 20%*Pending periodontal evaluation. Maintenance cleanings only. Some patients may require scaling and root planing treatment first.

All Other Procedures

• Fillings and core buildup – 20%
• Oral Surgery/Extractions – 20%
• Scaling and Root Planing – 15%
• Root Canal Treatment – 20%
• Crowns – 15%
• Veneers – 15%
• Dentures and Partials – 15%
• Implants – 15%
• Periodontics – 15%

Program Policies, Exclusions & Limitations

This program is a discount plan, not a dental insurance plan. This plan is only honored at Signature Smiles Dentistry locations and cannot be used at any other dental office.

Our Dental Savings Plan cannot be used:

• In conjunction with other dental plans, promotional offers or dental insurance
• For treatment in which the sole opinion of our doctors lies outside their scope
• For referrals to specialists
• For hospitalization or hospital charges of any kind.
• For costs of dental care which are covered under automobile medical
• For services of injuries covered under workers’ compensation

Patients who sign up for Signature Smiles Dentistry’s Dental Savings Plan agree that the fees stated must be paid at the time services are rendered. Any services not paid for at the time of service will be billed as usual and customary fees. Plan fees are valid only when paid at the time of enrollment. All family members must reside in the same household. No refunds of premiums will be issued at any time if the participant decides not to utilize their dental plan. Savings plan is non-refundable.

For more information, please contact one of our friendly front desk team at 281-333-3406.