HomeMy WebLinkAboutRESPONSE - RFP - P902 BENEFITS (3)MAMA
DELTA DENTAL PLAN OF
COLORADO
GROUP DENTAL PROPOSAL
11M
City of Fort Collins
Proposal Number P902
DELTA DENTAL PLAN OF COLORADO
4582 SOUTH ULSTER STREET STE 800
DENVER CO 80237
PHONE (303) 741-9300 OR (800) 233-0860
FAX (303) 741-9338
Prepared: August 25, 2003
ADDITIONAL CHECK LIST OF ITEMS INCLUDED WITH PROPOSAL
Yes No Description of Item
X Delta is in receipt of P902 Benefits Addendum 1
X Delta is in receipt of P902 Benefits Addendum 2
X Delta is in receipt of P902 Benefits Addendum 3
X Delta is in receipt of P902 Benefits Addendum 4
of Authorized Representative
e �-
f) Only dependent children underage nineteen (19) and dependent students under
age twenty-five (25) are eligible for Orthodontic Services.
5) EXTENDED COVERAGE: The extended coverage provision stated in PART VII,
CONDITIONS UNDER WHICH BENEFITS SHALL BE PROVIDED, Section 2.,
EXTENDED COVERAGE does not apply to Orthodontic Benefits.
CONTINUED COVERAGE OPTION RIDER
in consideration of the payment specified in PART I, PREFERRED OPTION ADMINISTRATIVE
AGREEMENT, Section 3. of the Agreement, and subject to all of the terms and conditions thereof,
Delta agrees to provide benefits to persons who elect continued coverage pursuant to this Rider.
1. For the purposes of this Rider, each of the following shall constitute a "Qualifying Event":
(a) Termination of an Eligible Employee's employment with the Group (other than for gross
misconduct), or a reduction in the number of hours worked by the Eligible Employee to less
than the minimum number of hours required under PART IV, ELIGIBILITY, Section 1., a)
of the attached Agreement.
(b) Death of an Eligible Employee.
(c) Divorce or legal separation from an Eligible Employee.
(d) An Eligible Employee becoming entitled to Medicare benefits.
(e) A dependent child ceasing to meet the definition of a dependent child contained in PART
IV, ELIGIBILITY, Section 1., b) of the attached Agreement.
2. Eligible Employees whose coverage under this program is terminated by reason of Qualifying
Event described in paragraph 1. (a) of this Rider may elect to continue coverage for themselves
and their Eligible Dependents for up to eighteen (18) months following the month in which the
Qualifying Event occurs.
3. Eligible Dependents whose coverage under this program is terminated by reason of any of the
Qualifying Events described in paragraph 1. (b) through (e) of this Rider may elect to continue
their coverage for up to thirty-six (36) months following the month in which the Qualifying Event
occurs.
4. After COBRA coverage begins, the employee may add a newborn child, an adopted child or a
child who has been placed with the employee for adoption and for whom the employee has
financial responsibility. The employee must notify the employer in writing within thirty-one (31)
days of the birth or placement in order to add the child to the COBRA coverage. A child born,
adopted or placed for adoption and enrolled as indicated will have the same COBRA rights as
any other dependents covered by the plan before the event that triggered COBRA coverage.
5. Any eligible employee or dependent who is eligible for COBRA continuation coverage who is
disabled and determined to be eligible for Social Security disability benefits at the time of
termination of employment or reduction of hours may elect to extend coverage for themselves
and their dependents for up to an additional eleven (11) months following the eighteen (18)
month extension allowed for the initial Qualifying Event. This right also applies if the eligible
employee or dependent is totally and permanently disabled at any time during the first sixty (60)
days of continuation coverage. The employee or dependent must notify the employer in writing
of the Social Security disability determination within sixty (60) days of the date it is issued, and
before the end of the initial eighteen (18) month COBRA coverage period. The employee or
dependent must also notify the employer within thirty (30) days of the date of any final
determination by the Social Security Administration that the employee or dependent is no longer
disabled.
A6. Eligible Employees or Eligible Dependent whose coverage under this Continued Coverage
Option Rider would otherwise terminate due to their becoming covered under another group
plan, may continue coverage under this Rider if the new group plan would exclude coverage for
a pre-existing condition. Coverage under this Rider may be continued until the earlier of:
(a) The end of the Maximum Period of coverage for which the initial Qualifying Event provided
coverage; or
(b) The date on which the pre-existing condition becomes covered under the new group plan.
The new plan must count the months for which the Qualified Beneficiary had coverage under
COBRA for the pre-existing condition.
7. If a Qualifying Event described in paragraph 1. (b),(c),(d) or (e) occurs during the eighteen (18)
months after the date of the Qualifying Event described in paragraph 1. (a), a Qualified
Beneficiary may continue coverage until thirty-six (36) months after the initial Qualifying Event.
8. In the case of a Qualifying Event as described in paragraph 1. of this Rider, a Qualified
Beneficiary must notify the Employer within sixty (60) days of the occurrence of the Qualifying
Event. The Employer will then have fourteen (14) days to provide the Qualified Beneficiary with
information concerning continuation coverage and rates. The Qualified Beneficiary will then
have sixty (60) days to elect to continue coverage. The first monthly payment must be received
by the Employer within forty-five (45) days of the date the Qualified Beneficiary elects to
continue coverage; the payment must include all monthly payments due at that time. If notice
by the Employee is not received by the Employer within sixty (60) days of the Qualifying Event,
the otherwise Qualified Beneficiary will not be eligible for continuation coverage.
9. Continuation coverage elected by a person under this Rider shall also be effective as of the first
day of the month following the applicable Qualifying Event described in paragraph 1. above.
However, benefits shall not be available to a person electing continuation coverage before the
group furnishes Delta with the data about such person required in PART III, GENERAL TERMS
AND CONDITIONS, Section 6. "(p)" of the Agreement, along with all dues then currently
payable for such person as stated in PART I PREFERRED OPTION ADMINISTRATIVE
AGREEMENT, Section 3. of the Agreement.
10. Continuation coverage as provided under paragraph 1. of this Rider will terminate on the earliest
of the following dates, as applicable:
(a) The period of continuation coverage specified in paragraphs 2. through 7. expires.
(b) This Agreement terminates.
(c) The Group fails to pay dues for the person as specified in PART I, PREFERRED OPTION
ADMINISTRATIVE AGREEMENT, Section 3. of the Agreement.
(d) The person becomes entitled to Medicare coverage.
(e) After election of COBRA, the person becomes first enrolled for dental benefits under
another group dental plan as an employee or dependent, except as described in paragraph
6., above.
