dental plan - employer's resources of colorado€¦ · dental plan (adp/pos/cl plan with ortho...

TRIPLE CHOICE Dental Plan

(ADP/POS/CL PLAN WITH ORTHO 3 TIER)

Employee Enrollment

Packet

(303) 744-3007 or 1-800-807-0706

FAX (303) 744-2890

www.betadental.com

WHAT IS THE TRIPLE CHOICE DENTAL PLAN?

The Triple Choice Dental Plan allows each employee the choice of enrolling in the Alpha Dental Plan (ADP), the CarePOS Dental Plan (POS) or an Insurance / PPO Dental Plan. There are 875 Alpha providers in Colorado and 116,000 on the CarePOS plan. There are over 1,735 combined providers in Colorado.

There are many advantages to this flexible arrangement.

Option #1 Option #2 Option #3

See Network Dentist Only

*Lower co-pays

*No forms to complete

*Unlimited services

*Orthodontics (child & adult)

*No waiting on services

*No pre-authorizations

*Cosmetic dentistry included

*Immediate access for all services

*Save an average of 65% overall

off of the normal full fee

*Low monthly cost

See Network Dentist Only

*Higher co-pays

*No forms to complete

*Unlimited services

*Orthodontics (child & adult)

*No waiting on services

*No pre-authorizations

*Cosmetic dentistry included

*Immediate access for all

services

*Save an average of 20 to 60%

overall off of the normal full fee

*Low monthly cost

Select Any Dentist -

*$1200 calendar year maximum

*In and out of network benefits

*For Best Benefits – receive dental

services from a DenteMax provider

* Benefit waiting periods may apply

* $1000 Orthodontic coverage

*Higher monthly cost

Triple Choice

Alpha Dental (ADP)

Network Plan with over 875 providers across Colorado

Companion Life Dental Plan

See Any Dentist

CarePOS (POS)

Network Plan with over 116,000 providers

nationally

Option #1 and Option #2

Plan Highlights

Cosmetic dentistry included

No waiting on any services

Orthodontics (braces) discounted for children and adults

No forms to complete

No age limits for members

No limit on visits

No exclusions for dental health conditions

No limits on access to discounts (use as much as you like each year)

Guaranteed acceptance

The following fee schedule represents the pre-negotiated discounts that have been arranged in advance with the dental providers that are participating in the network. Simply pay these amounts directly to these network providers at the time services are rendered…it’s that easy! There are no forms to complete.

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION

NORMAL FEE

ALPHA PLAN #19

CarePOS PLAN

999 ROUTINE OFFICE VISIT 35$ 5$ 20% discount

120 PERIODIC ORAL EVALUATION 53$ NO COST 25$ 140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED 79$ 15$ 42$ 150 COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED PATIENT 97$ 12$ 43$ 210 X-RAY INTRAORAL COMPLETE SERIES INC. BITEWINGS 134$ 29$ 75$ 220 X-RAY INTRAORAL PERIAPICAL-FIRST FILM 31$ 6$ 14$ 230 X-RAY INTRAORAL PERIAPICAL EACH ADDITIONAL FILM 26$ 5$ 12$ 240 X-RAY INTRAORAL OCCLUSAL FILM 48$ 5$ 21$ 250 X-RAY EXTRAORAL FIRST FILM 75$ 5$ 29$ 260 X-RAY EXTRAORAL-EACH ADDITIONAL FILM 63$ 5$ 28$ 270 X-RAY BITEWING-SINGLE FILM 31$ NO COST 15$ 272 X-RAY BITEWING-2 FILMS 48$ NO COST 23$ 274 X-RAY BITEWING-4 FILMS 68$ NO COST 33$ 330 X-RAY PANORAMIC FILM 116$ 49$ 61$ 340 CEPHALOMETRIC FILM 137$ 60$ 75$ 460 PULP VITALITY TEST 61$ NO COST 30$ 470 DIAGNOSTIC CASTS 122$ 49$ 64$ 999 EMERGENCY VISIT (SAME DAY) 90$ 25$ 20% discount

1110 PROPHYLAXIS-ADULT CLEANING (EVERY 6 MONTHS) 96$ 15$ 50$ 1120 PROPHYLAXIS-CHILD CLEANING (EVERY 6 MONTHS) 72$ 15$ 36$ 1203 TOPICAL APPLICATION OF FLUORIDE NOT INCL/PROPHY-CHILD 39$ 11$ 21$ 1330 ORAL HYGIENE INSTRUCTIONS 63$ NO COST 37$ 1351 SEALANT PER TOOTH 58$ 12$ 28$ 1510 SPACE MAINTAINER FIXED UNILATERAL 338$ 173$ 179$ 1515 SPACE MAINTAINER FIXED BILATERAL 461$ 250$ 235$ 1520 SPACE MAINTAINER-REMOVABLE-UNILATERAL 418$ 213$ 222$ 1525 SPACE MAINTAINER-REMOVABLE-BILATERAL 522$ 246$ 304$ 1550 RE-CEMENTATION OF SPACE MAINTAINER 90$ 17$ 38$ 1999 ADDITIONAL PROPHY (FOR PERIO MAINTENANCE) 96$ 41$ 20% discount

2140 AMALGAM-1 SURFACE (PRIMARY OR PERMANENT) 150$ 33$ 66$ 2150 AMALGAM-2 SURFACES (PRIMARY OR PERMANENT) 195$ 44$ 86$ 2160 AMALGAM-3 SURFACES (PRIMARY OR PERMANENT) 232$ 54$ 103$ 2161 AMALGAM-4 OR MORE SURFACES (PRIMARY OR PERMANENT) 272$ 63$ 126$ 2330 RESIN BASED COMPOSITE 1 SURFACE (ANTERIOR) 169$ 45$ 77$ 2331 RESIN BASED COMPOSITE 2 SURFACES (ANTERIOR) 212$ 58$ 99$ 2332 RESIN BASED COMPOSITE 3 SURFACES (ANTERIOR) 264$ 77$ 122$ 2335 RESIN 4 OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR) 328$ 124$ 142$ 2390 RESIN BASED COMPOSITE CROWN ( ANTERIOR) 476$ 262$ 203$ 2391 RESIN BASED COMPOSITE ONE SURFACE (POSTERIOR) 188$ 98$ 87$ 2392 RESIN BASED COMPOSITE TWO SURFACE (POSTERIOR) 243$ 135$ 121$ 2393 RESIN BASED COMPOSITE THREE SURFACE (POSTERIOR) 305$ 172$ 150$ 2394 RESIN BASED COMPOSITE FOUR OR MORE SURFACES (POSTERIOR) 364$ 188$ 156$

*2510 INLAY-METALLIC-ONE SURFACE 906$ 299$ 366$ *2520 INLAY-METALLIC-TWO SURFACE 936$ 309$ 415$ *2530 INLAY-METALLIC-THREE OR MORE SURFACES 991$ 327$ 478$ *2542 ONLAY-METALLIC-TWO SURFACES 1,005$ 332$ 439$ *2543 ONLAY-METALLIC-THREE SURFACES 1,037$ 343$ 491$ *2544 ONLAY-METALLIC-FOUR OR MORE SURFACES 1,069$ 352$ 512$ *2610 INLAY-PORCELAIN/CERAMIC-ONE SURFACE 965$ 318$ 431$ *2650 INLAY-RESIN BASED COMPOSITE-ONE SURFACE 927$ 306$ 284$ *2651 INLAY-RESIN BASED COMPOSITE-TWO SURFACES 952$ 314$ 337$ *2652 INLAY-RESIN BASED COMPOSITE-THREE OR MORE SURFACES 993$ 328$ 355$ *2710 CROWN-RESIN BASED COMPOSITE (INDIRECT) 963$ 319$ 227$ *2720 CROWN-RESIN WITH HIGH NOBLE METAL 1,139$ 375$ 625$ *2721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL 1,032$ 340$ 584$ *2722 CROWN RESIN WITH NOBLE METAL 1,048$ 346$ 597$ *2740 CROWN PORCELAIN/CERAMIC SUBSTRATE 1,196$ 395$ 639$ *2750 CROWN PORCELAIN FUSED TO HIGH NOBLE METAL 1,164$ 384$ 631$ *2751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 1,054$ 315$ 589$ *2752 CROWN-PORCELAIN FUSED TO NOBLE METAL 1,091$ 370$ 602$

Page 1

Diagnostic Services (Exams and X-rays)

Preventive Services (Cleanings)

Restorative Services (Fillings, Crowns, Inlays and Onlays)

Current Dental Terminology ©American Dental Association

Beta Health Association, Inc.Dental Fee Schedule

Alpha Plan #19and

CarePOSForm 9110


NORMAL FEE

ALPHA PLAN #19

CarePOS PLAN

*2790 CROWN FULL CAST HIGH NOBLE METAL 1,154$ 366$ 608$ *2791 CROWN FULL CAST PREDOMINANTLY BASE METAL 1,028$ 318$ 580$ *2792 CROWN FULL CAST NOBLE METAL 1,058$ 345$ 590$ 2910 RECEMENT INLAY, ONLAY, OR PARTIAL COVERAGE RESTORATION 116$ 15$ 52$ 2920 RECEMENT CROWN 116$ 31$ 54$ 2930 PREFAB. STAINLESS STEEL CROWN-PRIMARY 291$ 101$ 149$ 2931 PREFAB STAINLESS STEEL CROWN-PERMANENT 355$ 123$ 167$ 2932 PREFAB. RESIN CROWN 376$ 157$ 184$ 2933 PREFAB. STAINLESS STEEL CROWN WITH RESIN WINDOW 398$ 179$ 205$ 2940 SEDATIVE FILLING 132$ 37$ 57$ 2950 CORE BUILDUP INCLUDING ANY PINS 292$ 82$ 141$ 2951 PIN RETENTION PER TOOTH IN ADD. TO RESTORATION 81$ 23$ 29$ 2952 POST & CORE IN ADDITION TO CROWN, INDIRECTLY FABRICATED 456$ 134$ 216$ 2954 PREFAB POST & CORE IN ADDITION TO CROWN 365$ 107$ 179$ 2955 POST REMOVAL (NOT IN CONJUNCTION WITH ENDODONTIC THERAPY) 317$ 139$ 135$ 2960 LABIAL VENEER RESIN LAMINATE (CHAIRSIDE) 714$ 187$ 440$ 2999 BLEACHING (PER ARCH) 270$ 162$ 20% discount

2999 $125 ADDTL.CHARGE P/UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION

3110 PULP CAP DIRECT EXCLUDING FINAL RESTORATION 90$ 26$ 38$ 3120 PULP CAP INDIRECT EXCLUDING FINAL RESTORATION 93$ 27$ 30$ 3220 THERAPEUTIC PULPOTOMY EXCLUDING FINAL RESTORATION 218$ 72$ 92$ 3230 PULPAL THERAPY ANTERIOR, PRIMARY TOOTH EXCLUDING FINAL RESTORATION 328$ 102$ 97$ 3240 PULPAL THERAPY POSTERIOR, PRIMARY TOOTH EXCLUDING FINAL RESTORATION 370$ 113$ 104$ 3310 ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION) 778$ 275$ 388$ 3320 ENDODONTIC THERAPY, BICUSPID TOOTH (EXCLUDING FINAL RESTORATION) 874$ 320$ 474$ 3330 ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION) 1,058$ 400$ 612$ 3410 APICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR 741$ 328$ 443$ 3421 APICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT) 805$ 366$ 484$ 3425 APICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT) 950$ 424$ 547$ 3426 APICOECTOMY/PERIRADICULAR SURGERY-EACH ADDITIONAL ROOT 450$ 161$ 182$ 3430 RETROGRADE FILLING-PER ROOT 315$ 116$ 134$ 3910 SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM 279$ 64$ 71$

4210 GINGIVOPLASY OR GIGIVECTOMY- 4+ CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD 704$ 333$ 379$ 4211 GINGIVECTOMY OR GINGIVOPLASTY-1 TO 3 CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD 323$ 178$ 126$ 4240 GINGIVAL FLAP PROCEDURE, INCL.ROOT PLNG -4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD 820$ 352$ 446$ 4260 OSSEOUS SURG. INCL. FLAP ENTRY & CLOSURE-4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD 1,138$ 521$ 720$ 4320 PROVISIONAL SPLINTING-INTRACORONAL 556$ 260$ 240$ 4321 PROVISIONAL SPLINTING-EXTRACORONAL 527$ 246$ 211$ 4341 PERIODONTAL SCALING & ROOT PLNG- 4+ TEETH PER QUAD 265$ 112$ 130$ 4355 FULL MOUTH DEBRIDEMENT TO ENABLE COMP.EVAL. & DIAGNOSIS 197$ 89$ 86$ 4910 PERIODONTAL MAINTENANCE 146$ 57$ 78$ 4999 PERIO SCREENING AND SCORING 30$ 10$ 20% discount

5110 COMPLETE DENTURE-MAXILLARY 1,799$ 533$ 838$ 5120 COMPLETE DENTURE-MANDIBULAR 1,799$ 533$ 838$ 5130 IMMEDIATE DENTURE-MAXILLARY 1,921$ 764$ 915$ 5140 IMMEDIATE DENTURE-MANDIBULAR 1,958$ 778$ 915$ 5211 MAXILLARY PART. DENTURE-RESIN BASE (INCL. CLASPS, RESTS & TEETH) 1,474$ 463$ 823$ 5212 MANDIBULAR PARTIAL DENTURE-RESIN BASE (INCL. CLASPS, RESTS & TEETH) 1,448$ 442$ 823$ 5213 MAXILLARY PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS, RESTS & TEETH) 1,885$ 547$ 926$ 5214 MANDIBULAR PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS, RESTS & TEETH) 1,889$ 545$ 926$ 5410 ADJUST COMPLETE DENTURE-MAXILLARY 96$ 36$ 46$ 5411 ADJUST COMPLETE DENTURE-MANDIBULAR 95$ 36$ 46$ 5421 ADJUST PARTIAL DENTURE-MAXILLARY 95$ 36$ 46$ 5422 ADJUST PARTIAL DENTURE-MANDIBULAR 95$ 36$ 46$ 5510 REPAIR BROKEN COMPLETE DENTURE BASE 231$ 88$ 91$ 5520 REPLACE MISSING OR BROKEN TEETH-COMPLETE DENTURE-EACH TOOTH 197$ 62$ 77$ 5610 REPAIR RESIN DENTURE BASE 225$ 82$ 100$ 5620 REPAIR CAST FRAMEWORK 313$ 139$ 107$ 5630 REPAIR OR REPLACE BROKEN CLASP 286$ 105$ 130$ 5640 REPLACE BROKEN TEETH-PER TOOTH 198$ 68$ 84$ 5650 ADD TOOTH TO EXISTING PARTIAL DENTURE 241$ 93$ 114$ 5660 ADD CLASP TO EXISTING PARTIAL DENTURE 292$ 121$ 138$

Page 2

Restorative Services (Fillings, Crowns, Inlays and Onlays) Con't

Endodontic Services (Root Canals)

Periodontic Services (Gum Disease)

Prosthodontics (Removable/Complete Dentures, etc.)


