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14 East Highland Avenue | Philadelphia, Pennsylvania U.S.A. 19118 | |||
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American Foreign Service Association (AFSA) Group Dental PlanThe information below applies to coverage and rates
for the METROPOLITAN WASHINGTON, DC area only.
Dominion Dental does it better. Dominion
Dental Services, Inc. (DOMINION) is a managed care dental plan that has contracted with
carefully selected, established members of the dental profession
to deliver quality dental services to our subscribers. Dominion provides:
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Compare and save! |
| average fee* | Dominion fee** | Your Savings |
| Oral Examination | $96 | no charge | 100% | |||
| Fluoride Treatment | $38 | no charge | 100% | |||
| Complete Series X-rays† | $167 | $26 | 85% | |||
| Bitewing X- rays | $52 | no charge | 100% | |||
| Semi annual Cleaning | $96 | no charge | 100% | |||
| Filling (3 surfaces) | $184 | $52 | 72% | |||
| Crown | $1044 | $470 | 55% | |||
| Root Canal (Anterior) | $806 | $282 | 65% | |||
| Complete Denture | $1442 | $577 | 61% | |||
| Extraction | $168 | $57 | 66% | |||
*Based on the Captiva context fee schedule’s 80th percentile fee information.
**$10 Co-payment per visit not included
These procedures account for over 65% of dental services most frequently performed for adults, and almost 90% of the most frequently performed services for children. A $10 Co-Payment applies per visit.
With Dominion Dental, you and your dependents are eligible for all benefits, including unmarried children under age 20 or full time students up to 23 years of age. If your children need braces and a root canal, all in one year, Dominion Dental will cover it like no other dental plan will.
The low bi-weekly fee for Plan 605X coverage can be automatically paid through Federal Allotment (DC/MD/VA/DE/PA); for all other areas where coverage is available, the rates are monthly and are paid by automatic bank draft.
| Premium (DC/MD/VA/DE/PA) (with Administration Fee)*** |
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| Subscriber Only | $ 9.00 (bi-weekly) |
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| Subscriber and One Dependent | $15.00 (bi-weekly) |
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| Subscriber and Two or More Dependents | $23.00 (bi-weekly) |
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***These bi-weekly fees include a non-refundable charge payable to the Plan Services Coordinator for the monthly administration of the Direct Deposit payment plan.
You will receive treatment at the dental office
listed on your membership
card, except when an emergency arises or when otherwise directed by
your Plan Dentist.
For participating dental providers and information on areas other than the Washington, D.C. Metropolitan area, please use the Online Request Form.