No Text
AMENDMENT TO AGREEMENT
GROUP #1858
The Agreement dated January 1, 1997 as amended between CITY OF FORT COLLINS and DELTA DENTAL
PLAN OF COLORADO is hereby further amended effective January 1, 2003 as follows:
PART I PREFERRED OPTION ADMINISTRATIVE AGREEMENT
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT - On the tenth (10th), twentieth (20th), and
thirtieth (30th) day or the last business day closest to such date of each month, Delta will notify
the Group of the total claims paid for the specified period. The Group will make a prompt
transfer of funds to Delta to cover such disbursements as they become due and payable upon
receipt of said notification. In addition, the Group agrees to reimburse to Delta a monthly
Service Fee of $3.18 per eligible employee.
PART V
Section 1
BENEFITS, LIMITATIONS AND EXCLUSIONS
DIAGNOSTIC, PREVENTIVE AND ADJUNCTIVE BENEFITS
b) Limitations on Diagnostic, Preventive and Adjunctive Benefits:
1) Benefits for oral examinations and prophylaxis treatment (adult and child) shall not
be provided more than twice each in any twelve (12) month period except for
special need as determined by Delta. For payment purposes, an adult prophylaxis
is not a benefit for persons under age fourteen (14). Allowance separate from the
allowance for oral examination shall not be made for diagnosis, treatment planning
or consultation by the treating dentist, which for purposes of this Contract, are
considered components of a complete examination service.
All other provisions of this Agreement shall remain as previously stated.
DELTA DENTAL PLAN OF COLORADO
By �--�
Authorized Signature
DATED: JANUARY 1, 2003
CITY OF FORT COLLINS
m
On December 16, 2002 On
Title:
AMENDMENT TO AGREEMENT
GROUP #1858
The CONTRACT dated January 1, 1999 as amended between CITY OF FORT COLLINS and DELTA
DENTAL PLAN OF COLORADO is hereby further amended effective January 1, 2002 as follows:
PART IV ELIGIBILITY
Section 1. ENROLLMENT OF DEPENDENTS
a) Newly acquired dependents who are enrolled in the medical plan provided by this employer
must be enrolled within thirty-one (31) days of acquisition. Newborn children must be
enrolled within thirty-one (31) days of birth.
b) Any eligible dependents that suffer involuntary loss of coverage through another sources
will be allowed to enroll with satisfactory proof of coverage loss. Such dependents must
be enrolled within thirty-one (31) days of the loss of coverage and must be enrolled in the
medical plan provided by this employer.
The Continued Coverage Option Rider attached hereto includes amended provisions of COBRA.
All other provisions of this Contract shall remain as previously stated.
DELTA DENTAL PLAN OF COLORADO
By
Authorized Signature
On January 7, 2002
DATED: JANUARY 1, 2002
CITY OF FORT COLLINS
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kMENDMENT TO AGREEMENT
GROUP #1858
The Agreement dated January 1, 1999 as amended between CITY OF FORT COLLINS and DELTA
DENTAL PLAN OF COLORADO is hereby further amended effective January 1, 2002 as follows:
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT -On the tenth (10th), twentieth (20th),
and thirtieth (30th) day or the last business day closest to such date of each month, Delta
will notify the Group of the total claims paid for the specified period. The Group will make
a prompt transfer of funds to Delta to cover such disbursements as they become due and
payable upon receipt of said notification. In addition, the Group agrees to reimburse to
Delta a monthly Service Fee of $2.82 per eligible employee.
PART IV ELIGIBILITY
Section 1. ELIGIBLE PERSONS
All full-time permanent active employees working a minimum of twenty (20) hour per week
shall become eligible the first day of the month following thirty (30) days of employment.
Employees who have been absent from work due to strike, lay-off or leave of absence, and
who return to work, will become eligible on the first day of the month following the return
to work, provided the absence does not exceed six (6) months. If an absence exceeds six
(6) months, then such employees shall be considered newly hired employees in every
respect and must fulfill the eligibility requirements and application of deductibles, maximum
benefit payments and waiting periods. The following exception applies:
Delta Dental Plan of Colorado complies with all regulation related to the Uniformed
Services Employment and Reemployment Rights Act (USERRA) for employees called to
active duty in the uniformed services. Employees who return to active employment are
eligible to enroll as if there had been no leave of absence for uniformed service provided
they are still in an eligible class of employee as defined by the group. In addition, USERRA
allows for employees to elect continuation of coverage when coverage would otherwise
terminate due to an absence to serve in the uniformed services.
Services provided while an employee is not eligible, due to their leave of absence, shall
not be covered by this Contract, unless the employee or any dependent elects continued
coverage as provided in the Continued Coverage Option Rider attached hereto or
according to USERRA where applicable.
PART VII. CONDITIONS UNDER WHICH BENEFITS SHALL BE PROVIDED
Section 1. PAYMENT OF CLAIMS
b) Appeal of a Claim Denied in Whole or in Part:
1) Internal, Appeal:
i) With - the exception of a claim appeal that qualifies for Independent
E3 nal Review, the Employer, or his de nee(s) shall have authority for
determination of Benefits in any case involving disputed Benefits. The
Covered Person may appeal this determination within one hundred and
eighty (180) days by filing a written notice with the Dental Director of
Delta Dental. Any written communication should include documents or
records in support of the claim. Delta may submit the matter to Delta's
Executive Committee of the Board of Trustees for determination of
Benefits.
2) Appeal to request an Independent External Review (only available on
qualified claims):
i) In addition to the Internal Appeal procedures outlined above, Covered
Persons have certain rights under Colorado Division of Insurance
Regulation 4-2-21. Covered Persons may request an Independent
External Review of a claim when the above Internal Appeal procedures
result in a final denial AND that final denial is based on one of the
following reasons:
• medical necessity;
• effectiveness;
• efficiency;
• experimental; or
• investigational.
ii) When a claim qualifies for External Review, Delta will mail the Covered Person
a notice that explains their rights to request an Independent External Review of
the denied claim. In addition to the notice, the Covered Person will receive the
required form for submitting this request.
All other provisions of this Agreement shall remain as previously stated.
DATED: JANUARY 1, 2002
DELTA DENTAL PLAN OF COLORADO CITY OF FORT COLLINS
By ByV) 06
Authorized Signature it : �� aF
On December 5. 2001 On Ul /y0.-
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AMENDMENT TO AGREEMENT
GROUP #1858
The AGREEMENT dated January 1, 1999 as amended between CITY OF FORT COLLINS and DELTA
DENTAL PLAN OF COLORADO is hereby further amended effective January 1, 2000 as follows:
PART I PREFERRED OPTION ADMINISTRATIVE AGREEMENT
Section 2. TERM -The term of the Agreement is from January 1, 2000 through December 31, 2000
and for successive one-year periods thereafter unless terminated as herein provided.