*This applies to the Alpha Dental Plan only: These co-payments do not include an allowable $151 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fees. Temporary crowns are included with permanent crown preparation.


NORMAL FEE

ALPHA PLAN #19

CarePOS PLAN

5710 REBASE COMPLETE MAXILLARY DENTURE 630$ 276$ 340$ 5711 REBASE COMPLETE MANDIBULAR DENTURE 629$ 276$ 326$ 5720 REBASE MAXILLARY PARTIAL DENTURE 609$ 230$ 321$ 5721 REBASE MANDIBULAR PARTIAL DENTURE 609$ 231$ 321$ 5730 RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE) 402$ 175$ 192$ 5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) 402$ 175$ 192$ 5740 RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) 397$ 167$ 176$ 5741 RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) 402$ 167$ 176$ 5750 RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) 503$ 155$ 256$ 5751 RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) 503$ 155$ 256$ 5760 RELINE MAXILLARY PARTIAL DENTURE (LABORATORY) 503$ 158$ 253$ 5761 RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY) 503$ 157$ 253$ 5850 TISSUE CONDITIONING MAXILLARY 231$ 66$ 80$ 5851 TISSUE CONDITIONING MANDIBULAR 233$ 65$ 80$

*6210 PONTIC-CAST HIGH NOBLE METAL 1,133$ 359$ 553$ *6211 PONTIC-CAST PREDOMINANTLY BASE METAL 1,037$ 303$ 517$ *6212 PONTIC-CAST NOBLE METAL 1,075$ 320$ 538$ *6240 PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL 1,161$ 383$ 545$ *6241 PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 1,058$ 312$ 504$ *6242 PONTIC-PORCELAIN FUSED TO NOBLE METAL 1,084$ 331$ 531$ *6250 PONTIC-RESIN WITH HIGH NOBLE METAL 1,085$ 345$ 538$ *6251 PONTIC-RESIN WITH PREDOMINANTLY BASE METAL 1,042$ 323$ 497$ *6252 PONTIC-RESIN WITH NOBLE METAL 1,044$ 325$ 512$ *6720 CROWN-RESIN WITH HIGH NOBLE METAL 1,154$ 380$ 607$ *6721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL 1,042$ 344$ 577$ *6722 CROWN-RESIN WITH NOBLE METAL 1,067$ 352$ 586$ *6750 CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL 1,164$ 384$ 622$ *6751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 1,052$ 315$ 581$ *6752 CROWN-PORCELAIN FUSED TO NOBLE METAL 1,079$ 335$ 594$ *6790 CROWN-FULL CAST HIGH NOBLE METAL 1,133$ 359$ 602$ *6791 CROWN-FULL CAST PREDOMINANTLY BASE METAL 1,042$ 323$ 569$ *6792 CROWN-FULL CAST NOBLE METAL 1,084$ 330$ 591$ 6930 RECEMENT FIXED PARTIAL DENTURE 185$ 69$ 72$

7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) 185$ 46$ 85$ 7210 SURGICAL REMOVAL ERUPTED TOOTH WITH REMOVAL OF BONE AND/OR SECTION OF TOOTH 295$ 81$ 150$ 7220 REMOVAL OF IMPACTED TOOTH-SOFT TISSUE 345$ 92$ 169$ 7230 REMOVAL OF IMPACTED TOOTH PARTIALLY BONY 419$ 163$ 226$ 7240 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY 524$ 210$ 265$ 7241 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY W/ UNUSUAL SURG. COMPLICATION 635$ 248$ 332$ 7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) 322$ 118$ 143$ 7270 TOOTH REIMPL. AND/OR STAB. OF ACC.EVULSED OR DISPL. TOOTH 609$ 243$ 290$ 7280 SURGICAL ACCESS OF AN UNERUPTED TOOTH 540$ 235$ 318$ 7285 BIOPSY OF ORAL TISSUE-HARD (BONE-TOOTH) 497$ 217$ 517$ 7286 BIOPSY OF ORAL TISSUE-SOFT 344$ 150$ 230$ 7310 ALVEOPLASTY IN CONJ. WITH EXT.4 OR MORE TEETH OR TOOTH SPACES PER QUAD 329$ 126$ 157$ 7320 ALVEOPLASTY NOT IN CONJ WITH EXT. 4 OR MORE TEETH OR TOOTH SPACES PER QUAD 528$ 195$ 373$ 7510 INCISION AND DRAINAGE ABSCESS- INTRAORAL SOFT TISSUE 255$ 99$ 150$ 7910 SUTURE OF RECENT SMALL WOUNDS UP TO 5CM 341$ NO COST 210$ 7960 FRENULECTOMY (FRENECTOMY OR FRENOTOMY)- SEPARATE PROCEDURE 498$ 128$ 252$ 7970 EXCISION OF HYPERPLASTIC TISSUE- PER ARCH 582$ 207$ 341$

9110 PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN- MINOR PROCEDURE 138$ 48$ 54$ 9230 ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE - FIRST 30 MINUTES 95$ 27$ 30$ 9310 CONSULTATION (DIAG. SERV. PROV. BY DENTIST OR PHYSICIAN OTHER THAN PRACTIONER PROV. TREATMNT) 159$ NO COST 114$ 9910 APPLICATION OF DESENSITIZING MEDICAMENT 73$ 6$ 24$ 9941 FABRICATION OF ATHLETIC MOUTHGUARD 315$ 107$ 86$ 9951 OCCLUSAL ADJUSTMENT-LIMITED 212$ 77$ 69$ 9952 OCCLUSAL ADJUSTMENT-COMPLETE 770$ 286$ 386$ 9999 MISSED APPOINTMENT (WITHOUT 24 HOUR NOTICE) 54$ 30$ 20% discount

Page 3

Prosthodontics (fixed/Partial Dentures, etc.)

Oral Surgery (Extractions, etc.)

General Miscellaneous Services


Prosthodontics (Removable/ Complete Dentures, etc.) Con't

NOTE: For the Alpha Dental Plan only, the fees listed above in section 5000 thru 6000, additional fees may be charged for upgraded teeth and enhanced cosmetics, personalization beyond norm or techniques involving precision dentures.

*This applies to the Alpha Dental Plan only: These co-payments do not include an allowable $151 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fee.

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION (Alpha Dental Plan ONLY)

NORMAL FEE

ALPHA PLAN #19

CarePOS PLAN

Alpha 13 MONTH TREATMENT PLAN ($137/MONTH) 3,114$ 2,409$ 20% discount









Page 4Current Dental Terminology ©American Dental Association

Orthodontics (Braces) for Children & Adults Alpha Monthly Payment

Other Orthodontic Guidelines (These Orthodontic guidelines apply to the Alpha Dental Plan only)

1. A $382 charge will apply at the end of treatment (included in the above amounts) to cover all retention office visits(unlimited).

2. Services not listed above will be discounted 30% off of the participating Orthodontist's Usual and Customary fees (except #5listed below).

3. Services must only be provided by a contracted Orthodontic Specialist.4. The amounts listed above also include an initial one-time $246 charge for all records, mold, x-rays, etc. to determine

the Orthodontic Treatment for the patient.5. Invisalign® procedures are to be discounted 15% off the participating Orthodontist's Usual and Customary fees.____________________________________________________________________________________________

Alpha Dental Plan General Limitations and Exclusions

1. All fees listed above do not include all appropriate lab fees. Member must agree (in writing) to all upgraded materialsbefore treatment is started. See each section for specific details (if applicable).

2. All patients are responsible for paying all fees (as listed above) at the time services are rendered.3. These fees are for General Dentists only. A participating specialist list is available by calling our office at

303-744-3007 or 1-800-807-0706. 4. Any procedures not listed will be discounted 20% off the participating General Dentists normal fees.5. Medical costs associated with any dental procedures are not covered.6. Dentures or appliances will be replaced only after 3 years have elapsed since such dentures or appliances were

provided under any plan program, unless the denture or appliance becomes unserviceable due to illness or other causesnot controlled by other means. Replacement of dentures, appliances, or bridgework due to loss or theft are not covered.

7. Any dental treatment started prior to the Member's eligibility to receive services under this plan or started after a Member's termination are not covered.

8. Failure to follow the prescribed treatment or accidents occurring during the course of treatment may result in additional charges by your plan provider.

9. Failure to pay scheduled fees at the time service is rendered may prevent future dental services from being received until all fees have been paid in full.

10. Services provided by non-participating dentists are not covered. 11. Services which, in the opinion of the attending dentist, are not necessary for the patient's dental health, or are contrary to

established dental ethics are not covered.12. Cosmetic dental procedures are covered only if the attending dentist and patient agree on the specific procedure.13. Services which are compensable under Worker's Compensation or employer liability laws are not covered.14. General anesthesia and IV sedation are not covered.15. Myofunctional therapy procedure for training, treating or developing muscles in and around the jaw or mouth including TMJ

are not covered except by participating plan specialists.16. Any dental procedure or service that cannot be performed in the dental office due to general and/or physical limitations of a

member are not covered.17. Expenses incurred for dental procedures initiated prior to member's eligibility or after termination are not covered.18. Any services that the Participating General Dentist recommends be performed by a specialist are covered only by a plan

participating specialist.19. The liability of Beta Health Association, Inc. is limited to the return of the membership fees paid for one year by the member.20. Extractions for asymptomatic third molars (wisdom teeth) are not covered unless causing movement of the teeth. An

example of symptomatic include severe decay, and ontogenic cysts, chronic pericoronitis, and infection. 21. The Beta Health Association, Inc. dental programs do not constitute dental insurance and are considered discount, fee-for-

service dental plans.22. Fees are subject to change on an as needed basis. Please contact Beta Health Association, Inc. for current fees.CarePOS Plan General LimitationsThis is a discount program. This is not an insurance plan. Careington cannot guarantee specialty care in all areas. In cases in which you arereferred to a participating specialist, you will generally receive 15% to 20% off their usual and customary fees. Please verify such benefits witheach individual provider. Work in progress, after joining the plan, must be completed by the provider who started the work. Any proceduresperformed by a non‐participating provider are not included. Careington International cannot guarantee the continued participation of any provider. If he or she leaves the plan, you will need to select another provider. Not all types of providers may be available in your area. Some

providers may charge for missed or broken appointments if no prior notice is given. It is the member’s responsibility to verify that the provider is a participating provider. This plan does not include all procedures which might be provided. Any procedure delivered which is not listed on the Schedule of Services may cause additional cost to be incurred by the member. The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment because the treatment may require more than one procedure. Note to Utah Residents: This contract is not protected by the Utah Life and Health Guaranty Association. The program and the program administrators have no liability for providing or guaranteeing service and have no liability for the quality of service rendered. The most widely used dental procedures, discounted fees and limitations are illustrated. Please contact Beta Health Association, Inc. at (303) 744‐3007 or 1‐800‐807‐0706 with any questions.

Three Easy Ways

To find an Alpha Dental Plan Provider

1. Use the Provider Directory provided to you in the enrollment packet. You must select a provider when enrolling. The number in column 3 of the directory needs to be placed to the right of the Alpha Dental Plan selection on the enrollment form. You can change providers at any time. All family members must see the same provider for treatment.

2. Go to www.betadental.com/alpha19/ and enter the zip code of where you wish to see a participating Alpha Dental Plan provider.

3. Call our office at (303)744-3007 or 1(800)807-0706 for assistance. We are here to help!

Important:

All services received while you are enrolled in the Alpha Dental Plan MUST be provided by a participating Alpha Dental Plan provider or

dental office. Non network provider services are not available.

Alpha Dental Plan Complete Provider Directory and Orthodontists 10/23/2014

NAME OFFICE NAME PROVIDER # ADDRESS PHONE CITY SPECIALTY CODES

Dr. Richard Williams Dr. Richard Williams ADP #56 315 Edison 719-589-3686 Alamosa General Dentist *, **, C, E1-2, E3-4, N

Dr. David A. Zeitlin David A. Zeitlin ADP #228 9122 W. 88th Ave. 303-422-0836 Arvada General Dentist *, C, E1-2, E3-4

Dr. Julio Sekler Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Yehia Elgohary Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Wameedh A Abdulameer Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Aseel D Hasan Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Christopher S Mohr Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Kristin Lere Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Gilbert Vigil Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Jack F. Emmons Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Barbara Heupel-Chapman Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Jeffrey Patrician Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Craig A. Mellor Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Sampath Vidhyalakshmi Bright Now Dental - Arvada Adp ADP #231 7985 Wadsworth Blvd. #b 303-209-2250 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Joseph Taylor Joseph Taylor DDS ADP #254 7319 Allison Way 303-420-1114 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Shayna Bahr Comfort Dental - North Arvada ADP #36 8390 W. 80th Ave. 303-425-6419 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Juan Materon Comfort Dental - North Arvada ADP #36 8390 W. 80th Ave. 303-425-6419 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Marina Varshavskaya Comfort Dental - North Arvada ADP #36 8390 W. 80th Ave. 303-425-6419 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Alan Bueltel Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4

Dr. Mark Dean Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4

Dr. Neil Zimmet Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4

General Dentists

Complete Participating Provider Directory( Alpha Dental Plan including Orthodontists )

Plan providers are listed in alphabetical order according to city. The most up to date provider listings can be found at www.betadental.com/alpha19/.

