Dinadental.com

Ochsner Health Plan (HMO)

WEBCode Procedure Description Frequency Copayment D0120 Periodic Oral Evaluation 1/6 months $0.00 D0140 Limited Oral Evaluation 1/12 months $0.00 D0150 Comprehensive …

Actived: 6 days ago

URL: https://www.dinadental.com/pdfs/2024/2024%20OHP%20Plan%20Fee%20Schedules.pdf

Louisiana State Employees and Retirees PPO Plan ~ Highlights …

WEBOur DINA panel of providers are contracted, credentialed, and have agreed to charge predetermined fees for procedures. Co-payments not to exceed certain discounted …

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List of Covered Dental Services

WEBCDT Code@ Procedure Description Dina Pays Member Pays Member Pays D5610 Repair resin denture base $45.00 $45.00 $45.00 Balance due to the dentist D5640 Replace …

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Signed (Treating Dentist) Date Specialty Code Number ©2006 …

WEBGENERAL INSTRUCTIONS. A. The form is designed so that the name and address (Item 3) of the third-party payer receiving the claim (insurance company/dental benefit plan) is …

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Effective: January 1, 2021 Peoples Health

WEB***Only one (1) crown procedure code is covered every twelve (12) months per member*** Crowns - Single Restorations Only D2740 Crown - Porcelain/Ceramic Substrate $295.00

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DINA Dental Plan GUARANTY ASSURANCE COMPANY …

WEBDINA Dental Plan GUARANTY ASSURANCE COMPANY Peoples Health - Choices 65 #14 (HMO), Peoples Health Choices 65 Northshore #14 (HMO) Choice 65 #14 Parishes: …

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Ochsner Health Plan (HMO)

WEBD2790 Crown - full cast high noble metal $265.00 D2791 Crown - full cast predominantly base metal $210.00 D2792 Crown - full cast noble metal $230.00

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GUARANTY ASSURANCE COMPANY Peoples Health Network …

WEBEffective: January 1, 2019 Member Eligibility: (866)803-1672 Rev. 082718 1 of 2 . DINA Dental Plan. TM. GUARANTY ASSURANCE COMPANY Peoples Health Network

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Effective: January 1, 2022 Peoples Health

WEBD4342 Periodontal Scaling and Root Planing, 1-3 teeth 1/12 months $30.00 D4355 Full Mouth Debridement 1/12 months $32.00 D4381 Localized delivery antimicrobial agents …

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DINA Dental Plan GUARANTY ASSURANCE COMPANY …

WEBD5520 Replace missing or broken teeth – Complete Denture $31.00 Repairs to Partial Dentures D5611 Repair Resin Denture Base, mandibular $45.00

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Effective: January 1, 2022 Peoples Health

WEBEffective: January 1, 2022 $0 Annual Deductible $0 Co-payment $500 Maximum Annual Benefit per Calendar Year Out of Network Benefits Service Area:

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Effective: January 1, 2022 Peoples Health

WEBEffective: January 1, 2022 $0 Annual Deductible $0 Co-payment $3,000 Maximum Annual Benefit per Calendar Year No Out of Network Benefits Service Area:

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Effective: January 1, 2021 Peoples Health

WEBD2393 Resin - three surfaces, posterior $126.00 D2394 Resin - four or more surfaces, posterior $157.00 Prosthodontics - Removable Complete Dentures (Including Routine …

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