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT - On the tenth (10th), twentieth (20th),
and thirtieth (30th) day or the last business day closest to such date of each month, Delta
will notify the Group of the total claims paid for the specified period. The Group will make
a prompt transfer of funds to Delta to cover such disbursements as they become due and
payable upon receipt of said notification. In addition, the Group agrees to reimburse to
Delta a monthly Service Fee of $2.65 per eligible employee. The monthly Service Fee is
guaranteed from January 1, 2000 through December 31, 2001.
All other provisions of this Agreement shall remain as previously stated.
DATED: January 1, 2000
DELTA DENTAL PLAN OF COLORADO CITY OF FORT COLLINS
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PART
PREFERRED OPTION ADMINISTRATIVE AGREEMENT
DELTA DENTAL PLAN OF COLORADO
DELTA GROUP #1858
Section 1. PARTIES -The parties to this Agreement are CITY OF FORT COLLINS, herein called the
"Group," "Applicant," or "Employer' and Colorado Dental Service Inc., a not for profit
Colorado Corporation, d/b/a Delta Dental Plan of Colorado, herein called "Delta' .
Section 2. TERM - The term of the Agreement is from January 1, 1999 to December 31, 1999 and for
successive one-year periods thereafter unless terminated as herein provided.
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT - On the tenth (10th), twentieth (20th),
and thirtieth (30th) day or the last business day closest to such date of each month, Delta
will notify the Group of the total claims paid for the specified period. The Group will make
a prompt transfer of funds to Delta to cover such disbursements as they become due and
payable upon receipt of said notification. In addition, the Group agrees to reimburse to
Delta a monthly Service Fee of $2.55 per eligible employee.
Section 4. Changes - This Agreement may not be changed, altered or terminated except in
accordance with PART III, GENERAL TERMS AND CONDITIONS, of this Agreement.
Section 5. BENEFITS - Delta will provide to the Enrolled Eligible Employees and their enrolled eligible
dependents the Benefits as described in PART V, BENEFITS, LIMITATIONS AND
EXCLUSIONS of this Agreement.
Section6. AGREEMENT -PART I, ADMINISTRATIVE AGREEMENT; PART II, DEFINITIONS; PART
III, GENERAL TERMS, AND CONDITIONS; PART IV, ELIGIBILITY; PART V, BENEFITS,
LIMITATIONS AND EXCLUSIONS; PART VI, DEDUCTIBLE, MAXIMUM AMOUNT AND
COORDINATION OF BENEFITS: PART VII, CONDITIONS UNDER WHICH BENEFITS
SHALL BE PROVIDED; and the attached appendices and riders constitute the entire
Contract of the parties. The Agreement is binding upon the parties and their respective
successors and assigns.
1
Delta Preferred Option
(DPO)
GROUP DENTAL PROPOSAL
for
City of Fort Collins
Proposal Number P902
Provided by: DELTA DENTAL PLAN
4582 S. Ulster St., Ste 800
Denver, Colorado 80237
(303) 741-9300 or
(800) 233-0860
Date: August 25, 2003
Section 7. SIGNATURES - When accepted by the President of Delta Dental Plan of Colorado and the
Authorized Officer of the Group, this Agreement becomes binding and effective as of
January 1, 1999.
Countersigned:
Accepted:
DELTA DENTAL PLAN OF COLO O CITY OF FORT COLLINS
BY BY
/President Title: e���pof ��C�czNv
ON 2 2 ON << cl
2 Approved As T _ or
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PART II
For the purpose of this Agreement, the following definitions shall apply:
Section 1. APPLICANT means the Group or Employer for whose members or employees dental
benefits are being provided.
Section 2. ADMINISTRATIVE AGREEMENT means this agreement referenced in PART I, Section
6., between DELTA and the Applicant and the attached appendices and riders, if any. This
Agreement constitutes the entire agreement between the parties.
Section 3. PARTICIPATING AND NON -PARTICIPATING DENTIST
a) Participating Dentist means a dentist who is licensed to practice by the State of
Colorado, has executed a Participating Dentist Agreement with Delta, and agrees to
render dental care to Covered Persons in accordance with standard terms and
conditions applicable to Dentist participation in Delta prepaid dental care programs as
established by the Board of Trustees of Delta.
b) Non -Participating Dentists means a dentist licensed to practice by the State of Colorado
who has not executed a Participating Dentist Agreement with Delta.
Section 4. PREFERRED OPTION DENTIST means a dentist licensed to practice by the State of
Colorado who meets the criteria for the DELTA Preferred Option program and has made
a special agreement with Delta to participate in that program.
Section S. COVERED SERVICES means the dental procedures asset forth in AppendixA -Covered
Services, attached hereto and made a part of this Agreement.
Section 6. BENEFITS means those dental services which are available under the terms of this
Agreement as specified in PART V, BENEFITS, LIMITATIONS AND EXCLUSIONS.
Section 7. Each of the words in the term USUAL. CUSTOMARY AND REASONABLE as used herein
shall have the following meanings:
a) USUAL: A "usual fee" for a private patient is a fee charged or offered and received by
an individual dentist or group of dentists; i.e., his/her or their own usual fee. However,
if a dentist or group of dentists charge a lower fee to patient(s) who are members of any
individual or group dental care program for the same or similar service or procedure,
the "usual fee" shall be deemed to be the lowest fee charged or offered and received.
3
The "usual fee" shall not be affected by fees accepted for patients covered by non-
commercial programs funded by public or charitable funds primarily intended to assist the
poor or disadvantaged or those occasional instances where professional courtesy
discounts are given or fees waived or discounted in case of financial hardship.
Fees which are established by a bona fide arm's length agreement between a participating
dentist and any third -parry payor under a prepayment, insurance or health care service
corporation program shall not be considered to "regularly" or "usually" charge and
therefore, shall not affect a participating dentist's "usual fee." If so requested by Delta, it
shall be the responsibility of the participating dentist to document the existence of a "bona
fide arm's length agreement" between the dentist and such third -party payor, in order for
the dentist's fees charged to such payor to be considered to be not "regularly or usually
charged." This interpretation shall not be construed to alter the following well established
policies of Delta:
The fee considered to be the participating dentist's usual fee for a particular
dental procedure shall in no event be more than the lowest fee charged or
offered and received by the same dentist or group of dentists for prepayment or
indemnity insurance healthcare service corporation programs, except as
specified immediately above, or for uninsured patients.
2. Fees which are advertised shall be made available to Delta -eligible patients if
lower than the participating dentist's accepted filed fees.
3. Offers, arrangements, or agreements by which a participating dentist waives any
or all of the co -payment or deductible chargeable under the terms of a dental
prepayment, insurance, or healthcare service corporation program shall be
considered in determining what constitutes the dentist's "usual fee."
b) CUSTOMARY: A fee is customary when it is within the range of usual fees charged
and received by Participating Dentists within the same geographic area forthe same
Covered Service.
c) REASONABLE: A fee is reasonable if it is usual and customary, or if it falls above
customary if it is justifiable considering special circumstances, or extraordinary
difficulty of the case in question.