You can also call 303-744-3007 or 1-800-807-0706 for assistance. All dentists listed are accepting new patients. Contact the office directly if you wish to verify.

Page 1 of 24



Dr. James R. Mayo Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. 303-421-7000 Arvada General Dentist *, C, E1-2, E3-4

Dr. Bradley Eckhardt Ault Family Dentistry ADP #240 120 2nd Ave. 970-834-2058 Ault General Dentist *, C, E1-2, E3-4

Dr. Breanna Behrens Ault Family Dentistry ADP #240 120 2nd Ave. 970-834-2058 Ault General Dentist *, C, E1-2, E3-4

Dr. Roy Theriot Dr. Roy Theriot ADP #10 941 S. Havana, #200 303-341-5313 Aurora General Dentist *, C

Dr. Tiffany Fritz Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Wameedh A Abdulameer Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Aseel D Hasan Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Kristin Lere Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Mark Lawson Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Symone Webley Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Manisha Patil Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Thomas Mulheran Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Sampath Vidhyalakshmi Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Michael Gioia Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Michael Miller Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Semiramida Condoianis Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Mirela Giurgiu Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Craig A. Mellor Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. James A. Fischer Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Ekatrina Butkevich Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Tracie E. Keller Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Hyunseo Park Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Charles Woyda Bright Now Dental - Smoky Hill Adp ADP #107 23963 Prospect Ave. #e 303-400-9898 Aurora General Dentist *, C, E1-2, E3-4

Dr. Clyde A. Bowden Clyde A. Bowden ADP #133 14591 E. Alameda Ave. 303-343-7072 Aurora General Dentist C, E1-2, N

Dr. Kris Komanduri Hanu Dental Care ADP #163 12343 E. Cornell Ave., #-17 720-748-7902 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Jeffrey Gilliam Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Zachary D. Bergeson Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Page 2 of 24



Dr. Gerald Edwards Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Matthew Rowan Comfort Dental - Aurora ADP #173 1050 S. Peoria 303-367-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Jeffrey Gilliam Comfort Dental-Havana Adp ADP #202 10401 E. Colfax Ave., #150 303-344-2273 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Michael W Zendig Comfort Dental-Havana Adp ADP #202 10401 E. Colfax Ave., #150 303-344-2273 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Justin J. Kwon Green Dental ADP #219 10700 E. Bethany Dr., #210 303-745-8828 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Marc Resnick Agreeable Dental Care, LLC. ADP #241 1700 S. Chambers Rd. 303-369-7272 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Oanh T Pham Dentrust Dental ADP #262 601 Salida Way #b-11 303-340-3330 Aurora General Dentist **, E1-2, E3-4

Dr. Sheldon R Omi Dentrust Dental ADP #262 601 Salida Way #b-11 303-340-3330 Aurora General Dentist **, E1-2, E3-4

Dr. Kathy Tomlinson Aurora Dental Group, LLC. ADP #264 1344 S. Chambers Rd. #201 303-745-2052 Aurora General Dentist **, E1-2, E3-4

Dr. Keith Shaw Aurora South Dental Partners ADP #272 15286 E. Hampden Ave. 480-339-4800 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Nicolas Porter Aurora South Dental Partners ADP #272 15286 E. Hampden Ave. 480-339-4800 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Jeffrey A. Varner Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Zoulfia Magaril Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Ezra Christian Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Richard Doerhoff Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Matthew Tobkin Comfort Dental - East Aurora ADP #34 2131 S. Chambers Rd. 303-750-2273 Aurora General Dentist *, **, C, E1-2, E3-4, N

Dr. Barry Wohlgemuth Wohlgemuth & Rush, DDS ADP #41 3095 S. Parker Rd., #150 303-755-8388 Aurora General Dentist C, N

Dr. Steven Rush Wohlgemuth & Rush, DDS ADP #41 3095 S. Parker Rd., #150 303-755-8388 Aurora General Dentist C, N

Dr. Thomas E. Daniel Dr. Thomas E. Daniel ADP #46 1101 Havana 303-366-3577 Aurora General Dentist C

Dr. Wameedh A AbdulameerBright Now Dental - Aurora - S. Tower Rd.

AdpADP #74 3551 S. Tower Rd., #c 303-400-3669 Aurora General Dentist *, **, C, E1-2

Dr. Craig A. MellorBright Now Dental - Aurora - S. Tower Rd.


Dr. Ekatrina ButkevichBright Now Dental - Aurora - S. Tower Rd.


Dr. Charles WoydaBright Now Dental - Aurora - S. Tower Rd.


Dr. Manisha PatilBright Now Dental - Aurora - S. Tower Rd.


Dr. Symone WebleyBright Now Dental - Aurora - S. Tower Rd.


Dr. Sampath VidhyalakshmiBright Now Dental - Aurora - S. Tower Rd.


Dr. Thomas MulheranBright Now Dental - Aurora - S. Tower Rd.


Page 3 of 24



Dr. Matthew YoungBright Now Dental - Aurora - S. Tower Rd.


Dr. Michael MillerBright Now Dental - Aurora - S. Tower Rd.


Dr. Mirela GiurgiuBright Now Dental - Aurora - S. Tower Rd.


Dr. James A. FischerBright Now Dental - Aurora - S. Tower Rd.


Dr. Tiffany FritzBright Now Dental - Aurora - S. Tower Rd.


Dr. Semiramida CondoianisBright Now Dental - Aurora - S. Tower Rd.


Dr. Mark LawsonBright Now Dental - Aurora - S. Tower Rd.


Dr. Julio SeklerBright Now Dental - Aurora - S. Tower Rd.


Dr. Michael GioiaBright Now Dental - Aurora - S. Tower Rd.


Dr. Traver L. Maxwell Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy, D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2

Dr. James Liu Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy, D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2

Dr. John W. Thousand, Iii Comfort Dental - Quincy Buckley ADP #76 16981 E. Quincy, D1-D3 303-617-8400 Aurora General Dentist **, C, E1-2

Dr. Homer R Warner Comfort Dental - Vail Valley ADP #265 0101 Fawcett Rd. Unit 170 970-949-7911 Avon General Dentist *, C, E1-2, E3-4

Dr. David W. Lindman Comfort Dental - Vail Valley ADP #265 0101 Fawcett Rd. Unit 170 970-949-7911 Avon General Dentist *, C, E1-2, E3-4

Dr. Owen Eames Comfort Dental - Vail Valley ADP #265 0101 Fawcett Rd. Unit 170 970-949-7911 Avon General Dentist *, C, E1-2, E3-4

Dr. Lisa Sheldon Comfort Dental - Boulder ADP #112 3400 Arapahoe Rd. 303-444-2129 Boulder General Dentist *, C, E1-2, E3-4

Dr. Mark Cannon Comfort Dental - Boulder ADP #112 3400 Arapahoe Rd. 303-444-2129 Boulder General Dentist *, C, E1-2, E3-4

Dr. Sheldon R Omi Delicate Smiles Dental ADP #274 1790 East Bridge Street 303-659-1064 Brighton General Dentist **

Dr. Oanh T Pham Delicate Smiles Dental ADP #274 1790 East Bridge Street 303-659-1064 Brighton General Dentist **

Dr. Justin J. Kwon Green Dental ADP #232 290 Nickel St., #500 303-469-5301 Broomfield General Dentist C, E1-2, E3-4

Dr. Gregory E. Micheli Shadow Hills Dental Clinic ADP #215 831 Forest Ave. 719-275-7740 Canon City General Dentist *, C, E1-2, E3-4

Dr. Michael K. Rollert Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Dr. Symone Webley Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Dr. Craig A. Mellor Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Dr. Michael Miller Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Dr. Jennifer Parker Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Dr. Thomas Mulheran Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Page 4 of 24



Dr. Christopher S Mohr Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Dr. Mark Lawson Bright Now Dental - Castle Rock Adp ADP #049 188 Founders Parkway Unit A 303-668-0252 Castle Rock General Dentist *, **, C

Dr. Vikash Kanchanlal Vikash Kanchanlal DMD ADP #197 734 Wilcox St., #-200 303-257-8237 Castle Rock General Dentist *, **, C, E1-2, E3-4

Dr. Dwight M. Bratton Castle Rock Dental Group PC ADP #246 1001 S. Perry St #104a 303-663-6030 Castle Rock General Dentist *, **, C

Dr. Michael Miller Castle Rock Dental Group PC ADP #246 1001 S. Perry St #104a 303-663-6030 Castle Rock General Dentist *, **, C

Dr. Michael G Yurth Castle Rock Dental Group PC ADP #246 1001 S. Perry St #104a 303-663-6030 Castle Rock General Dentist *, **, C

Dr. Chad J. Carubia Castle Rock Dental Group PC ADP #246 1001 S. Perry St #104a 303-663-6030 Castle Rock General Dentist *, **, C

Dr. David T Sugiyama Cedar Mountain Family Dentistry ADP #266 1189 S. Perry St. Ste. 250 303-688-3398 Castle Rock General Dentist C

Dr. Asha Chinni Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. 303-680-9990 Centennial General Dentist *, **, C, E1-2, E3-4, N

Dr. Jeffrey Hamilton Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. 303-680-9990 Centennial General Dentist *, **, C, E1-2, E3-4, N

Dr. Michael Millward Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. 303-680-9990 Centennial General Dentist *, **, C, E1-2, E3-4, N

Dr. Margarita Aleksanyan Guaranteed Smiles - Southglenn ADP #116 2001 E. Easter Ave., #200 303-703-4544 Centennial General Dentist C, E1-2, E3-4

Dr. Kevin Marshall Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4

Dr. Michael G. Jacobs Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4

Dr. David W. Lindman Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4

Dr. Derrick Q. Price Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4

Dr. Murray Jacobs Comfort Dental - Centennial ADP #6 8223 S. Quebec St., Unit A 303-689-2273 Centennial General Dentist *, C, E1-2, E3-4

Dr. William Case Dr. William Case ADP #71 7180 E. Orchard Rd., #302 720-488-6600 Centennial General Dentist *, C

Dr. Richard H. Wiedey Dr. Richard H. Wiedey ADP #106 1819 North Circle, #6 719-520-5884 Colorado Springs General Dentist **, E1-2, E3-4, N

Dr. Grant Mack Comfort Dental - Citadel Crossing ADP #108 509 N. Academy Blvd. 719-591-7599 Colorado Springs General Dentist *, C, E1-2

Dr. Travis L. Edwards Comfort Dental - Citadel Crossing ADP #108 509 N. Academy Blvd. 719-591-7599 Colorado Springs General Dentist *, C, E1-2

Dr. Brian Anderson Comfort Dental - Citadel Crossing ADP #108 509 N. Academy Blvd. 719-591-7599 Colorado Springs General Dentist *, C, E1-2

Dr. Ryan Pini Comfort Dental - Citadel Crossing ADP #108 509 N. Academy Blvd. 719-591-7599 Colorado Springs General Dentist *, C, E1-2

Dr. Dustin B. Dial Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Christian Lovejoy Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Jamison Miller Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Joshua Bevans Comfort Dental - North Powers ADP #118 6076 Stetson Hills Blvd. 719-637-2079 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Page 5 of 24



Dr. Dan Kingsford Comfort Dental - Austin Bluffs Adp ADP #158 3952 North Academy Blvd. 719-591-1811 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Patrick Hudson Comfort Dental - Austin Bluffs Adp ADP #158 3952 North Academy Blvd. 719-591-1811 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Jeremy Bullock Comfort Dental - Austin Bluffs Adp ADP #158 3952 North Academy Blvd. 719-591-1811 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Seth T Williams Comfort Dental - Austin Bluffs Adp ADP #158 3952 North Academy Blvd. 719-591-1811 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Thomas MulheranBright Now Dental - Colorado Springs -

Parkmoor Village AdpADP #159 3208 N. Academy Blvd., #140 719-596-7000 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Paul HenneganBright Now Dental - Colorado Springs -


Dr. Craig A. MellorBright Now Dental - Colorado Springs -


Dr. Curtis BroekerBright Now Dental - Colorado Springs -


Dr. Tracie E. KellerBright Now Dental - Colorado Springs -


Dr. Michael MillerBright Now Dental - Colorado Springs -


Dr. Paul Rygg Jadeerindale Dental ADP #164 6020 Erin Park Dr. 719-266-9393 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Kathleen Brower Jadeerindale Dental ADP #164 6020 Erin Park Dr. 719-266-9393 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Steven Castillo Deer Creek Dental ADP #190 425 W. Rockrimmon 719-593-1053 Colorado Springs General Dentist **, E1-2, E3-4, N

Dr. Benjamin Weir Comfort Dental-South Powers ADP #200 1580 Space Center Dr., #107 719-574-8922 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Joseph Hale Comfort Dental-South Powers ADP #200 1580 Space Center Dr., #107 719-574-8922 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Nathan Budge Comfort Dental-South Powers ADP #200 1580 Space Center Dr., #107 719-574-8922 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Jay Johnson Comfort Dental-South Powers ADP #200 1580 Space Center Dr., #107 719-574-8922 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Ted L. Rigby Rigby Dental PC ADP #206 2190 Academy Circle 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Kathleen Brower Rigby Dental PC ADP #206 2190 Academy Circle 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Leopoldo Rodríguez Rigby Dental PC ADP #206 2190 Academy Circle 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Paul Rygg Rigby Dental PC ADP #206 2190 Academy Circle 719-596-3939 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Angelo M. Camerino North Summit Dental Care ADP #212 1720 Jet Stream Dr., #110 719-481-8373 Colorado Springs General Dentist *, C, E1-2, E3-4

