BRIGHT CHOICE EXAMPLES OF

Savings

DENTAL PLAN

Simple, affordable, and easy to use! The Bright Choice Plus plan is great

for me and my wife. As we grow older, dental visits have become a top priority

for our overall health. The Plus plan

has everything we need!

Great plan and we love the savings! With the Bright Choice Basic Plan, our whole family receives exams and x-rays at no charge, and cleanings at a price we can afford. The Bright Choice Basic Plan is great for our whole family!

Hypothetical scenarios of how the Bright Choice Dental Plan may work for you and your family.

Sign up online atbrightchoicedentalplan.comSign up over the phone:1-800-874-1986Send your completed application with payment:Bright Choice Dental PlanP.O. BOX 3470CAMARILLO CA 93011-3470 We accept VISA, MasterCard, Discover, American Express, Checks, and Money Orders.

Provide enrollment application along with payment (checks must be payable to Bright Choice Dental Plan) to your participating provider for submission to Bright Choice Dental Plan.

ALL PARTICIPANTS WILL RECEIVE:• A welcome letter with individual ID Cards• Bright Choice Dental Plan Fee Schedule (online or call 1-800-874-1986)• Instant Savings! Your eligibility begins when you receive your ID Card• Unlimited access for savings for you and your family

4 WAYS TO

Sign Up

• This dental discount plan provides discounts from providers of health care who provide health care or dental services to members.

• This dental discount plan does not make payments directly to the providers of dental care.

• You (member) will be required to pay for all health care or dental services, but will receive a discount from those providers of health care who have contracted with the Bright Choice Dental Plan.

• Members will have 30 days to cancel their plan if they have not utilized and received discounts under the plan.

• Participating Dental Providers have agreed to discount their usual and customary fees for services not listed on the Bright Choice Plus Summary of Discounted Fees, provided those ADA codes/ servicesareofferedinoffice.“Usual”referstothe normal rate charged for the service by the Provider renderingthetreatment,and“Customary”is definedastheusualratesoftheProvider’s competitors in that local area. The UCR fee can vary by location.Now is the time to protect

your healthy smile with the affordable, easy-to-use

Bright Choice Dental Plan

Choose a lifetime of brighter smiles with the affordable, simple-to-use Bright Choice Dental Plan. Because a bright smile means a healthy you!

BRIGHTCHOICEDENTALPLAN.COM

BRIGHTCHOICEDENTALPLAN.COM

ON BRIGHT CHOICE Plus DENTAL PLANon services not listed on Summary.

20% Savings!

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ARE YOU LOOKING TO

Save Money ON YOUR DENTAL CARE?

DENTAL PLAN

Join Today & Start Saving!

PROCEDURECOST

WITHOUTTHE PLAN

COST WITHTHE PLAN

YOUR SAVINGS

Exam $103.00 NO CHARGE $103.00

Complete Full-Mouth X-rays $154.00 NO CHARGE $154.00

Panoramic Image $130.00 NO CHARGE $130.00

Cleaning – Adult $106.00 $89.00 $17.00

Filling $205.00 $101.00 $104.00

Crown $1,325.00 $767.00 $558.00

Extraction $210.00 $125.00 $85.00

Total $2,233.00 $1,082.00

Your Total Savings as a Plan Member $1,151.00

WHY BRIGHT CHOICE

Dental Plan?Bright Choice Dental Plan is not insurance, therefore all applicants are guaranteed acceptance. And you can haveaddedconfidenceknowingthisis a licensed discount dental plan.

DENTAL SERVICE Discounts ON:

n Examsn X-raysn Sealantsn Cleaningsn Fillingsn Extractionsn Root Canalsn Crowns

n Bridgesn Denturesn Partials n Implants n Periodonticsn Orthodonticsn Cosmeticn Specialty

4 Immediate plan activation

4 Low yearly membership fee

4 NO waiting periods

4 NO annual maximums

4 NO claim forms to submit

4 Cosmetic Services included

4 Specialty Services included ifavailableatoffice

Membership Advantages:

EXAMPLE OF Savings

t

MAKE THE BRIGHT CHOICE

How it Works

ADA Code DESCRIPTION OF SERVICES Member

Pays

ENDODONTICSD3110 Pulp cap – direct (excluding final restoration) $51.00

D3220 Therapeutic pulpotomy $198.00

D3310 Root canal (anterior) $580.00

D3320 Root canal (bicuspid) $760.00

D3330 Root canal (molar) $880.00

PROSTHODONTICSRemovable – Denture

D5110 Complete denture – maxillary (upper) $888.00

D5120 Complete denture – mandibular (lower) $888.00

D5130 Immediate denture - maxillary (upper) $888.00

D5140 Immediate denture - mandibular (lower) $888.00

D5213 Maxillary partial denture (upper) $1,058.00

D5214 Mandibular partial denture (lower) $1,058.00

D5730 – D5731 Reline denture – upper or lower (chairside) $190.00

D5750 – D5751 Reline denture – upper or lower (laboratory) $251.00

D5820 Interim partial denture $347.00

Implants

D6010 Surgical placement of implant body endosteal implant

$1,637.00

D6059 Abutment porcelain fused to metal crown $778.00

Fixed – Bridge

D6740 Crown – porcelain/ceramic substrate $767.00

D6750 Crown - porcelain fused to high noble metal $767.00

ORAL SURGERYD7111 Extraction, deciduous tooth $49.00

D7140 Extraction, erupted tooth $125.00

D7210 Surgical removal of erupted tooth $214.00

D7220 Removal of impacted tooth – Soft tissue $230.00

D7230 Removal of impacted tooth – Partially Bony $320.00

D7240 Removal of impacted tooth – Completely Bony $385.00

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ADA Code DESCRIPTION OF SERVICES Member

Pays

RESTORATIVE – FillingsResin-based composite-anterior

D2330 One surface $101.00

D2331 Two surfaces $121.00

D2332 Three surfaces $144.00

D2335 Four or more surfaces $204.00

Resin-based composite-posterior

D2391 One surface $115.00

D2392 Two surfaces $145.00

D2393 Three surfaces $183.00

D2394 Four or more surfaces $218.00

RESTORATIVE – CrownsD2740 Crown – porcelain/ceramic substrate $767.00

D2750 Crown – porcelain fused to high noble metal $767.00

D2940 SedFill $69.00

D2950 Core buildup $150.00

D2954 Prefabricated post and core in addition to crown $197.00

D2962Labial veneer (porcelain laminate) – laboratory

$767.00

PERIODONTICSD0180 Comprehensive perio evaluation NO CHARGE

D4210Gingivectomy or gingivoplasty – four or more contiguous teeth per quadrant $438.00

D4211Gingivectomy or gingivoplasty – one to three contiguous teeth per space $216.00

D4263 Bone replacement graft – first site in quadrant $300.00

D4264 Bone replacement graft – each additional site $166.00

D4266 Guided tissue regeneration – per site $300.00

D4341 Periodontal scaling and root planing – four or more teeth per quadrant $150.00

D4342 Periodontal scaling and root planing – one to three teeth per quadrant $115.00

D4381 Localized delivery of antimicrobial agents $35.00

D4910 Periodontal maintenance $104.00

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ADA Code DESCRIPTION OF SERVICES Member

Pays

DIAGNOSTIC & PREVENTATIVED0150 Comprehensive oral evaluation – 2 per year NO CHARGE

D0120 Periodic oral evaluation – 2 per year NO CHARGE

D0140 Limited oral evaluation – problem focused - unlimited NO CHARGE

D0210 Intraoral – complete series of radiographic images NO CHARGE

D0220 Intraoral – periapical - first radiographic image NO CHARGE

D0230 Intraoral – periapical - each additional radiographic image NO CHARGE

D0270 Bitewing – single radiographic image NO CHARGE

D0272 Bitewings – two radiographic images NO CHARGE

D0274 Bitewings – four radiographic images NO CHARGE

D0330 Panoramic radiographic image NO CHARGE

D1110 Prophylaxis (Cleaning) Adult $89.00

D1120 Prophylaxis (Cleaning) Child $60.00

D1206 Topical application of fluoride varnish $20.00

D1351 Sealant – per tooth $25.00

D9972 External tooth whitening per arch – in-office $245.00

D9975 Teeth whitening with custom take home trays $89.00

Bright Choice BasicDENTAL PLAN

$49 INDIVIDUAL PER YEAR

$99 FAMILY PER YEAR

( 2 OR ) MORE

Upgrade to PLUS +$40Upgrade to PLUS FAMILY +$100

Upgrade to PLUS FAMILY +$50

4FREE Exams4FREE X-rays4Sealants4Cleanings4Whitenings

Includes Bright Choice Basic!$89 INDIVIDUAL PER YEAR

4Fillings4Extractions4Root Canals4Crowns

4Bridges4Dentures4Partials4 Implants

4Cleanings4Periodontics4Cosmetic4Specialty Choose your plan –

4Bright Choice Basic DENTAL PLAN

4Bright Choice Plus DENTAL PLAN

Book your appointment

Show your Member ID card at your visit

Pay the discounted member fee and Save!

$AVE

$149 FAMILY PER YEAR

( 2 OR ) MORE

OR