Section 8. PREVAILING FEE is the fee for a single procedurewhich satisfies the majority of dentists
in Colorado, and is determined by Delta based upon confidential fee listings from
Participating Dentists (the 51st percentile).
4
Section 9. PREFERRED OPTION DENTIST'S FEE means the fee which the Preferred Option dentist
has contractually agreed with Delta to accept for treating Covered Persons under this
program, or the fee actually charged, whichever is less, for a single procedure.
Section 10. COVERED AMOUNT
a) Payment for completed Covered Services provided by a Participating Dentist will be
based upon the Participating Dentist's Usual and Customary fee or the fees actually
charged, whichever is less.
b) Payment for completed Covered Services provided by a dentist who is not a
Participating Dentist will be based upon the Non -Participating Dentist's fee not to
exceed the Prevailing Fee charged by Participating Dentists.
Section 11. ELIGIBLE DEPENDENT UNIT is the group of Eligible Dependents, as defined in PART IV,
ELIGIBILITY hereof, attributable to an Eligible Employee, as defined in said PART IV.
Section 12. ENROLLED EMPLOYEE, or ENROLLED ELIGIBLE EMPLOYEE, is an Eligible Employee,
as defined in PART IV, ELIGIBILITY hereof, enrolled as a member or employee of the
Group, and covered by the Group Dental Care Plan provided in accordance with this
Agreement.
Section 13. COVERED PERSON means Enrolled Eligible Employees, Retirees, and enrolled Eligible
Dependents or a person ceasing to be eligible who elects continued coverage as provided
in PART IV, ELIGIBILITY, and for whom the appropriate monthly payment specified in
PART I, ADMINISTRATIVE AGREEMENT, Section 4. is received.
Section 14. AGREEMENT YEAR is the 365-successive-day period (or, if a February 29 is
encompassed, the 366-successive-day period) beginning on the day and month set forth
in this Agreement, PART 1, Section 2.
Section 16. ANNIVERSARY DATE shall be the first day of each Agreement Year subsequent to the
initial Agreement Year.
Section 16. ACTIVE for purposes of PART IV, ELIGIBILITY, Section 1. ELIGIBLE PERSONS, means
performing in the customary manner on the Group's scheduled work days, all of the regular
duties of the employee's employment with the Group either at one of the Group's business
establishments or at some location to which the Group's business requires the employee
to travel. An employee will be considered active on a day which is not one of the Group's
scheduled work days only if he was performing in the customary manner all of the regular
duties of his employment on the next preceding scheduled work day.
61
Section 17. PREDETERMINATION means review by Delta of a dentist's statement, including
diagnostic material, describing his planned treatment and expected charges for the
purpose of determining benefits available under the terms of this Agreement.
Section 18. RETIREE means an Employee who has ten (10) or more years of eligible service
completed with the Employer in a classified position or an unclassified management
position, and who is eligible to file without penalty for receipt of retirement benefits and who
has been covered under the Plan continuously and immediately prior to retirement for
twelve (12) consecutive months; or who is totally and permanently disabled and has ten
(10) or more years of eligible service completed with the Employer in a classified position
or unclassified management position and has exhausted his/her COBRA continuation
period.
Con
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Section 1. TERMS OF AGREEMENT - This Agreement shall continue for the period specified in
Part I, ADMINISTRATIVE AGREEMENT.
Section 2. RENEWAL - The Agreement shall be renewed for four successive one year periods
unless during any Agreement year either party elects not to renew by giving the
other party written notice of such election at least one hundred twenty (120) days
prior to the end of the current Agreement year. In the event that Delta shall desire
to change the rates or other terms and conditions of this Agreement effective on an
Anniversary Date, advice of any such proposed changes shall be given in writing no
fewer than sixty (60) days in advance of the of the notice of renewal.
Section 3. TERMINATION - This Agreement shall be terminated as follows:
a) At the end of the original Term of Agreement provided the required notice of
non -renewal has been given.
b) At the end of any renewal year provided the required notice of non -renewal is
given.
c) In the event any payment due pursuant to PART I, ADMINISTRATIVE
AGREEMENT, Section 4. MONTH DUES of this Agreement is not paid within
twenty (20) days of the due date, Delta may give written notice that payment
is due, and if such payment is not received within ten (10) days after such
notice, Delta may at its option, terminate all further obligations. The date of
termination shall be specified by Delta.
d) By election of the Group if Delta defaults in providing the Benefits under the
Agreement and such default is not corrected within sixty (60) days of such
default, the termination date shall be specified by the Group.
e) At any time by either party with sixty (60) days advance written notice.
•;• • ; •►am 4 :u I I Z RVIKOR
In the event of termination by Delta as stated in Part III, Section 3, paragraph a, all
Benefits shall terminate and Delta shall be released from all further obligations of this
Contract, however, Delta shall make payment to dentist for dental services
authorized by Delta prior to termination and performed in reliance of such
authorization. Applicant shall remain liable to Delta for the greater of:
a. the unpaid payments applicable for the period this Agreement was in effect prior
to termination; or
7
b. the full amount of all Dentist's statements paid or otherwise discharged by Delta during
the full term of this Contract, plus $7.00 per paid claim (to compensate Delta for its
administration for the dental program), less amounts actually paid by the Group to Delta
during the term of the Agreement.
If Group notifies Delta in writing of its intention to terminate this Agreement as of any
date other than the end of the Agreement Term, such termination shall be treated as
termination for failure to pay Service Fee, and the notice by Group of the intention to
terminate shall constitute a waiver of notification and billing by Delta.
In the event of termination of this Agreement for any cause, Delta shall not be required
to authorize services beyond the termination date or to pay for services provided
beyond such termination date, except for the completion of single procedures started
while this Agreement was in effect, which are otherwise Benefits under the terms of this
Agreement.
If on termination of this Agreement for any cause, Group has not paid Fees to Delta
applicable to a period of time before the termination date, Group shall, within thirty (30)
days after termination, remit such portion of the Fees on claims, if any.
Section 5. REINSTATEMENT
Acceptance by Delta of the proper amount of Service Fee after the termination of this
Agreement and without requiring a new application shall reinstate the Contract as though
it never terminated, unless Delta shall, within five (5) business days of receipt of such
payment, either refund the payment made or issue to Applicant a new Contract
accompanied by written notice stating clearly those respects in which the new Contract
differs from the terminated Agreement in Benefits, coverage, or otherwise. If Applicant
does not approve the new Contract, Delta shall refund the payment made.