Dr. Carolyn T. Camerino Centennial Dental Care PC. ADP #213 5731 Silverstone Terr., #-200 719-632-7778 Colorado Springs General Dentist *, C, E1-2, E3-4

Dr. Orlando J. Lucero Orlando J. Lucero PC. ADP #243 1855 Austin Bluffs Pkwy 719-599-5980 Colorado Springs General Dentist **, C, E1-2, E3-4

Dr. Paul HenneganBright Now Dental - Colorado Springs -

Academy-Woodmen AdpADP #244 7136 N. Academy Blvd. 719-452-4120 Colorado Springs General Dentist *, **, C, E1-2, E3-4

Dr. Tracie E. KellerBright Now Dental - Colorado Springs -


Dr. Craig A. MellorBright Now Dental - Colorado Springs -


Page 6 of 24



Dr. Thomas MulheranBright Now Dental - Colorado Springs -


Dr. Curtis BroekerBright Now Dental - Colorado Springs -


Dr. Arnold Cullum Lowell District Dental, PC ADP #247 251 E. Fountain, #100 719-473-4300 Colorado Springs General Dentist *, E1-2, E3-4

Dr. Kathleen Bower Stafford Dental Group ADP #25 559 E. Pikes Peak Ave., #208 719-636-3311 Colorado Springs General Dentist **, E1-2, E3-4

Dr. Leopoldo Rodriquez Stafford Dental Group ADP #25 559 E. Pikes Peak Ave., #208 719-636-3311 Colorado Springs General Dentist **, E1-2, E3-4

Dr. James Kalhorn Stafford Dental Group ADP #25 559 E. Pikes Peak Ave., #208 719-636-3311 Colorado Springs General Dentist **, E1-2, E3-4

Dr. Dwayne A. Moore Woodmen View Dentistry ADP #263 3210 E. Woodmen Rd. #200 719-358-6998 Colorado Springs General Dentist **, C, E1-2, E3-4

Dr. Howard Short Dr. Howard Short ADP #268 5739 Constitution Ave. 719-574-7631 Colorado Springs General Dentist C

Dr. Tracie E. Keller Tracie E. Keller DDS ADP #275 6760 Corporate Drive Suite 270 719-528-8822 Colorado Springs General Dentist *, C, E1-2, E3-4

Dr. Thomas Mulheran Bright Now Dental - Citadel Dr. Adp ADP #50 701 Citadel Dr. East 719-574-7288 Colorado Springs General Dentist **, C, E1-2, E3-4, N

Dr. Tracie E. Keller Bright Now Dental - Citadel Dr. Adp ADP #50 701 Citadel Dr. East 719-574-7288 Colorado Springs General Dentist **, C, E1-2, E3-4, N

Dr. Curtis Broeker Bright Now Dental - Citadel Dr. Adp ADP #50 701 Citadel Dr. East 719-574-7288 Colorado Springs General Dentist **, C, E1-2, E3-4, N

Dr. Michael Miller Bright Now Dental - Citadel Dr. Adp ADP #50 701 Citadel Dr. East 719-574-7288 Colorado Springs General Dentist **, C, E1-2, E3-4, N

Dr. Craig A. Mellor Bright Now Dental - Citadel Dr. Adp ADP #50 701 Citadel Dr. East 719-574-7288 Colorado Springs General Dentist **, C, E1-2, E3-4, N

Dr. Paul Rodr Guez Dr. Paul Rodríguez ADP #77 703 N. Tejon St., #d 719-633-5501 Colorado Springs General Dentist **, C, E1-2, E3-4

Dr. Leopoldo Rodríguez Jade Dental Associates ADP #89 703 N. Tejon St., #a 719-633-0770 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Paul Rygg Jade Dental Associates ADP #89 703 N. Tejon St., #a 719-633-0770 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Natalie Jones Comfort Dental - North Academy ADP #9 1634 York Rd. 719-522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4

Dr. Robert B. Wyeth Comfort Dental - North Academy ADP #9 1634 York Rd. 719-522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4

Dr. Peter Lovejoy Comfort Dental - North Academy ADP #9 1634 York Rd. 719-522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4

Dr. Rachel Ross Comfort Dental -Commerce City ADP #192 7201 Monaco St. 303-287-2755 Commerce City General Dentist *, **, C, E1-2, E3-4

Dr. Owen Eames Comfort Dental -Commerce City ADP #192 7201 Monaco St. 303-287-2755 Commerce City General Dentist *, **, C, E1-2, E3-4

Dr. Ramsey Warner Comfort Dental -Commerce City ADP #192 7201 Monaco St. 303-287-2755 Commerce City General Dentist *, **, C, E1-2, E3-4

Dr. Todd Rinaldi Todd Rinaldi ADP #238 7270 Magnolia St. 303-399-4350 Commerce City General Dentist *, **, C, E1-2, E3-4

Dr. Brandon Braud Brandon M. Braud, DDS. ADP #256 7230 Locust Street 303-289-2831 Commerce City General Dentist *, **, E1-2, E3-4

Dr. Jacqueline Blasko Comfort Dental-Conifer ADP #101 25597 Conifer Rd. 303-838-2811 Conifer General Dentist *, **, C, E1-2, E3-4

Dr. Teniel Seifert Comfort Dental-Conifer ADP #101 25597 Conifer Rd. 303-838-2811 Conifer General Dentist *, **, C, E1-2, E3-4

Page 7 of 24



Dr. Grace Jeong Comfort Dental-Conifer ADP #101 25597 Conifer Rd. 303-838-2811 Conifer General Dentist *, **, C, E1-2, E3-4

Dr. Jason Mahoney Comfort Dental-Conifer ADP #101 25597 Conifer Rd. 303-838-2811 Conifer General Dentist *, **, C, E1-2, E3-4

Dr. James Parfitt Comfort Dental - Mile High ADP # 237 881 N. Federal Blvd. 303-825-0013 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Matthew Carlston Comfort Dental - Mile High ADP # 237 881 N. Federal Blvd. 303-825-0013 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Lyda Martinez Comfort Dental - North Denver ADP #113 4450 W. 38th Ave., #110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4

Dr. John Adams Comfort Dental - North Denver ADP #113 4450 W. 38th Ave., #110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Robert Unrath Comfort Dental - North Denver ADP #113 4450 W. 38th Ave., #110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Gary Saddler Comfort Dental - North Denver ADP #113 4450 W. 38th Ave., #110 303-455-2273 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Alan Coombs Alpha Dental Ii, PC ADP #12 1660 S. Albion, #715 303-758-4287 Denver General Dentist **

Dr. Jason Ray Hampden Family Dental ADP #124 7090 E. Hampden Ave., #-A 303-758-1113 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Thomas Sniegowski Dr. Thomas Sniegowski ADP #151 7475 Dakin St., Ste. #309 303-429-2727 Denver General Dentist *, E3-4, N

Dr. Mark Jolsted Comfort Dental - Cherry Creek ADP #183 201 University Blvd., #101 303-321-2233 Denver General Dentist *, C, E1-2, E3-4

Dr. Todd Light Comfort Dental - Cherry Creek ADP #183 201 University Blvd., #101 303-321-2233 Denver General Dentist *, C, E1-2, E3-4

Dr. Richard H. Koch Greentree Dental ADP #204 10101 E. Hampden Ave., #100 303-671-0101 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Douglas R. Koch Greentree Dental ADP #204 10101 E. Hampden Ave., #100 303-671-0101 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Malgorzata R. Korosciel Southeast Denver Dental Associates ADP #211 2660 S. Monaco Pkwy. 303-757-7175 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Jon Hanchett Comfort Dental - Southeast ADP #245 3488 S. Willow St. 303-338-8181 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Amy Hazen Comfort Dental - Southeast ADP #245 3488 S. Willow St. 303-338-8181 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Mario Martinez Comfort Dental - Southeast ADP #245 3488 S. Willow St. 303-338-8181 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Arnold Cullum Blake Street Dental, PC ADP #248 1732 Blake St. 303-814-2200 Denver General Dentist *, E1-2, E3-4

Dr. Gary Rotolo Comfort Dental - East Colfax ADP #26 5200 E. Colfax Ave. 303-377-3876 Denver General Dentist *, **, C, E1-2

Dr. Donald Mardis Comfort Dental - East Colfax ADP #26 5200 E. Colfax Ave. 303-377-3876 Denver General Dentist *, **, C, E1-2

Dr. Jeff D. Johnston Ascent Dental Group ADP #271 4500 Cherry Creek Dr. South 303-975-6987 Denver General Dentist *, C, E1-2, E3-4

Dr. Thomas Pyne Dr. Thomas Pyne ADP #29 12075 E. 45th Ave., #333 303-371-9131 Denver General Dentist *, C, E1-2, E3-4

Dr. Kristin Lere Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Thomas Mulheran Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Manisha Patil Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

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Dr. Jack F. Emmons Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. David Bryant Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Leigh A. Stephens Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Aseel D Hasan Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Ekatrina Butkevich Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. James A. Fischer Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Semiramida Condoianis Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Barbara Heupel-Chapman Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Mark Lawson Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Michael Gioia Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Paul Pantleo Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Matthew Young Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Yehia Elgohary Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Gilbert Vigil Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Jeffrey Patrician Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Craig A. Mellor Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Sampath Vidhyalakshmi Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Mariano De La Riva Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Lindsey Schroepfer Bright Now Dental - Denver Downtown Adp ADP #30 1955 Arapahoe St., Ste. A 303-296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Lindsey Schroepfer Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Paul Pantleo Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Mirela Giurgiu Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Tiffany Fritz Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Craig A. Mellor Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Gilbert Vigil Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Ekatrina Butkevich Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. James A. Fischer Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Page 9 of 24



Dr. Charles Woyda Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Leigh A. Stephens Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Hyunseo Park Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Semiramida Condoianis Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. David Bryant Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Manisha Patil Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. David Koo Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Thomas Mulheran Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Sampath Vidhyalakshmi Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Kristin Lere Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Julio Sekler Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Aseel D Hasan Bright Now Dental - Cherry Creek Adp ADP #47 3865 Cherry Creek Dr. North, #200 303-321-1181 Denver General Dentist C, N

Dr. Jessica Klein Gentle Smiles Of Colorado ADP #53 2709 S. Colorado Blvd. 303-756-2770 Denver General Dentist C, E1-2, E3-4

Dr. Timothy Wachuta Gentle Smiles Of Colorado ADP #53 2709 S. Colorado Blvd. 303-756-2770 Denver General Dentist C, E1-2, E3-4

Dr. Kenneth Chernoff Gentle Smiles Of Colorado ADP #53 2709 S. Colorado Blvd. 303-756-2770 Denver General Dentist C, E1-2, E3-4

Dr. Melissa J. Hinze Gentle Smiles Of Colorado ADP #53 2709 S. Colorado Blvd. 303-756-2770 Denver General Dentist C, E1-2, E3-4

Dr. Kelly White Auraria Dental Centre ADP #96 1050 W. Colfax, Ste. G 303-573-5533 Denver General Dentist **, E1-2, E3-4

Dr. Semiramida Condoianis Dentistry 360 ADP# 233 5140 W. Dartmonth Ave. 720-596-4760 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Jason Ray Dentistry At Lincoln Center ADP #126 12501 E. Lincoln Ave., #-102 303-768-8137 Englewood General Dentist **, C, E1-2, E3-4

Dr. Laura D Ellefson Little Smiles Dental Care ADP #258 101 W. Hampden Ave. #a 303-761-1126 Englewood General Dentist *, **, C, E1-2, E3-4

Dr. Benjamin J Bullen Comfort Dental - Englewood ADP #45 2780 S. Broadway 303-783-0100 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. Larry Nessel Comfort Dental - Englewood ADP #45 2780 S. Broadway 303-783-0100 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. James M. Brown Comfort Dental - Englewood ADP #45 2780 S. Broadway 303-783-0100 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. Hillery J. Oliver Comfort Dental - Englewood ADP #45 2780 S. Broadway 303-783-0100 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. Gary Rotolo Comfort Dental - Evergreen ADP #229 1232 Bergen Parkway 303-674-6070 Evergreen General Dentist *, C, E1-2, E3-4

Dr. Snahel Prajapati Comfort Dental - Evergreen ADP #229 1232 Bergen Parkway 303-674-6070 Evergreen General Dentist *, C, E1-2, E3-4

Dr. Michael J Mierzejewski Comfort Dental-Westminster ADP #125 10350 N. Federal Blvd., #300 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4

Page 10 of 24



Dr. Arthur Abercrombie Comfort Dental-Westminster ADP #125 10350 N. Federal Blvd., #300 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4

Dr. Helen Stella Comfort Dental-Westminster ADP #125 10350 N. Federal Blvd., #300 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4

Dr. Hiba Kellow Comfort Dental-Westminster ADP #125 10350 N. Federal Blvd., #300 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4

Dr. Cory S. Higginbotham Comfort Dental-Westminster ADP #125 10350 N. Federal Blvd., #300 303-427-2722 Federal Heights General Dentist *, **, C, E1-2, E3-4

Dr. Nathan Eames Comfort Dental- South College ADP #216 4032 S. College Ave., #a-1 970-225-2273 Fort Collins General Dentist *, **, C, E1-2, E3-4

Dr. Andrea M. Mustian Comfort Dental- South College ADP #216 4032 S. College Ave., #a-1 970-225-2273 Fort Collins General Dentist *, **, C, E1-2, E3-4

Dr. Brandon Bohn Comfort Dental- South College ADP #216 4032 S. College Ave., #a-1 970-225-2273 Fort Collins General Dentist *, **, C, E1-2, E3-4

Dr. David Whitlock Comfort Dental- South College ADP #216 4032 S. College Ave., #a-1 970-225-2273 Fort Collins General Dentist *, **, C, E1-2, E3-4

Dr. Ryan Workman Comfort Dental- South College ADP #216 4032 S. College Ave., #a-1 970-225-2273 Fort Collins General Dentist *, **, C, E1-2, E3-4

