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City of Santa Ana
<br />- Exhibit B
<br />DentiCare Prepaid Dental Phan
<br />Lab reimbursement
<br />12
<br />F 096
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<br />n ti Car
<br />X-Rav
<br />o
<br />Cleaning
<br />100%
<br />_ �.
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<br />Fillings. Single amalgam
<br />100%
<br />Extractions: single
<br />10096
<br />Impaction: soft tissue
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<br />Acrylic Croce
<br />520*
<br />Porcelain
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<br />Glaglve,:to y per quadrant
<br />100
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<br />Molar
<br />$60
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<br />Full bande4. chili
<br />Ano
<br />$166
<br />adult
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<br />Start -up ea:
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<br />Employee
<br />to ee
<br />$11.
<br />mi if
<br />If send Propaid carrier
<br />Rates remain,
<br />50 e ' H aun,
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<br />of Yea h
<br />year
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<br />of dental offices
<br />69
<br />of dentists
<br />Lab reimbursement
<br />12
<br />F 096
<br />,, L�
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