Section 6. GENERAL PROVISIONS
a) Clerical errors or delays in keeping or relating data relative to coverage shall not
validate or invalidate coverage which would otherwise be in force. Upon discovery of
such errors or delays, an equitable adjustment of Service Fees shall be made.
b) Any notice under this Agreement shall be sufficient if given by either the Applicant or
Delta to the other (or in the case of the Applicant, to its designated agent) addressed
as stated below and shall be effective forty-eight (48) hours after deposit in the United
States mail with postage fully prepaid thereon.
Group: City of Fort Collins
200 West Mountain Ave., Ste A
Fort Collins, CO 80522-0580
E
DELTA: The Delta Dental Plan of Colorado
Colorado Dental Service Inc.
4582 South Ulster Street, Suite 800
Denver, CO 80237
c) Notice to Covered Persons shall be in writing and sent by regular U.S. mail to their
addresses last shown in the records of Delta. Such notice shall be deemed to be
delivered when deposited in the United States Mail, addressed to the Covered Person
at such address with postage thereon prepaid.
d) No action at law or inequity shall be brought to recover on this Agreement prior to the
expiration of sixty (60) days afterfinal notice of claims has been filed in accordance with
the requirements of this Agreement; nor shall such action be brought at all unless
brought within three (3) years from the date the claim for benefits was presented to
Delta.
e) All statements made by the Group or by an individual shall be deemed representations
and not warranties. No such statement shall be used in defense to a claim under this
Agreement unless it is contained in a written application.
f) This Agreement shall be the entire, full, and complete agreement between Delta and
the Group concerning group dental care. This Agreement may not be orally amended
or changed. This Agreement may at any time be amended and changed by written
agreement between Delta and the Group. Any such amendment shall be binding on
all Covered Persons regardless of the date their coverage became effective.
g) No agent or employee of Delta has the authority to change the Agreement or its
provisions. No change in the Agreement shall be valid unless approved in writing by
the President of Delta.
h) The Group agrees to permit Delta, by its auditors or other authorized representatives,
upon reasonable advance written notice, to inspect records of the Group pertinent to
eligibility in order to verify the accuracy of lists of Covered Persons prepared by the
Group and submitted to Delta. Delta agrees to keep all information regarding the
Group confidential,
i) Delta agrees that the Group or its designated representative, upon reasonable advance
written notice, shall have the right of access to all files and records pertinent to the
Group for examination and audit.
j) Any dispute arising out of or relating to this Agreement or the breach thereof between
Delta, a Participating Dentist, and Covered Person or any of them, including any
disagreement with a claim determination made by Delta after exhaustion of the
N
procedure outlined in PART VII, CONDITIONS UNDER WHICH BENEFITS SHALL BE
PROVIDED, Section 1. Payment of Claims (a) of this Agreement, shall be settled by
arbitration in accordance with the Commercial Arbitration Rules of the American
Arbitration Association, and judgment upon the award rendered by the Arbitrator(s) may
be entered in any Court having jurisdiction thereof. Arbitration may be initiated by any
party to a dispute by giving notice to each other party two copies of such notice with the
American Arbitration Association and by complying with other applicable provisions of
the Association's rules.
k) Delta shall furnish to the Applicant on the Effective Date of this Agreement and at
reasonable times thereafter a directory of Participating Dentists and Preferred Option
Dentists who have agreed to provide services described in this Agreement. The
directory of Preferred Option Dentists shall be furnished by Delta in such quantities that
the Applicant may distribute a copy to each Eligible Employee. It is understood that the
composition of such directory may be subject to change from time to time, and Delta
reserves the right to change the directory without prior notice to the Applicant, but shall
give notice within reasonable time of any provider's termination or breach of contract,
or inability to perform, which will materially and adversely affect the Applicant. Current
information concerning the Participating Dentist status of any dentist may be obtained
by telephoning Delta. The dentists providing or contracting to provide dental services
under this Agreement shall be solely responsible therefor, and in no case shall Delta
or the Applicant be liable for any act or omission by such dentists, their agents or
employees.
1) Delta will issue to the Group, and the Group will make available to each Eligible
Employee, an evidence of coverage summarizing the benefits to which the employee
is entitled and other provisions of this Agreement. If any amendment of this Agreement
shall materially affect any benefits described in such evidence of coverage, a corrected
evidence of coverage, riders, or inserts showing the change shall be issued to the
Group.
m) Delta, at its own expense, will have the right and opportunity to examine any individual
for whom claim or request for predetermination of benefits is pending under this
Agreement when and so often as it reasonably may require and to make an autopsy
in case of death where it is not prohibited by law.
n) Where applicable herein, the use of the singular shall include the plural, the plural the
singular, and the use of any gender shall include all genders.
o) This Agreement is not to be construed as satisfying any requirement for coverage by
worker's compensation insurance.
10
p) The Group shall compile and furnish Delta on or prior to the first day of every month,
commencing on the effective date, a list of all Eligible Employees, showing their social
security numbers, the dates of hire, and if applicable, the location code. The Group
shall also furnish a monthly list of all persons electing continued coverage pursuant
to PART IV, ELIGIBILITY, Section 4. Delta agrees to keep all information regarding
the Group confidential.
q) This agreement shall be constructed in accordance with and governed by laws of the
State of Colorado. Delta agrees to comply with all applicable Federal, State and local
laws, rules, regulations or ordinances, and all provisions required thereby to be
included herein, are hereby incorporated by reference. Delta agrees to indemnify and
hold GROUP harmless from any loss, damage or liability resulting from a violation on
the part of Delta of such laws, rules, regulations or ordinances.
r) All obligations of the City of Fort Collins hereunder are expressly contingent upon the
annual appropriation of funds sufficient and intended to carry out the same by the
City Council of the city of Fort Collins, in its discretion.
11
DELTAPREFERRED OPTION (DPO)
DeltaPreferred Option (DPO) is the name of a preferred provider organization (PPO)
introduced by Delta Dental Plan of Colorado. The DeltaPreferred Option plan is different
from other PPOs in that only dentists who are participating members of Delta are accepted
for participation in the DPO panel. These dentists have agreed to accept the amount
agreed upon for each service provided to a DPO covered patient. The patient is
responsible only for any deductible and copayment that applies to the service received.
Under the DPO approach, all employees will be offered a free choice to use either a DPO
or a non-DPO provider. Those employees who select a DPO provider will qualify for the
higher DPO level of benefits while those who select a non-DPO provider will receive the
standard level of benefits. The advantages of using a DPO Dentist are:
• The Patient receives the highest benefit available for all services
• Less actual out of pocket costs when paying the Patient copayment (i.e., the
DPO dentists' allowable fees are lower therefore Patient's costs are lower).