Dr. Jamie Fillmore Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N

Dr. Douglas Haschke Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N

Dr. Alois Tripam Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N

Dr. Katerina Sorensen Comfort Dental - Ft. Collins ADP #32 934 S. Lemay 970-498-8300 Fort Collins General Dentist C, E1-2, N

Dr. Thomas Mulheran Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Geoffery Dilbert Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Ethelyn G Thomason Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Christopher C Friedl Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Yehia Elgohary Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Scott Bares Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Craig A. Mellor Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Jack F. Emmons Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Mariano De La Riva Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. James A. Fischer Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Julio Sekler Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Paul Avery Bright Now Dental - Fort Collins Adp ADP #38 3531 S. College Ave., #110 #5 970-498-8706 Fort Collins General Dentist C, E1-2

Dr. Thomas L. Losacco Dr. Thomas L. Losacco ADP #8 801 6th St. 303-569-3141 Georgetown General Dentist *, C, E1-2, E3-4, N

Dr. Benjamin D. Coon Glenwood Meadows Dental ADP #178 40 - A Market Street 970-947-1717 Glenwood Springs General Dentist **, C, E1-2, E3-4

Page 11 of 24



Dr. Brian Talley Comfort Dental - Glenwood Springs ADP #91 1512 Grand Ave. 970-947-1273 Glenwood Springs General Dentist *, **, C, E1-2, E3-4

Dr. Michael Shea Comfort Dental - Glenwood Springs ADP #91 1512 Grand Ave. 970-947-1273 Glenwood Springs General Dentist *, **, C, E1-2, E3-4

Dr. Kenneth Chernoff Gentle Smiles Of Colorado ADP #128 2305 Jackson St. 303-278-2800 Golden General Dentist C, E1-2, E3-4

Dr. Timothy Wachuta Gentle Smiles Of Colorado ADP #128 2305 Jackson St. 303-278-2800 Golden General Dentist C, E1-2, E3-4

Dr. Melissa J. Hinze Gentle Smiles Of Colorado ADP #128 2305 Jackson St. 303-278-2800 Golden General Dentist C, E1-2, E3-4

Dr. Jessica Klein Gentle Smiles Of Colorado ADP #128 2305 Jackson St. 303-278-2800 Golden General Dentist C, E1-2, E3-4

Dr. Scott Welch Golden View Dental ADP #210 727 Simms St., #e 303-232-3636 Golden General Dentist *, **, C, E1-2, E3-4

Dr. Nicholas L. Groneman Comfort Dental - Golden ADP #90 17531 S. Golden Rd. 303-278-6953 Golden General Dentist *, **, C, E1-2, E3-4

Dr. Paulette Dilizia Comfort Dental - Golden ADP #90 17531 S. Golden Rd. 303-278-6953 Golden General Dentist *, **, C, E1-2, E3-4

Dr. Heath Colledge Comfort Dental - Golden ADP #90 17531 S. Golden Rd. 303-278-6953 Golden General Dentist *, **, C, E1-2, E3-4

Dr. James M. Tarr Dr. James M. Tarr ADP #102 2531 W. Pinyon Ave. 970-242-5367 Grand Junction General Dentist C, E1-2

Dr. Matthew Hudson Hudson Family Dental ADP #208 132 Walnut Ave., #-6 970-242-5151 Grand Junction General Dentist *, C

Dr. Joshua Hollingshead Comfort Dental - G.J. West ADP #252 2502 Highway 6 & 50 #700 970-241-2080 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. Jeffery Greene Comfort Dental - G.J. West ADP #252 2502 Highway 6 & 50 #700 970-241-2080 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. Jason Noah Comfort Dental - G.J. West ADP #252 2502 Highway 6 & 50 #700 970-241-2080 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. John A. Wood` John A. Wood, DDS ADP #269 102 Lorey Drive 970-242-4945 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. Scott Stoddard Comfort Dental-Grand Junction ADP #61 2650 North Ave. 970-255-1222 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. Tyson Black Comfort Dental-Grand Junction ADP #61 2650 North Ave. 970-255-1222 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. Nicolas Gandola Comfort Dental-Grand Junction ADP #61 2650 North Ave. 970-255-1222 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. James Bradley Comfort Dental-Grand Junction ADP #61 2650 North Ave. 970-255-1222 Grand Junction General Dentist *, **, C, E1-2, E3-4

Dr. Eric Benefield Grand Dental ADP #86 1035 Grand Ave. 970-243-8580 Grand Junction General Dentist *, C, E1-2, E3-4

Dr. Stephen Brown Dr. Stephen Brown ADP #65 3400 W. 16th St., Bldg. 3, Ste. S 970-356-8118 Greeley General Dentist **, E1-2

Dr. Patrick Rinaldis Comfort Dental - Greeley ADP #67 3766 West 10th St. 970-304-1273 Greeley General Dentist **, C, E1-2, E3-4

Dr. Courtney Stevens Comfort Dental - Greeley ADP #67 3766 West 10th St. 970-304-1273 Greeley General Dentist **, C, E1-2, E3-4

Dr. Andrey A. Kondratenko Comfort Dental - Greeley ADP #67 3766 West 10th St. 970-304-1273 Greeley General Dentist **, C, E1-2, E3-4

Dr. Kent Day Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Dinorah Moya Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Page 12 of 24



Dr. Patrick Harrison Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Shivaun Mcartor Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Alex Knecht Sunrise Dental Center ADP #83 1006 A. St. 970-352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Michael Miller Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Craig A. Mellor Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Michael Gioia Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Tiffany Fritz Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Hyunseo Park Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Mirela Giurgiu Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Tracie E. Keller Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Ekatrina Butkevich Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. James A. Fischer Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Semiramida Condoianis Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Curtis Broeker Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Manisha Patil Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Mark Lawson Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Wameedh A Abdulameer Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Symone Webley Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Charles Woyda Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Thomas Mulheran Bright Now Dental - Highlands Ranch Adp ADP #93 3626 Highlands Ranch Pkwy., #107 303-471-0841 Highlands Ranch General Dentist *, **, E1-2, E3-4, N

Dr. Jarom Paice Comfort Dental - Lafayette ADP #187 535 W. South Boulder Rd., #200 303-604-2804 Lafayette General Dentist *, **, C, E1-2, E3-4

Dr. Marc Yasoni Comfort Dental - Lafayette ADP #187 535 W. South Boulder Rd., #200 303-604-2804 Lafayette General Dentist *, **, C, E1-2, E3-4

Dr. Evan Kneale Comfort Dental - Lafayette ADP #187 535 W. South Boulder Rd., #200 303-604-2804 Lafayette General Dentist *, **, C, E1-2, E3-4

Dr. Jack F. Emmons 95th Street Dental ADP #227 1373 Forest Park Circle, #103 303-666-7773 Lafayette General Dentist *, **, C, E1-2, E3-4

Dr. Daniel G. Hill Professional Dental Group ADP #270 1120 W. South Boulder Road 720-638-2169 Lafayette General Dentist *, **, C, E1-2, E3-4

Dr. Efren Martinez Dr. Efren Martinez ADP #130 1200 S. Wadsworth 303-733-7533 Lakewood General Dentist **, E1-2, E3-4

Dr. Jace Williamson Comfort Dental- Green Mountain ADP #220 12810 W. Alameda Ave. 303-987-2273 Lakewood General Dentist *, **, C, E1-2, E3-4

Page 13 of 24



Dr. Andreea Torok Comfort Dental- Green Mountain ADP #220 12810 W. Alameda Ave. 303-987-2273 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Jackson Nguyen Comfort Dental- Green Mountain ADP #220 12810 W. Alameda Ave. 303-987-2273 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Joesolyn Caldron-Kidd Comfort Dental- Bear Creek ADP #222 3200 S. Wadsworth Blvd., #e 303-716-8546 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Eloisa Lovato Comfort Dental- Bear Creek ADP #222 3200 S. Wadsworth Blvd., #e 303-716-8546 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Jeffrey Bernardy Comfort Dental- Bear Creek ADP #222 3200 S. Wadsworth Blvd., #e 303-716-8546 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Khiem Duy Hoang-Xuan Dk Dental ADP #239 95 C S. Sheridan Blvd. 720-524-3959 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Benjamin Butler Comfort Dental - Lakewood ADP #260 6800 W. Alameda 303-727-9100 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Nathan Eames Comfort Dental - Lakewood ADP #260 6800 W. Alameda 303-727-9100 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Pat Flood Comfort Dental - Lakewood ADP #260 6800 W. Alameda 303-727-9100 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Colin Barton Comfort Dental - Lakewood ADP #260 6800 W. Alameda 303-727-9100 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Dale Steen Comfort Dental - Lakewood ADP #260 6800 W. Alameda 303-727-9100 Lakewood General Dentist *, **, C, E1-2, E3-4

Dr. Richard Glucksman Alpha Dental Xx ADP #3 7373 W. Jefferson, #203 303-988-1530 Lakewood General Dentist *

Dr. Wameedh A Abdulameer Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Symone Webley Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Charles Woyda Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Manisha Patil Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Thomas Mulheran Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Sampath Vidhyalakshmi Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. David Bryant Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Ekatrina Butkevich Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Michael Gioia Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Lindsey Schroepfer Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Jeffrey Patrician Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Matthew Young Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. James A. Fischer Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Jennifer K. Lee Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Craig A. Mellor Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Page 14 of 24



Dr. Mirela Giurgiu Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Michael Miller Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Gilbert Vigil Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Paul Pantleo Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Barbara Heupel-Chapman Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Leigh A. Stephens Bright Now Dental - Lakewood Adp ADP #92 7611 W. Colfax Ave., #d 303-202-0900 Lakewood General Dentist *, C, E1-2

Dr. Sonia Grewal Highplains Community Health Center ADP #54 200 Kendall Drive 719-336-8445 Lamar General Dentist **, C, E1-2

Dr. Salvador Ramirez Highplains Community Health Center ADP #54 200 Kendall Drive 719-336-8445 Lamar General Dentist **, C, E1-2

Dr. Angela Nagel Highplains Community Health Center ADP #54 200 Kendall Drive 719-336-8445 Lamar General Dentist **, C, E1-2

Dr. Richard Phillips Highplains Community Health Center ADP #54 200 Kendall Drive 719-336-8445 Lamar General Dentist **, C, E1-2

Dr. Kyle R Lambert Lasalle Family Dentistry ADP #23 202 2nd St. 970-284-7730 Lasalle General Dentist **, C

Dr. Richard J. Birkel Comfort Dental- Littleton Blvd. ADP #132 209-B W. Littleton Blvd. 303-734-2273 Littleton General Dentist *, **, C, E1-2, E3-4, N

Dr. Jeffrey Spiegel Comfort Dental- Littleton Blvd. ADP #132 209-B W. Littleton Blvd. 303-734-2273 Littleton General Dentist *, **, C, E1-2, E3-4, N

Dr. Bruce H. Johnson Bruce H. Johnson ADP #140 7641 Shaffer Pkwy 303-989-0577 Littleton General Dentist *, **, C, E1-2

Dr. David Kim Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4

Dr. Thomas Klumb Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4

Dr. Bill Oldershaw Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4

Dr. Brad Weekes Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. 303-904-2273 Littleton General Dentist *, C, E1-2, E3-4

Dr. Katrina Rojohn Comfort Dental- Belleview & Simms ADP #217 11625 W. Belleview 303-972-8700 Littleton General Dentist *, **, C, E1-2, E3-4

Dr. Tam Than Comfort Dental- Belleview & Simms ADP #217 11625 W. Belleview 303-972-8700 Littleton General Dentist *, **, C, E1-2, E3-4

Dr. Jason Heintz Comfort Dental- Belleview & Simms ADP #217 11625 W. Belleview 303-972-8700 Littleton General Dentist *, **, C, E1-2, E3-4

Dr. Nancy Cashman Southwest Adult Dentistry ADP #273 6931 S. Pierce St. 720-974-2500 Littleton General Dentist *, **, E1-2, E3-4

Dr. Matthew Stevens Comfort Dental - Highlands Ranch ADP #40 91 W. Mineral Ave. #150 303-738-9499 Littleton General Dentist *, **, C, E1-2, E3-4

Dr. Nina Gomenyuk Comfort Dental - Highlands Ranch ADP #40 91 W. Mineral Ave. #150 303-738-9499 Littleton General Dentist *, **, C, E1-2, E3-4

Dr. Michael Love Comfort Dental - Highlands Ranch ADP #40 91 W. Mineral Ave. #150 303-738-9499 Littleton General Dentist *, **, C, E1-2, E3-4

Dr. William D Mcreynolds Comfort Dental - Highlands Ranch ADP #40 91 W. Mineral Ave. #150 303-738-9499 Littleton General Dentist *, **, C, E1-2, E3-4

Dr. Ellias Najjar Belleview Dental Associates ADP #69 10184 W. Belleview 303-932-1077 Littleton General Dentist *

Page 15 of 24



Dr. Margareta Pavel Dutch Creek Dental ADP #78 8370 W. Coal Mine Ave., #103 303-978-1522 Littleton General Dentist *, C, E1-2, E3-4

Dr. Eric Walker Classic Dental, Ltd. ADP #230 10047 Park Meadows Dr., #b 303-768-8848 Lone Tree General Dentist **, C, E1-2, E3-4

Dr. Conrad Stutznegger Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4

Dr. Aaron D. Mortensen Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4

Dr. Stephen Sidwell Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4

Dr. Jolly Johnson Comfort Dental - Longmont ADP #156 1750 Mountain View 303-678-7783 Longmont General Dentist *, **, C, E1-2, E3-4

Dr. Craig G. Larson Larson Family Dentistry ADP #242 2051 Terry St. #f 303-678-7232 Longmont General Dentist **, C, E1-2, E3-4

Dr. Jack F. Emmons Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Yehia Elgohary Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Craig A. Mellor Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. James A. Fischer Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Geoffery Dilbert Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Julio Sekler Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Jeffrey Patrician Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Mariano De La Riva Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Brandon Murri Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Thomas Mulheran Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. David R. Maki Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. David Bryant Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Christopher C Friedl Bright Now Dental - Longmont Adp ADP #59 15 Ken Pratt Blvd., #280 303-678-1155 Longmont General Dentist *, C, E1-2, E3-4

