Utah Dental Plan

We all need a financial break right now!

Our discount plan allows you and your family to receive quality dental services at Quarry Bend Dental at substantial savings. These savings are usually greater than those of the insurance companies because their plans have become outdated and coverage is very limited due to annual maximums and deductibles.

Better Than Insurance

Insurance

Outdated Annual Maximums
High Deductibles ($50-$100)
High Monthly Premiums
Restrictions/Pre-existing Conditions

Discount Plan

No Annual Maximums
No Deductibles
No Restrictions or Pre-existing Conditions

This is a dental discount plan that is available for dental discounts.

Mutually Beneficial

*YOU SAVE MONEY

*WE GROW OUR BUSINESS

We are willing to give you a substantial discount on our fees. In return, you help us grow into a very successful practice. We both benefit.

MISSION STATEMENT:

We are committed to do everything in our power to ensure that any procedure performed in our office:

*Looks Good

*Lasts a Long Time

*Is Comfortable and Feels Good

Most importantly we want you to know that you are the boss.

FEE SCHEDULE

	Usual and Customary Rate Fee	Discount Plan Fee
Exam and X-Rays	$167	$20
Prophy (basic cleaning)	$55	$10
Filling (2 surface)	$132	$98
Root Canal (molar)	$799	$599
Crown (all porcelain)	$850	$638
Extraction (simple)	$107	$80
Bleaching (in office bleach)	$300	$225
Denture (immediate)	$1230	$922

Examples:

Exam, X-rays and basic cleaning:
Without discount plan $222
With discount plan $30
Save $192

Root Canal, Build-up and Crown:
Without discount plan $1799 With discount plan $1349 Save $445

10 extractions and upper and lower dentures:
Without discount plan $3530
With discount plan $2644
Save $886

Dental Limitations and Exclusions

Procedures performed at Quarry Bend Dental are limited to those that the dentist is comfortable performing. Exclusions may include oral surgery such as setting fractured jaws, removing malignancies, procedures performed in the hospital, general anesthesia and any procedure the dentist feels should be completed by a specialist.

*THIS IS NOT A HEALTH INSURANCE POLICY. *A HEALTH/DENTAL DISCOUNT PLAN MEMBER IS RESPONSIBLE FOR THE ENTIRE PAYMENT OF THEIR MEDICAL OR HEALTHCARE BILL AFTER THE DISCOUNT IS APPLIED. *SERVICES UNDER DISCOUNT PLAN ARE ONLY PROVIDED AT QUARRY BEND DENTAL BY GREGORY J RANDALL. LIMITATIONS AND EXCLUSIONS APPLY, SEE WEBSITE.

ANNUAL Cost of Discount Plan

1 Person	Family of 2 People	Family of 3 People	Family of 4 or more
$120	$216	$300	$360

Payments:
*Annual payment must be made.

Who is eligible?
YOU! There are no restrictions to individual plans. Family is defined as you and your spouse along with any dependent children under the age of 23.

When am I eligible?
NOW! NO WAITING PERIODS. Eligibility starts when paperwork has been finished and financial arrangements have been made.

Obligations:
Ours: As always we are committed to providing quality dental services to the best of our ability
Yours: After the initial 30 days you are committed to pay discount plan fees for a minimum of 11 months, after which the plan will continue on an annual basis.

Cancellation:
We offer a 30-day money back guarantee on any monthly dental discount plan fee. This 30-day period begins once materials have been received and signed. If you cancel after the initial 30-day period and before a total of 12 months, you are responsible for the UCR fees on all previously performed procedures. For dispute resolution or to cancel, simply call or come into the office.