• Patient receives all the benefits shown below under the Delta Participating
dentist benefits
Patients who select a Delta Participating Dentist who is not a DPO Dentist will receive the
standard benefits. The benefits of using a Participating Dentist are:
• The Dentist files claims for Delta patients
• The Dentist can charge the patient only the portion not covered by the plan and
that amount is spelled out on the Explanation of Benefits
• The Dentist has guaranteed reasonable and customary fees - benefits will be
paid at the standard level and the patient will have no excess out of pocket
expense due to the fee exceeding the Usual and Customary fee. The patient
pays only the deductible and/or copayment applicable to the service received
Patients who select a non -participating dentist (one who is not a participating member of
Delta Dental Plan and not a DPO dentist) will receive benefits on the basis of the prevailing
fee based on the standard level of benefits. Those who choose a non-DPO, non-
participating dentist do risk significant out of pocket expense as well as the inconvenience
of having to file their own claims and being responsible for payment of the entire fee at the
time services are rendered (at the non -participating dentist's discretion).
DeltaPreferred Option
The Delta Difference
PART IV
ELIGIBILITY
Section 1. ELIGIBLE PERSONS
a) Eligible Employees are defined as follows:
All full-time permanent active employees working a minimum of twenty (20) hours per
week shall become eligible the first day of the month following thirty (30) days of
employment.
Employees who have been absent from work due to strike, lay-off or leave of absence,
and who return to work, will become eligible on the first day of the month following the
return to work, provided the absence does not exceed six (6) months. If an absence
exceeds six (6) months, then such employees shall be considered newly hired
employees in every respect and must fulfill the eligibility requirements and application
of deductibles, maximum benefit payments and waiting periods. Services provided
during the period such employees were not eligible due to strike, lay-off or leave of
absence shall not be covered by this Agreement, unless the employee or any
dependents have elected continued coverage as provided in the Continued Coverage
Option Rider attached hereto.
b) Eligible Dependents are defined as follows:
1) The Eligible Employee's lawful spouse.
2) The Eligible Employee's unmarried children wholly dependent upon the employee
for support and maintenance until the end of the month to which they attain
nineteen (19) years of age or any unmarried children, nineteen (19) years of age
until the end of the month to which they attain twenty-five (25) years who attend an
accredited educational institution on a full-time basis. This includes any stepchild,
foster child, or legally adopted child who lives with the employee in a regular parent -
child relationship.
A covered unmarried child reaching the age of nineteen (19) years may continue to
be eligible as a dependent if he is incapable of self-support because of physical
handicap or mental incapacity that commenced prior to reaching age nineteen (19)
and if he is chiefly dependent on the Eligible Employee for support and
maintenance, provided proof of such handicap or incapacity and dependency is
submitted within thirty-one (31) days after a request by either Delta or Applicant,
and subsequently as may be required by either Delta or the Applicant, but not more
frequently than annually after the handicapped or incapacitated and dependent child
12
has attained age twenty-one (21). Upon failure to submit such required proof or to
permit such an examination, or when the child ceases to be so incapacitated,
coverage with respect to such child shall cease.
No one may be covered as a dependent and also as an employee. If both parents
are covered as employees, children may be covered as dependents under both
employees.
Persons in active military service will not be considered as Eligible Dependents.
"Dependent" also means any child for whom the employee or spouse is responsible
for medical or other health care benefits under a Qualified Medical Child Support
Order.
c) Eligible Retirees are covered as follows:
All Retirees and their eligible Dependents with coverage at the time of retirement may
elect to continue coverage in that plan or switch to the other plan available to the
Group. After this time, coverage must remain under the same plan. Once coverage
is terminated, it may not be reinstated.
Section 2. ENROLLMENT OF DEPENDENTS
a) You must select the same level of dependent coverage as chosen for medical
coverage.
b) Newly acquired dependents who are enrolled in the medical plan provided by this
employer must be enrolled within thirty-one (31) days of acquisition. Newborn children
must be enrolled within thirty-one (31) days of birth.
c) Any eligible dependents that suffer involuntary loss of coverage through another source
will be allowed to enroll with satisfactory proof of coverage loss. Such dependents
must be enrolled within thirty-one (31) days of the loss of coverage and must be
enrolled in the medical plan provided by this employer.
Section 3. EFFECTIVE DATE OF INDIVIDUAL COVERAGE
a) Coverage for Eligible Employees becomes effective the first day of the month
coincident with or next following the date such persons become eligible as defined in
PART IV, ELIGIBILITY, Section 1. ELIGIBLE PERSONS.
b) Coverage for Eligible Dependents becomes effective on the date the employee's
coverage becomes effective. Dependents acquired after the employee effective date
13
shall become eligible on the first day of the month following attainment of dependent
status.
Section 4. TERMINATION OF INDIVIDUAL COVERAGE
a) Coverage for Enrolled Eligible Employees will terminate on the earliest date of the
following:
1) The last day of the month that eligibility is terminated in accordance with the
eligibility rules of this Agreement, unless the Eligible Employee elects continued
coverage under the Continued Coverage Option Rider.
2) The last day of the month for which Service Fees have been paid.
3) The day this Agreement is terminated.
b) Coverage for enrolled eligible dependents will terminate on the earliest of the following:
1) The day the Enrolled Eligible Employee's coverage under which they are covered
terminates in accordance with the above.
2) The last day of the month during which the enrolled eligible dependent ceases to
be eligible in accordance with the eligibility rules of this Agreement unless continued
coverage is elected by or on behalf of any dependent under the Continued
Coverage Option Rider.
14
PART V
BENEFITS LIMITATIONS AND EXCLUSIONS
Subject to the limitations and exclusions hereinafter set forth, the following completed dental services
are Benefits when provided by a dentist (or other person legally permitted to perform such services by
authority of license) and are determined under the standards of generally accepted dental practice to be
necessary. THE SPECIFIC DENTAL PROCEDURES ARE SET FORTH IN APPENDIX A - COVERED
SERVICES.
Section 1. DIAGNOSTIC PREVENTIVE AND ADJUNCTIVE BENEFITS
Delta shall pay or otherwise discharge Sixty Percent (60%) of the Dentist's Usual,
Customary and Reasonable fees or the fees actually charged, whichever is less, or Eighty
Percent (80%) of the Preferred Option Dentist's Fees for the following Covered Services:
a) Diagnostic - certain services performed to assist the dentist in evaluating the existing
conditions and determining the dental care required. Appendix A, Section I.
Preventive - certain services performed to prevent the occurrence of dental
abnormalities or disease. Appendix A, Section II.