Dr. Heath Colledge Comfort Dental - Louisville ADP #17 339 Mccaslin Blvd., #b 303-673-0500 Louisville General Dentist *, **, C, E1-2, E3-4

Dr. Ryan T Leary Comfort Dental - Louisville ADP #17 339 Mccaslin Blvd., #b 303-673-0500 Louisville General Dentist *, **, C, E1-2, E3-4

Dr. Eric B Boucher Comfort Dental - Louisville ADP #17 339 Mccaslin Blvd., #b 303-673-0500 Louisville General Dentist *, **, C, E1-2, E3-4

Dr. Nicholas L. Groneman Comfort Dental - Louisville ADP #17 339 Mccaslin Blvd., #b 303-673-0500 Louisville General Dentist *, **, C, E1-2, E3-4

Dr. Joanne L Bancroft Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Jack F. Emmons Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Mariano De La Riva Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Page 16 of 24



Dr. Yehia Elgohary Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Craig A. Mellor Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Geoffery Dilbert Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Ethelyn G Thomason Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Jeffrey Patrician Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Christopher C Friedl Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Ekatrina Butkevich Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. David Bryant Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. Thomas Mulheran Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Dr. James A. Fischer Bright Now Dental - Loveland ADP #146 1440 W. 29th St., #400 970-622-0922 Loveland General Dentist **, E1-2

Page 17 of 24



Dr. Gregory S. Winslow Comfort Dental- North Loveland ADP #193 274 W. 64th St. 970-667-0446 Loveland General Dentist **, C, E1-2, E3-4

Dr. Mikal Lindman Comfort Dental- North Loveland ADP #193 274 W. 64th St. 970-667-0446 Loveland General Dentist **, C, E1-2, E3-4

Dr. Jeffery Bourne Comfort Dental- North Loveland ADP #193 274 W. 64th St. 970-667-0446 Loveland General Dentist **, C, E1-2, E3-4

Dr. Patrick Harrison Loveland Community Health Center ADP #87 450 N. Cleveland Ave. 970-461-8942 Loveland General Dentist *, **, C, E1-2, E3-4

Dr. Victoria L. Driskill Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4

Dr. Michael Gioia Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4

Dr. Steve Carter Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4

Dr. Christopher Hasselback Comfort Dental-Monument ADP #142 556 W. Highway 105 719-484-0043 Monument General Dentist *, C, E1-2, E3-4

Dr. Stewart Moss Stuart Moss & Associates ADP #4 421 W. 104th Ave., #201 303-427-6462 Northglenn General Dentist *, **, E1-2, N

Dr. Ronald J. Freimuth Comfort Dental - Parker ADP #111 12870 Stroh Ranch Court 303-840-6543 Parker General Dentist *, C, E1-2, E3-4, N

Dr. Scott Henderson Comfort Dental - Parker ADP #111 12870 Stroh Ranch Court 303-840-6543 Parker General Dentist *, C, E1-2, E3-4, N

Dr. Nathaniel M. Sherman Comfort Dental - Parker ADP #111 12870 Stroh Ranch Court 303-840-6543 Parker General Dentist *, C, E1-2, E3-4, N

Dr. Michael A. Holm Comfort Dental - Parker ADP #111 12870 Stroh Ranch Court 303-840-6543 Parker General Dentist *, C, E1-2, E3-4, N

Dr. Michael Miller Foxfield Dental ADP #207 16350 E. Arapahoe Rd., #-114 720-870-0401 Parker General Dentist *, **, C, E1-2, E3-4

Dr. Paul Pantleo Bright Now Dental - Parker Adp ADP #234 11183 S. Parker Rd., #c 303-209-2245 Parker General Dentist *, **, C, E1-2, E3-4

Dr. Ethelyn G Thomason Bright Now Dental - Parker Adp ADP #234 11183 S. Parker Rd., #c 303-209-2245 Parker General Dentist *, **, C, E1-2, E3-4

Dr. Mark Lawson Bright Now Dental - Parker Adp ADP #234 11183 S. Parker Rd., #c 303-209-2245 Parker General Dentist *, **, C, E1-2, E3-4

Dr. Sampath Vidhyalakshmi Bright Now Dental - Parker Adp ADP #234 11183 S. Parker Rd., #c 303-209-2245 Parker General Dentist *, **, C, E1-2, E3-4

Dr. Craig A. Mellor Bright Now Dental - Parker Adp ADP #234 11183 S. Parker Rd., #c 303-209-2245 Parker General Dentist *, **, C, E1-2, E3-4

Dr. Symone Webley Bright Now Dental - Parker Adp ADP #234 11183 S. Parker Rd., #c 303-209-2245 Parker General Dentist *, **, C, E1-2, E3-4

Dr. Daniel Larscheid Floss Dental ADP #255 10233 S. Parker Rd. #203 303-927-0562 Parker General Dentist *, C, E1-2, E3-4

Dr. Michael G. Hale Dr. Michael G. Hale ADP #27 19751 E. Mainstreet, #r16 303-841-3322 Parker General Dentist C, N

Dr. Joel Stafford Comfort Dental-Falcon Hills ADP #127 11605 Meridian Market View, #154 719-495-8989 Peyton General Dentist *, **, C, E1-2, E3-4

Dr. Jonathan Harvey Comfort Dental-Falcon Hills ADP #127 11605 Meridian Market View, #154 719-495-8989 Peyton General Dentist *, **, C, E1-2, E3-4

Dr. Chad J. Murdock Comfort Dental-Falcon Hills ADP #127 11605 Meridian Market View, #154 719-495-8989 Peyton General Dentist *, **, C, E1-2, E3-4

Dr. Anthony Knowlton Dr. Anthony Knowlton ADP #42 3939 Sandalwood Lane 719-564-5833 Pueblo General Dentist *, C, E1-2, E3-4, N

Dr. Richard C. Moreschini Dr. Richard C. Moreschini ADP #52 1000 W. 6th St. 719-542-7420 Pueblo General Dentist C, E1-2, N

Page 18 of 24



Dr. Phillip Holden Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, #a 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Karleen L. Trefil Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, #a 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Elden M. Rice Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, #a 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Brady T. Smith Comfort Dental - Pueblo - North ADP #63 2025 W. Us Hwy. 50, #a 100 719-542-2472 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Steven P. Rose Comfort Dental - Pueblo - South Adp ADP #80 1221 S. Pueblo Blvd. 719-565-2274 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Bradley Michael Almond Comfort Dental - Pueblo - South Adp ADP #80 1221 S. Pueblo Blvd. 719-565-2274 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Ralph Downey Comfort Dental - Pueblo - South Adp ADP #80 1221 S. Pueblo Blvd. 719-565-2274 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Jeffery A. Moeller Comfort Dental - Pueblo - South Adp ADP #80 1221 S. Pueblo Blvd. 719-565-2274 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Gino Ortegon Dr. Gino Ortegon ADP #85 401 W.12th St. 719-583-0555 Pueblo General Dentist **, C, E1-2, N

Dr. Gary Graves Dr. Gary Graves ADP #99 1345 S. Pueblo Blvd. 719-542-3595 Pueblo General Dentist *, **, C, E1-2

Dr. Lorraine Mundy Comfort Dental- Summit County Adp ADP #64 354 Blue River Pkwy, #a 970-262-2273 Silverthorne General Dentist *, C, E1-2, E3-4

Dr. John Rollow, Iv Comfort Dental- Summit County Adp ADP #64 354 Blue River Pkwy, #a 970-262-2273 Silverthorne General Dentist *, C, E1-2, E3-4

Dr. Randall C. Jones Randall C. Jones ADP #15 1402 S. 3rd Ave. 970-522-6280 Sterling General Dentist *, C, E1-2, E3-4

Dr. Lindsey Schroepfer Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Luan K. Tran Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Julio Sekler Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Thomas Mulheran Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Gilbert Vigil Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Kristin Lere Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Christopher C Friedl Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Ethelyn G Thomason Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Aseel D Hasan Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Brandon Murri Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Jack F. Emmons Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Page 19 of 24



Dr. Geoffery Dilbert Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Sampath Vidhyalakshmi Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Leigh A. Stephens Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Hyunseo Park Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Ekatrina Butkevich Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Mariano De La Riva Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Matthew Young Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Barbara Heupel-Chapman Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Yehia Elgohary Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Travis Willey Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. James A. Fischer Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Joanne L Bancroft Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Craig A. Mellor Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Jeffrey Patrician Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. David Bryant Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Wameedh A Abdulameer Bright Now Dental - Westminster Adp ADP #121 3003 W. 104th Avenue 303-410-9800 Westminster General Dentist C, E1-2

Dr. Constanza Cubillos Comfort Dental-80th & Sheridan ADP #223 7990 N. Sheridan Blvd. 303-650-4101 Westminster General Dentist *, **, C, E1-2, E3-4

Dr. Ryan Mangrum Comfort Dental-80th & Sheridan ADP #223 7990 N. Sheridan Blvd. 303-650-4101 Westminster General Dentist *, **, C, E1-2, E3-4

Dr. Ian Ferguson Comfort Dental-80th & Sheridan ADP #223 7990 N. Sheridan Blvd. 303-650-4101 Westminster General Dentist *, **, C, E1-2, E3-4

Dr. Sara Marchbanks Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave, #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Dr. Christopher Hasselback Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave, #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Dr. Lewis Sherman Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave, #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Dr. William Mcglashan Comfort Dental - Wheat Ridge ADP #153 9990 W. 26th Ave, #100 303-232-4500 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Dr. Joseph Stoll Joseph Stoll ADP #253 7015 W 38th Ave 303-940-9755 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Dr. Kelvan C Luff Bel-Aire Dental Partners ADP #261 3815 N. Wadsworth Blvd. 720-536-0400 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Dr. Stephen Spencer Bel-Aire Dental Partners ADP #261 3815 N. Wadsworth Blvd. 720-536-0400 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Page 20 of 24



Dr. Travis K Rust Bel-Aire Dental Partners ADP #261 3815 N. Wadsworth Blvd. 720-536-0400 Wheat Ridge General Dentist *, **, C, E1-2, E3-4

Dr. Melissa J. Hinze Gentle Smiles Of Colorado ADP #267 8850 W. 38th Ave. Suite D 303-425-5100 Wheat Ridge General Dentist C, E1-2, E3-4

Dr. Timothy Wachuta Gentle Smiles Of Colorado ADP #267 8850 W. 38th Ave. Suite D 303-425-5100 Wheat Ridge General Dentist C, E1-2, E3-4

Dr. Kelvan C Luff Bright Now Dental - Arvada Not Needed 7985 Wadsworth Blvd., #b 303-209-2250 Arvada Orthodontist N/A

Dr. James H. Mason Colo Orthodontics Not Needed 6390 Gardenia St., #200 303-421-2616 Arvada Orthodontist N/A

Dr. Galen L. Callender Galen L. Callender Not Needed 7207 Grandview Ave. 303-421-1984 Arvada Orthodontist N/A

Dr. Hilary Neilberg-Baskin All About Braces Not Needed 15159 E. Colfax Ave. #b 303-476-6233 Aurora Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Aurora - S. Tower Rd. Not Needed 3551 S. Tower Rd., #c 303-400-3669 Aurora Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Smoky Hill Not Needed 23963 Prospect Ave, #e 303-400-9898 Aurora Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Smoky Hill Not Needed 23963 Prospect Ave, #e 303-400-9898 Aurora Orthodontist N/A

Dr. James H. Mason Colo Orthodontics Not Needed 2993 S. Peoria St., #260 303-751-5700 Aurora Orthodontist N/A

Dr. John Bailey Colo Orthodontics Not Needed 2993 S. Peoria St., #260 303-751-5700 Aurora Orthodontist N/A

Dr. Randall Snyder Comfort Dental - Havana Not Needed 10401 E. Colfax Ave., #150 303-344-2273 Aurora Orthodontist N/A

Dr. Jack E. Duran Dr. Jack E. Duran Not Needed 13701 E. Mississippi Ave., # 360 303-789-9257 Aurora Orthodontist N/A

Dr. Jennifer Berwick Ohmart Orthodontics Not Needed 25521 E. Smoky Hill Road, #200 303-586-5750 Aurora Orthodontist N/A

Dr. Roy M. Lorenz Roy M. Lorenz, DMD, MS Not Needed 14991 E. Hampden Ave., #320 303-690-2333 Aurora Orthodontist N/A

Dr. John Walker Dr. John Walker Not Needed 350 Broadway, #120 303-494-3535 Boulder Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Castle Rock Not Needed 188 Founders Parkway, Unit A 303-668-0252 Castle Rock Orthodontist N/A

Dr. Randall Snyder Comfort Kids South Not Needed 4121 E. County Line Road 720-277-5930 Centennial Orthodontist N/A

Dr. David E. Gold David E. Gold Jr. Not Needed 9025 E. Mineral Cir., #100 303-792-0345 Centennial Orthodontist N/A

Dr. Louis Talmoumis Apple Orthodontics Not Needed 1694 E. Cheyenne Mtn. Blvd. 719-538-4671 Colorado Springs Orthodontist N/A

Dr. David Schroeder Apple Orthodontics Not Needed 1694 E. Cheyenne Mtn. Blvd. 719-538-4671 Colorado Springs Orthodontist N/A

Dr. Irina A LovinescuBright Now Dental - Colorado Springs -

Parkmoor VillageNot Needed 3208 N. Academy Blvd., #140 719-596-7000 Colorado Springs Orthodontist N/A

Dr. Randall Snyder Comfort Dental - Austin Bluffs Not Needed 3952 North Academy Blvd. 719-591-1811 Colorado Springs Orthodontist N/A

Dr. Scott Suter Front Range Ortho Not Needed 3100 N. Academy Blvd., #200 719-550-0222 Colorado Springs Orthodontist N/A

