Oregon Dental Insurance

• Routine and emergency exams
• Bitewing x-rays
• Cleanings for adults and children
• Fluoride treatment for children through age 12
• Head and neck cancer screening
• Oral hygiene instruction
• Periodontal Screening
• Periodontal Maintenance

• Sealant per quadrant
• After hours visits
• Panoramic x-rays

• Restorative fillings, amalgam, or anterior composite
• Simple extractions
• Simple denture/partial repairs

• All other covered services, including major services (not listed above), are provided at 20% discount from Willamette Dental Group's usual fees, after per-visit copay.
• 6 month waiting period for all major services

Monthly Rates

Individual: $31

Individual & Spouse: $62

One Adult & Child(ren): $60

Family: $91

Monthly Rates: Clark County Only

Individual: $30

Individual & Spouse: $60

One Adult & Child(ren): $58

Family: $88

The following is only a summary of the limitations and exclusions. Please refer to the contract for a complete list of benefits, limitations and exclusions.

These Benefits Are Limited

• We will not duplicate benefits for which you are eligible under Medicare except as required by law.
• We will not cover the replacement of an existing denture, crown, or bridge less than seven years after the date of the most recent placement.
• We will not cover a denture replacement made necessary by loss, theft, or breakage.

The benefits of this plan are not subject to any coordination of benefits provision.

• Services or supplies you receive before your coverage starts or after your coverage ends. The date artificial teeth are prepared is considered as the date of service.
• Services that are not necessary dental care.
• Services and supplies related to the diagnosis or treatment of the temporomandibular joint.
• Dental Implants
• Lost, stolen, or broken appliances.
• Splints, nightguards, and other appliances used to increase vertical dimensions, restore bite, or correct habits such as tongue thrusting or teeth grinding.
• Treatment(s), procedures, equipment, medications, devices, and supplies that are experimental or investigational even when provided by foreign providers.
• Services or supplies not received from a Willamette Dental dentist (except as specifically listed).
• Surgery for fractures, cysts, or tumors.
• Models of teeth and surrounding tissue for purposes of study and treatment planning.
• Services provided by a dentist or denturist that are beyond the scope of his or her license.
• Cosmetic dental services including complications arising out of such services.
• General anesthesia, unless recommended by the referring or attending dentist for a medical condition which requires general anesthesia before services can be performed.
• Recording of jaw movements or positions.
• Services or supplies you receive from a dental or medical department maintained by or on behalf of any employer, a mutual benefit association, labor union, trustee, or similar person or group.
• Services and supplies not specifically listed.