Adjunctive - certain additional services including emergency palliative treatment
performed as a temporary measure which does not effect a definite cure. Appendix A,
Section IX.
b) Limitations on Diagnostic, Preventive and Adjunctive Benefits:
1) Benefits for oral examinations and prophylaxis treatment shall not be provided
more than twice each in any twelve-month period except for special need as
determined by Delta. Allowance separate from the allowance for oral examination
shall not be made for diagnosis, treatment planning or consultation by the treating
dentist, which for purposes of this Agreement, are considered components of a
complete examination service.
2) Topical fluoride application is a benefit only through age fifteen (15) and only once
in twelve (12) months.
3) Benefit for full mouth x-rays is made only after sixty (60) months have elapsed
following any prior provision of payment for full mouth x-rays under any Delta
program. Benefit for supplementary bite -wing individual x-rays is provided on
request by the dentist, but not more than once every twelve (12) months while the
patient is under any Delta program. A panoramic survey (which may include
15
bitewing x-rays and/or periapical) is considered a full mouth x-ray for purposes of
this Agreement. Total allowance for individual periapical and/or bitewing x-rays
shall not exceed allowance for full mouth x-rays. Exception to this Limitation may
be made in documented cases of special need, but only as determined by DELTA.
4) X-rays and other specific and/or usual diagnostic services associated with
determination of the need for treatment covered by an Amendment or Rider may
be covered only under terms of such Amendment or Rider and only when such an
Amendment or Rider is made a part of this Agreement but only when such
services are included in such Amendment or Rider.
5) Payment of a separate charge for examination shall not be made when performed
in conjunction with any covered Adjunctive Service.
6) Benefitfor Covered Diagnostic Services may be applied toward the cost of special
diagnostic services or techniques and the patient shall be responsible for the
portion of the dentist's fee in excess of the Delta allowance.
7) Benefit for space maintainers shall only be made for premature loss of primary
(deciduous) teeth for children through age thirteen (13).
8) Sealant Benefits are described as topically applied resin, composite or other
material used to seal developmental grooves and pits in teeth for the purpose of
preventing dental decay and are available only to Covered Persons underthe age
of fifteen (15).
9) Sealant Benefits include the application of sealants only to intact occlusal surfaces
of permanent molar teeth when those teeth have no caries (decay) and no
restorations on any surface.
10) Separate benefit shall not be made for any preparation or conditioning of the tooth
or any other procedure associated with sealant application.
11) Sealant Benefits do not include any repair or replacement of a sealant on any
tooth within thirty-six (36) months of its application under this Contract. Such
repair or replacement is considered included in the fee for the initial placement of
the sealant.
12) Payment of Benefits for Adjunctive Services provided in relation to or as a result
of another categoryof Covered Services, or Covered Services provided under any
Amendment or Rider, shall be made at a percentage no greater than the related
category of Covered Services or Amendment or Rider.
16
Section 2. BASIC RESTORATIVE BENEFITS
Delta shall pay or otherwise discharge Fifty Percent (50%) of the dentist's Usual,
Customary and Reasonable fees or the fees actually charged, whichever is less, or Sixty
Percent (60%) of the Preferred Option Dentist's Fees for the following Covered Services:
a) Basic Restorative - amalgam restorations (fillings) on posterior teeth, intraorally cured
resin or plastic restorations (fillings) on anterior teeth and preformed shell crowns for
treatment of carious lesions (visible destruction of hard tooth structure resulting from
the process of dental decay or loss of tooth structure due to fracture). Appendix A,
Section III -A.
b) Limitations on Basic Restorative Benefits
1) Benefit for the same Covered Basic Restorative Service shall not be provided
more than once in any twelve (12) month period.
2) Allowance for amalgam or intraorally cured resin or plastic restorations may be
made toward the cost of more expensive procedures or materials selected, and
the patient shall be responsible for the portion of the dentist's fee in excess of the
Delta allowance.
Section 3. ORAL SURGERY ENDODONTIC AND PERIODONTIC BENEFITS
Delta shall pay or otherwise discharge Fifty Percent (50%) of the dentist's Usual,
Customary and Reasonable fees or the fees actually charged, whichever is less, or Sixty
Percent (60%) of the Preferred Option Dentist's Fees for the following Covered Services:
a) Oral Surgery - extractions and certain other surgical services and associated covered
anesthesia and/or related covered services. Appendix A, Section VIII and IX.
Endodontic- certain services.for treatment of non -vital tooth pulp. Appendix A, Section
IV.
Periodontic - certain services for treatment of gums and bone supporting teeth.
Appendix A, Section V.
b) Limitations on Endodontic and Periodontic Benefits
1) Unless special need is documented, benefit for Covered Surgical Periodontic
Services shall not be provided more than once in any thirty-six (36) month period
and for Covered Adjunctive Periodontic Services not more than once in a twenty-
four (24) month period while the patient is an Covered Person.
17
2) Benefit for pulpotomy/pulpectomy shall be made only for primary (deciduous)
teeth.
3) No Benefits shall be provided for teeth retained in relation to an overdenture.
4) Nonsurgical periodontal procedures which include any component of prophylaxis
are limited to Part V, Section 1.,b), paragraph 1).
Section 4. GENERAL LIMITATIONS - ALL SERVICES
a) If an Covered Person selects a service that is not provided for under the terms of this
Agreement or specialized techniques rather than standard services, Delta will pay the
applicable percentage of the fee for the least costly commonly performed Covered
Service and the patient is responsible for the remainder of the dentist's fee.
b) When services involving veneers, facings, or any other cosmetic services posterior to
the first molar are provided, allowance shall be limited to the Covered Amount for
Covered Service without veneers, facings or cosmetic component, or the service
actually performed, whichever is less. The patient is responsible for the remainder of
the Dentist's fee.
c) If the expenses to be incurred for the performance of Covered Services (except
Covered Diagnostic and Emergency Services) which can reasonably be expected to
total Four Hundred Dollars ($400.00) or less, those expenses may be paid, provided
Delta agrees through Predetermination prior to the performance of the service, to
accept those expenses as Covered Services. If Delta does not so agree through
Predetermination, or if a description of the procedures to be performed and an estimate
of the Dentist's charges are not submitted in advance, then the amount of expenses
included as Covered Services will be determined by Delta, taking into account alternate
procedures, services, or courses of treatment based upon professionally endorsed
standards of dental care.
d) Local anesthesia is considered a component of any procedure in which it is used.
e) The Covered Amount for a Covered Service started but not completed shall be limited
to the amount determined by Delta.
f) A temporary dental service will be considered an integral part of a complete dental
service rather than a separate service, and separate payment shall not be made for a
temporary service unless otherwise included as a Covered Service of this Agreement.
g) Allowance for assistant surgeon when determined by Delta to be a Covered Benefit
shall not exceed 20% of the surgeon's fee for the same Covered Service.