Orthodontists

Page 21 of 24



Dr. Voytek Bobak Dr. Voytek Bobak Not Needed 26697 Pleasant Park Rd., #b-120 303-816-5239 Conifer Orthodontist N/A

Dr. Hilary Neilberg-Baskin All About Braces Not Needed 2250 S. Monaco Pkwy. 303-476-6233 Denver Orthodontist N/A

Dr. Andrey Nazarov Allegro Orthodontics Not Needed 390 S. Dayton St. 303-751-0031 Denver Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Denver Downtown Not Needed 1955 Arapahoe St., Ste. A 303-296-0888 Denver Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Denver Downtown Not Needed 1955 Arapahoe St., Ste. A 303-296-0888 Denver Orthodontist N/A

Dr. Michael D. Bellon Dr. Michael D. Bellon Not Needed 7200 E. Hampden, #203 303-692-9610 Denver Orthodontist N/A

Dr. Eunice P. Lee Hampden Family Dentistry $ Orthodontics Not Needed 9250 E. Hampden Ave. 303-930-8828 Denver Orthodontist N/A

Dr. Jack E. Duran Orthodontics Exlusively Not Needed 3601 S. Clarkson 303-789-9257 Englewood Orthodontist N/A

Dr. Hilary Neilberg-Baskin All About Braces Not Needed 1015 S. Taft Hills Rd. #q 303-476-6233 Fort Collins Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Fort Collins Not Needed 3531 S. College Ave., #110 970-498-8706 Fort Collins Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Fort Collins Not Needed 3531 S. College Ave., #110 970-498-8706 Fort Collins Orthodontist N/A

Dr. Timothy C. Hardy Taft Hill Orthodontics Not Needed 1015 South Taft Hill Rd. Unit 2 970-980-2145 Fort Collins Orthodontist N/A

Dr. T. Allan Hymas Mesa Orthodontics Not Needed 1190 Bookcliff, Ave., Ste. 202 970-245-8810 Grand Junction Orthodontist N/A

Dr. Gary Barth Dr. Gary Barth Not Needed 1640 25th St., #a 970-353-4249 Greeley Orthodontist N/A

Dr. Shawn Murray Murry Orthodontics Of Greeley Not Needed 1825 56th Ave., #a 970-330-5363 Greeley Orthodontist N/A

Dr. David Richter Richter Orthodontics Not Needed 1813 61st Ave. 970-392-1733 Greeley Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Highlands Ranch Not Needed 3626 Highlands Ranch Pkwy, #107 970-498-8706 Highlands Ranch Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Highlands Ranch Not Needed 3626 Highlands Ranch Pkwy, #107 970-498-8706 Highlands Ranch Orthodontist N/A

Dr. Paul A. Hamersky Douglas County Orthodontics Not Needed 9362 S. Colorado Blvd., #d14 720-344-2662 Highlands Ranch Orthodontist N/A

Dr. Bryan Nelson Dr. Bryan Nelson Not Needed 9567 S.University Blvd., #c-1a 720-344-2662 Highlands Ranch Orthodontist N/A

Dr. Paul Rocke Dr. Paul Rocke Not Needed 200 W. County Line Rd., #340 303-730-7002 Highlands Ranch Orthodontist N/A

Dr. Shawn M. Murray Murray Orthodontics Not Needed 257 Johnstown Center Dr., #201 970-587-5228 Johnstown Orthodontist N/A

Dr. Howard Stringert Dr. Howard Stringert Not Needed 313 W. 3rd St., #104 719-384-5583 La Junta Orthodontist N/A

Dr. Hilary Neilberg-Baskin All About Braces Not Needed 2020 Wadsworth Blvd. 303-476-6233 Lakewood Orthodontist N/A

Dr. Antonio Silva-Oseguera Antonio Silva-Oseguera Not Needed 1200 S. Wadsworth Blvd. #101 303-934-4285 Lakewood Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Lakewood Not Needed 7611 W. Colfax Ave., #d 303-202-0900 Lakewood Orthodontist N/A

Page 22 of 24



Dr. Jack Allen Jr. Dr. Jack M. Allen D.D.S. Not Needed 7373 W. Jefferson Ave., #302 303-988-9220 Lakewood Orthodontist N/A

Dr. Voytek Bobak Dr. Voytek Bobak Not Needed 1840 S. Wadsworth Blvd. 303-988-0844 Lakewood Orthodontist N/A

Dr. Michael D. Bellon Dr. Michael D. Bellon Not Needed 7325 S. Pierce St., #204 303-933-6830 Littleton Orthodontist N/A

Dr. Paul Rocke Front Range Orthodontic Not Needed 200 West County Line Rd., #340 303-730-7002 Littleton Orthodontist N/A

Dr. Amir R. Fereydouni Kids And Family Dentistry Not Needed 40 W. Littleton Blvd. 303-327-4091 Littleton Orthodontist N/A

Dr. Irina A Lovinescu Littleton Family Orthodontics Not Needed 9200 West Cross Drive, Ste #426 303-972-2898 Littleton Orthodontist N/A

Dr. Eunice P. Lee Southpark Orthodontics Not Needed 8199 South Park Lane, #150 303-738-8828 Littleton Orthodontist N/A

Dr. Fazila Durkin Durkin Orthodontics Not Needed 7430 Park Meadows Dr. 303-799-8882 Lone Tree Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Longmont Not Needed 15 Ken Pratt Blvd., #280 303-678-1155 Longmont Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Longmont Not Needed 15 Ken Pratt Blvd., #280 303-678-1155 Longmont Orthodontist N/A

Dr. Gary Dixon Smile Zone Orthodontics Not Needed 1075 S. Boulder Rd., #235 303-604-0300 Louisville Orthodontist N/A

Dr. David Hamula Hamula Orthodontics Not Needed 1860 Woodmoor Dr. #200 719-488-3737 Monument Orthodontist N/A

Dr. Andrey Nazarov Allegro Orthodontics Not Needed 10450 S. Progress Way, #100 720-842-4544 Parker Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Parker Not Needed 11183 S. Parker Rd., #c 303-209-2245 Parker Orthodontist N/A

Dr. Randall Snyder Comfort Dental - Pueblo- South Not Needed 1221 S. Pueblo Blvd. 719-565-2274 Pueblo Orthodontist N/A

Dr. Howard Stringert Dr. Howard Stringert Not Needed 3955 Sandelwood Lane 719-564-3333 Pueblo Orthodontist N/A

Dr. Randall Snyder Comfort Dental - Summit County Not Needed 354 Blue River Pkwy, #a 970-262-2273 Silverthorne Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Thornton Not Needed 951 E. 120th Ave., #d 303-305-4466 Thornton Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Thornton Not Needed 951 E. 120th Ave., #d 303-305-4466 Thornton Orthodontist N/A

Dr. James H. Mason Colo Orthodontics Not Needed 3984 E. 120th Ave. 303-428-8800 Thornton Orthodontist N/A

Dr. James H. Mason Colo Orthodontics Not Needed 901 E. 120th Ave., #e 303-428-8800 Thornton Orthodontist N/A

Dr. John Bailey Colo Orthodontics Not Needed 3984 E. 120th Ave. 303-428-8800 Thornton Orthodontist N/A

Dr. John Bailey Colo Orthodontics Not Needed 901 E. 120th Ave., #e 303-428-8800 Thornton Orthodontist N/A

Dr. Colin Gibson 1st Impressions Orthodontics Not Needed 1333 W. 120th Ave., #303 303-452-2277 Westminster Orthodontist N/A

Dr. Irina A Lovinescu Bright Now Dental - Westminster Not Needed 3003 W. 104th Avenue 303-410-9800 Westminster Orthodontist N/A

Dr. Kelvan C Luff Bright Now Dental - Westminster Not Needed 3003 W. 104th Avenue 303-410-9800 Westminster Orthodontist N/A

Page 23 of 24



Dr. Gary Dixon Smile Zone Orthodontics Not Needed 9910 Wadsworth Pkwy. 303-430-4200 Westminster Orthodontist N/A

Dr. David Richter Richter Orthodontics Not Needed 1218 W. Ash St. 970-392-1744 Windsor Orthodontist N/A

Dr. Bradley E. Goings Windsor Smiles Orthodontics Not Needed 1218 W. Ash St., Unit D 970-460-0791 Windsor Orthodontist N/A

Dr. Shawn Murray Windsor Smiles Orthodontics Not Needed 1218 W. Ash St., Unit D 970-460-0791 Windsor Orthodontist N/A

bottom page

Code Definitions:

* - This office provides nitrous oxide.

C - This office accepts most children over the age of 4 for routine care. Please check with your selected dental office for their specific guidelines.

E1-2 - This office will provide most 1 and 2 canal root canal procedures depending on the complexity of the situation.

E3-4 - This office will provide most 3 and 4 canal root canal procedures depending on the complexity of the situation.

N - This office will only see members that are identified on the eligibility roster provided by the plan administrative office at the beginning of each month.

General Provisions:

• All needed specialty care (except Orthodontics) that cannot be provided by your selected General Dentist can be provided by a plan participating specialist. These specialists have been contracted to offer plan members up to a 20% discount off of their normal full fee. You may see any of the contracted plan specialists as the needed without contacting your selected General Dentist. Call us at 303-744-3007 or 1-800-807-0706 for a list of plan participating specialists or visit our web site at www.betadental.com.

• Orthodontic treatment discounts are listed on your plan schedule of benefits.

• All family members must see the same General Dentist for treatment.

• You may change your General Dentist selection at any time by contacting us at 303-744-3007 or 1-800-807-0706.

• Some large dental offices with multiple locations list all contracted providers from all locations

Page 24 of 24

Please note:

TO FIND A CONTRACTED CarePOS DENTIST IN YOUR AREA VISIT:

www.betadental.com and click on the “Provider Locator” link the “quick links” box. Then go to the Careington logo and click on the logo. Then enter your zip code.

FOR THE FULL CarePOS FEE SCHEDULE IN

YOUR AREA VISIT:

www.betadental.com and click on the “All Plan Fee Schedule” link in the “quick links” box. Then go to the Careington POS Fee Schedule box and enter your zip code. Your zip code specific fee schedule will appear in a PDF format. You will then be able to open the PDF file showing the discounted fees in your area.

The CarePOS dental plan is a discount fee for service dental plan and is in no way considered insurance.

Not all products are available in all states. Please visit http://www.betadental.com/betacarepos/ for the most up-to-date provider listings and fee schedules.

Total Locations: 116,550 (3 in Puerto Rico, 65 in Columbia)

Updated: October 22, 2012

TX 18,629

WA 1,474*

MT * 1

ND 0

SD 1

ID 53 WY

2

CO 1,735

UT 1,096

NM 260

AZ 3,655

NE 85

KS 52

OK 1,734

NV 1,654

OR 402

CA 26,878

MN 768

IA 290

MO 417

AR 21

LA 124

IL 2,273

WI 520 MI

1,228

IN 1,880

KY 362

TN 478

MS 36

AL 78

GA 3,701

NC 199

SC 135

FL 22,431

PA 3,706 OH

4,298

VA 684

WV 11

NY 6,091

ME 125

VT * NH 7 132

MA –1,319

RI – 41

CT – 497 NJ –5,667 DE – 6 MD – 1,179 DC - 69

AK 0

HI 67

Beta Health CarePOS Plan Network Providers

* Only dependents can enroll in these states. Employees residing in these states are not eligible for the CarePOS plan available through BHA.

OPTION #3

DENTAL INSURANCE PLAN

To locate a Companion Life provider please visit:

www.betadental.com and click on the “Provider Locator” link the “quick links” box. Then go to the Companion logo and click which takes you to DenteMax. Then enter your zip code and then click “search”.

Benefits provided by:

A Dental Plan For ERC

Covered Services Description SELECT ANY DENTIST Preventive, Basic, Major and Orthodontic services are not subject to a deductible. The Companion Life Dental Plan must be offered with one of the Beta Health Association, Inc. Network Dental Plans as an option for all eligible employees. 30% of all eligible employees must be enrolled between all plans. Employees and covered dependents must use a DenteMax Dentist to receive In Network Benefits. DenteMax dentists can be found at www2.dentemax.com/. Out of network Benefits are paid at the 90th percentile and may be subject to usual and customary charges.

Preventive Services In Network Out-of-Network No waiting periods before benefits begin Routine exams, cleanings (once every 6 months) Fluoride treatments for dependent children under age 19 (once every 12 months) Bitewing x-rays (once every 12 months) Emergency exams for dental pain (minor procedures)

Basic Services No waiting periods before benefits begin Periapical x-rays Full mouth or panorex x-rays (once every 36 months) Simple restorative procedures (fillings) Simple extractions Palliative treatment for dental pain and local anesthesia

Major Services 12 month waiting period before benefits begin (except for takeover credit) Replacement of prosthodontics, dentures, crowns, and inlays Major restorative procedures (crowns and inlays) Dental implants (adult only) Prosthetic procedures (bridges and dentures) Space maintainers Oral surgery procedures (non-simple extractions) Denture relines General anesthesia (for services dentally necessary) Periodontic procedures (Gum disease) Endodontic procedures (Root canals)

Plan Maximum Benefit Per covered person per calendar year Combined between Preventive, Basic, and Major Services only

Orthodontic Services 12 month waiting period before benefits begin (except for takeover credit) No deductible applies to Orthodontic procedures $1,000 lifetime maximum benefit per covered dependent For children only to age 19

Takeover Benefits (if prior plan is being replaced with like benefits) Takeover means that credit is given for waiting periods for like coverages only which were accumulated under an existing dental plan at the initial open enrollment only.

1. For an employer group to be eligible for Takeover Benefits, at least five employees must enroll in the Companion Life plan at the initial open enrollment. 2 In order to provide Takeover Benefits, your employers current dental plan must have been in effect continuously for at least 12 months. 3. All employees covered on the effective date with continuous coverage from the prior group plan are eligible for Takeover Benefits. Waiting periods will be

reduced by the amount of time covered under the prior plan. 4. Takeover Benefits must be requested when the group is submitted for coverage and are subject to the approval of Companion Life. Benefit payments are based upon the allowable charges in the area in which the service is provided. Any Dentist charges above this allowable fee are not an eligible expense. A monthly billing fee of $1 per covered employee per month (not to exceed $10 per month) will also apply.

Note: This a general outline of covered services and does not include all the covered services , limitations and exclusions of the policy. See your certificate for specific details.

100%

100%

$1,000

$1,200

50%

80%

80%

50%

Limitations and Exclusions Covered expenses will not include and no benefits will be payable for :

1. For any treatment which is for cosmetic purposes or to correct congenital malformations, except for medically necessary care and treatment of congenial cleft lip and palate.

2. To replace any prosthetic appliance, crown, inlay or onlay restoration, or fixed bridge within five years of the date of the last placement of these items, unless required because of an accidental bodily injury sustained while the Insured is covered. Replacement is not covered if the item can be repaired.

3. For initial placement of any prosthetic appliance or fixed bridge unless such placement is needed because of the extraction of natural teeth during the same period of continuous coverage. But the extraction of a third molar (wisdom tooth) will not qualify the item for payment. Any such appliance or fixed bridge must include the replacement of the extracted tooth or teeth. Coverage does not include the part of the cost that applies specifically to replacement of teeth extracted prior to the period of coverage.

4. For the addition of teeth to an existing prosthetic appliance or fixed bridge unless for replacement of natural teeth extracted during the same period of continuous coverage.

5. For any expense incurred or procedure started prior to the Insured’s current period of continuous coverage.

6. For any expense incurred or procedure started after the Insured’s insurance under this section terminates, except for a prosthetic appliance, fixed bridge, crown, or inlay or onlay restoration for which both (a) the procedure begins before insurance ends and (b) the item’s final placement is within 90 days after insurance terminates.

7. To duplicate appliances or replace lost or stolen appliances.

8. For appliances, restorations or procedures to:

a. alter vertical dimension;

b. restore or maintain occlusion;

c. splint or replace tooth structure lost as a result of abrasion or attrition; or

d. treat jaw fractures or disturbances of the temporomanbibular joint.

9. For education or training in, and supplies used for, dietary or nutritional counseling, personal oral hygiene or dental plaque control.

10. For broken appointments or the completion of claim forms.

11. For orthodontia service or for any services associated with orthodontic therapy when this optional coverage is not elected and the additional premium is not paid.

12. For sealants which are:

a. not applied to a permanent molar;

b. applied before age 6 or after attaining age 16; or

c. reapplied to a molar within three years from the date of a previous sealant application.

13. For sub gingival curettage or root planning (procedure numbers 4220 and 4321) unless both x-rays and depth summaries of each tooth confirm the presence of periodontal disease involved.

14. Because of an Insured’s injury arising out of, or in the course of, work for wage or profit.

15. For an Insured’s sickness, injury or condition for which he or she is eligible for benefits under any Worker’s Compensation Act or similar laws.

16. For charges for which the Insured is not liable or which would not have been made had no insurance been in force.

17. For service which are not recommended by a dentist, not required for necessary care and treatment, or do not have a reasonably favorable prognosis.

18. Because of war or any act of war, declared or not, or while on full-time active duty in the armed forces of any country.

19. To an Insured if payment is not legal where the Insured is living when expenses are incurred.

20. For any services related to: equilibration, bite registration or bite analysis.

21. For crowns for the purpose of periodontal splinting.

22. For charges for: over dentures, and associated precision or semi-precision attachments and any related Endodontic treatment associated with it; or other customized attachments.

23. For charges for myofunctional therapy, orthognathic surgery or athletic mouth guards.

24. For procedures for which benefits are payable under the employer’s medical expense benefit plan for employees and their dependents.

25. Services or supplies provided by a family member or a member of the Insured’s household.

090108

Predetermination of Benefits: As a service to protect the Insured, Companion Life will provide predetermination of benefits for recommended treatment plans that exceed $300. This predetermination of benefits explains which of the recommended procedures will be covered and at what amount. This benefit helps insured’s better understand their coverage. The Insured or Insured’s Dentist should submit the treatment plan to Companion Life for review and predetermination of benefits before the service begins.

Designed and Marketed By Beta Health Association, Inc. 9725 East Hampden Avenue, #400, Denver, CO, 80231

303-744-3007 or 1-800-807-0706

Underwritten and Administered by Companion Life Insurance P.O. Box 100102, Columbia, SC, 29202-3102

1-800-753-0404, Fax 803-735-0736

Check out these Free National

Discount Programs!

All employees and dependents enrolling in one of the attached dental plans can use any of the attached programs free of charge. It is our thanks to you for using Beta Health as your dental carrier! Simply follow the instructions on the attached discount program description sheets….it’s that easy. You can photocopy these items and distribute to all of your dependents as well. If you have questions, please call Beta Health at 303-744-3007 or 1-800-807-0706.

Introducing Discount Services for Dental Plan Members Free of Charge

The Vision Discount Plan

Vision Care Services In Network Only Exam with Dilation (as necessary) $5 off exam Contact Lens Fit and Follow-up Standard $10 off exam Premium $10 off exam Frames When a complete pair of glasses is purchased (frame, lenses and lens options purchased in the same transaction) a 35% discount will apply.* Standard Plastic Lenses Member Pays Single Vision $50 Bifocal $70 Trifocal $105 Lens Options Member Pays UV Coating $15 Tint (Solid and Gradient) $15 Standard Scratch Resistant Coating $15 Standard Polycarbonate $40 Standard Anti-Reflective Coating $45 Standard Progressive (Add-on to Bifocal) $65 Other Add-ons and Services 20% off retail Contact Lens Materials (Discount applied to materials only) Conventional 15% off retail price Disposable no discount Laser Vision Correction** Lasik or PRK 15% off retail price or 5% promotional price Frequency Examination Unlimited Frame Unlimited Lenses or Contact Lenses Unlimited

* Items purchased separately will be discounted 20% off of the retail price. ** Since Lasik or PRK vision correction is an elective procedure, performed by specially trained providers, this discount may not always be available from a provider in your immediate location.

For a location near you and the discount authorization, please call 1-877-5LASER6.

Beta Health Association, Inc. has teamed up with EyeMed Vision Care to offer easy access to over 43,000 national, conveniently lo-cated vision care providers including optometrists, ophthalmologists, opticians and many leading optical retailers, such as LensCrafters®, Target Optical®, and most Sears Optical® and Pearl Vision® locations. This benefit is free of charge for Beta Health Dental Plan members. Note that this is not insurance, only a discount plan to save you and your family members $ as needed!

This hearing care program combines unlimited choices with quality and value. It’s provided free of charge to all employees and family members enrolled in a Beta Health Association, Inc. dental plan. Beta Health and EPIC Hearing Health Care give you easy access to a large national network of thousands of hearing care professionals — primarily physicians and audiologists — who can help you

achieve your maximum hearing potential throughout your life. The prices you get from EPIC may be as much as 50% below the manu-facturer’s suggested retail price and up to 35% lower than most discount offers. EPIC can coordinate the coverage with your existing

healthcare plan. Note that this is not insurance, only a discount plan to save you and your family members $ as needed!

Introducing Discount Services for Dental Plan Members Free of Charge

The Hearing Discount Plan

To activate your hearing discount plan, call EPIC Hearing Health at 1-866-956-5400. EPIC will send you a card with all the information you need to access your benefits, including referrals to providers near you and activation forms to access them. Tell them that you are a Beta Health member and you will be connected to a personal EPIC phone contact who can answer any questions you may have. A booklet that outlines the plan benefits (as well as pricing) will be mailed to your home. Then you will follow through with an appointment, examination and treatment. All payments should be made to EPIC HSP. No other billing or payments should occur. Contact EPIC at any time for assistance, advice and information.

Check out these benefits and savings! The hearing discount plan benefits and savings are:

Hearing tests Hearing aids, aid cleaning supplies, accessories and batteries

Ear protection, swim and musician earplugs Assistive listening devices

TV ears (amplifies and clarifies television) Alerting and signaling devices

The Prescription Drug Discount Plan Do you want to SAVE an average of 10% to 85% on the cost of prescription medications? With the HealthTrans nationwide national discount prescription drug program this is easy!

To use your HealthTrans discount drug card: 1.) Write in your specific member I.D. number on the member I.D. cards (attached) for use at the pharmacy.

2.) Take your card and prescription(s) to a participating pharmacy. Pharmacy locations can be found at the web site below. 3.) Pay the pharmacy the negotiated reduced discount!

Note that this is not insurance, only a discount plan to save you and your family members $ as needed!

It’s simply a great way to save money on prescription drugs! After working closely with pharmacies and drug manufacturers, HealthTrans has negotiated lower prices for thousands of medications, and have passed these savings on to all Beta Health

Association members and their families. The average discounts range from up to 16% on brand name and up to 55% on generic drugs. There are no limits on quantities and no paperwork to complete. Discounts are available at over 55,000 pharmacies nationwide and are

also available to the entire family on an as needed basis!

See how much you can save today by going to http://cashcard.lc.healthtrans.com

Thank you for choosing Beta Health Association, Inc. as your dental partner. We are proud to offer you, free of charge, the EyeMed® Vision Discount Plan, the Epic Hearing Health® Plan and the HealthTrans® Prescription Discount Plan. Please use the ID cards provided below to access these “Free of Charge” benefits. Follow all instructions as identified on each set of cards. We appreciate our relationship!

EyeMed Group Number: 9235409 Group Name: Beta Health Association, Inc.

Member Name: ______________________________________

Call 1-866-723-0596 to locate the nearest EyeMed Provider. This is a discount program and not insurance.

EyeMed Group Number: 9235409 Group Name: Beta Health Association, Inc.

Member Name: ______________________________________

Call 1-866-723-0596 to locate the nearest EyeMed Provider. This is a discount program and not insurance.

Epic Hearing: Call 1-866-956-5400 for ID card information. Group Name: Beta Health Association, Inc.

Member Name:

This is a discount program and not insurance.

Epic Hearing: Call 1-866-956-5400 for ID card information. Group Name: Beta Health Association, Inc.

Member Name:______________________________________

This is a discount program and not insurance.

BIN #: 011867 Group ID: DDS01 Member ID: _________________ Please enter your initials &

the last four digits of your phone #) Member Name: _________________________________________ This is a discount program and not insurance. Visit http://cashcard.lc.healthtrans.com for more information or call 877-459-8474.

BIN #: 011867 Group ID: DDS01 Member ID: _________________ Please enter your initials &

the last four digits of your phone #) Member Name: _________________________________________ This is a discount program and not insurance. Visit http://cashcard.lc.healthtrans.com for more information or call 877-459-8474.

http://cashcard.lc.healthtrans.com/

http://cashcard.lc.healthtrans.com/

9725 E Hampden Avenue #400Denver, CO 802311-800-807-0706 (Phone)303-744-2890 (Fax)

� New Employee � Change Address� COBRA � Change Dependent Status

� Terminate*

ADP/POS/CompanionGROUP ENROLLMENT, WAIVER,AND CHANGE REQUEST FORM

TO BE COMPLETED BY EMPLOYER

TO BE COMPLETED BY EMPLOYEES ELECTING TO ENROLL

COMPLETE FOR DENTAL

Name of Employer (Use Name from Group Billing Notice or Master Application)

Social Security Number Effective DateMonth Day Year

Date of HireMonth Day Year

Date of BirthMonth Day Year

Phone #

Work: ______________

Home: ______________

Your Name Last First M.I. Gender� Female� Male

Marital Status� Single� Married

Dental Options (please check your selection)

Alpha Dental Plan only** � Provider Selection: ADP #

CarePOS Dental Plan only �

Companion Life Dental Plan only �

**You must select a plan provider for all services. Please visit www.betadental.com for a current provider directory. The Alpha and CarePOS dental planoptions are discount fee for service dental plans and are in no way considered insurance. Alpha Dental providers can be changed at any time by calling 303-744-3007 or 1-800-807-0706.

Your Home Address City State Zip Code

E-mail Address:

Is your spouse to be enrolled? � Yes � No

Enrollment Selection (Check the Correct Box Below): � Employee Only � Employee � Employee

Plus One Plus Two or more

Are you enrolled in anyother dental plans? � Yes � No

Complete for Dependent(s) Full-time Gender Do any of your dependents have any other Spouse Name (Last) (First) (Middle Initial) Student Y/N Date of Birth M or F dental plan? If Yes, Name of Carrier

/ / � Yes � No

/ / � Yes � No

/ / � Yes � No

/ /

/ /

/ /

/ /

� Yes � No

� Yes � No

� Yes � No

� Yes � No

DEPENDENT

(S)

1

2

3

4

5

6

Date Your SignatureX

10/08

Companion Group #

Beta Health Group #

It is unlawful to knowingly provide false, incomplete, or misleading facts on this form or to defraud or attempt to defraud Beta Health or one of their partners. Penalties may include impris-onment, fines, denial of services and civil damages. Please report any organization or agent who you feel knowingly provides false, incomplete or misleading facts for the purpose ofdefrauding the participants to the Colorado Division of Insurance. I also agree to remain on the plan for a minimum of one year or until the next open enrollment period (which ever comesfirst). The only exception to this is if I loose employment (either voluntarily or involuntarily).

DENTAL PLAN WAIVERI have been offered the above dental plan options and I am declining participation at this time. I also understand that the next time that I may enrollin one of these plans is at the next open enrollment period only (one year from now). The only exception to this is if a qualifying event occurs.

Date Signature of Employee

* Can only terminate at open enrollment or if employment is terminated.Div. Class

THREE TIER

rhenningsen

Typewritten Text

119-1482365

rhenningsen

Typewritten Text

000

rhenningsen

Typewritten Text

1978000

rhenningsen

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Employer Resources of Colorado

dental plan - employer's resources of colorado€¦ · dental plan (adp/pos/cl plan with ortho...

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