18
Section 5. EXCLUSIONS - The following services are not benefits
a) Services for injuries or conditions which are compensable under Worker's
Compensation or employer's liability laws, no-fault auto insurance, or services which
are provided to the Covered Person by any federal or state government agency or are
provided without cost to the Covered Person by any municipality, county or other
political subdivision, or any services for which the Covered Person would have no
obligation to pay in absence of this coverage, except as such exclusion may be
prohibited by law, such as Medicaid.
b) Any Covered Service or any portion thereof started during any period when the person
was not eligible for such service under this Agreement.
c) Services for treatment of congenital (present at birth) or developmental (following birth)
malformations, except intraoral dental services for treatment of a condition which is
related to or developed as a result of cleft lip and/or cleft palate, unless otherwise
included as a Covered Service of this Agreement.
d) Services for cosmetic reasons.
e) Services for restoring tooth structure lost from wear or for any services related to
protecting, altering, correcting, stabilizing, rebuilding or maintaining teeth due to
improper alignment, occlusion or contour or for periodontal stabilization.
f) Habit appliances, night guards, occlusal guards, athletic mouth guards and
gnathological (jaw function) services, bite registration or analysis, or any related
services (except as covered under provisions of an Amendment or Rider).
g) Pre -medication, analgesia, hypnosis or any other patient management services (except
covered anesthetic services).
h) Charges for prescription drugs.
i) Experimental procedures, or any procedures other than those Covered Services for
which the prognosis is good. Any procedures done in anticipation of future need
(except Covered Preventive Services).
j) Hospital costs and any additional fees charged by the dentist or hospital for hospital
services, visits, or charges for use of any facility.
k) Anesthesia other than general anesthesia, intravenous sedation or analgesia
administered in connection with Covered Oral Surgery Services. (See PART V,
BENEFITS, LIMITATIONS AND EXCLUSIONS, Section 3. Oral Surgery).
19
I) Extraoral grafts (grafting of tissues or other substances from outside the mouth to or
into oral tissues), augmentations or implants and/or any associated appliances.
Removal of implants or any services associated therewith.
m) Orthodontic services including any related diagnostic, preventive or interceptive
services (surgical and other treatment of malalignment of teeth and/or jaws) except as
covered under provisions of an Orthodontic Amendment or Rider. Myofunctional
therapy or speech therapy.
n) Services for the treatment of any disturbances of the temporomandibularjoint(jawjoint)
facial pain, or any related conditions, including any related diagnostic, preventive or
interceptive services (except as covered under provisions of an Amendment or Rider).
o) Services not performed in accordance with the laws of the State of Colorado, services
performed by any person other than a person authorized by license to perform such
services, or services performed to treat any condition, other than an oral or dental
disease, malformation, abnormality or condition.
p) Oral hygiene instructions or dietary instructions.
q) Completion of forms, providing diagnostic information or records, or duplication of x-
rays or other records.
r) Replacement of lost, stolen or damaged appliances.
s) Preparation for placement or replacement, removal or repair, or any other procedure
related in any way to any procedure or service not included in Covered Services.
t) Any services not specifically included in Covered Services.
u) Services to the extent that payment for which under this Agreement is prohibited by any
law of the jurisdiction in which the Covered Person resides at the time the expenses are
incurred.
v) Services for which charges would not have been made if this coverage had not existed,
I
xcept for services as provided under Medicaid.
w) Services for which legal payment obligations have been reduced due to a professional
or courtesy discount, or for services by a relative as the provider.
x) Services which result from an act of declared or undeclared war or armed aggression.
20
y) Services which result, whether the insured person is sane or insane, from an
intentionally self-inflicted injury or sickness.
z) Any payable expense under any other group or individual plan, medical or dental plan,
whether claimed or not.
aa) Charges for failure to keep a scheduled visit with your Dentist.
bb) Charges for Special Restorative are not covered expenses.
cc) Charges for Prosthodontics are not covered expenses.
21
PROPOSED PLAN AND MONTHLY RATES
DeltaPreferred Option
DPO NON-DPO
100% 80%
DIAGNOSTIC AND PREVENTIVE SERVICES
•
Routine periodic examinations twice in a twelve-month
•
period.
Full mouth x-rays once in any sixty -month period, bitewing x-rays once in a twelve-month period.
•
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more than twice in a twelve-
month period.
•
Topical fluoride applications as prescribed by the dentist for children through age 15, but not more
than once in any 12-month interval.
•
Emergency treatment for relief of pain.
•
Application of sealants for children through age 14 on unrestored, noncarious permanent molars,
but not more than once in any 36-month period.
80% 60%
BASIC SERVICES
•
Regular restorative services: amalgam, synthetic porcelain and plastic restorations (fillings).
•
Oral surgery provides for extractions and other oral surgery, including pre- and post -operative
care.
•
Periodontics which includes surgical and non -surgical treatment of the diseases of the gingiva
(gums) and bone supporting the teeth.
•
Endodontics includes pulpal and root canal therapy.
60% 50%
MAJOR SERVICES
•
Cast Restorations includes gold restorations (fillings), crowns and jackets when teeth be
cannot
restored with other materials.
•
Prosthodontics includes construction, placement or repair of fixed bridges, partial and complete
dentures.
50% 50%
ORTHODONTIC SERVICES
•
Orthodontic services include the necessary procedures for the orthodontic movement the teeth
of
into proper alignment, position and occlusion. Orthodontic services are available for dependent
children less than 19 years of age.
DEDUCTIBLE: $25.00 per person per calendar year. Limit $50.00 per family. The deductible is waived for
Diagnostic, Preventive and Orthodontic Services.
MAXIMUM BENEFIT: $1,500.00 per person per calendar year. $1.500.00 per eligible person per lifetime
Orthodontic benefit.
CURRENT DPO PLAN 1
Self -Funded Monthly Fee
Efile:
Administrative Fee per Eligible net Commissions
Paper:
Administrative Fee per Eligible net Commissions
One Year Two Year
$3.41 $3.54
$3.65 $3.79
PART VI
DEDUCTIBLE MAXIMUM AMOUNT AND COORDINATION OF BENEFITS
Section 1. DEDUCTIBLE
Delta shall not be obligated to pay, in whole or in part, the first Twenty -Five Dollars ($25.00)
of fees for Benefits received by a Covered Person during the calendar year of the
Agreement. Fees shall be computed on the basis of the Preferred Option Dentist's Fees by
a Preferred Option Dentist and the Covered Amount for all other Dentists. If a patient
received services from a Preferred Option Dentist or a Non -Preferred Option Dentist, the
deductible will not apply to Diagnostic and Preventive Services. The Twenty -Five Dollar
($25.00) annual deductible is limited to Fifty Dollars ($50.00) per family.
Section 2. MAXIMUM BENEFIT PAYMENT
Delta will pay up to a maximum of Four Hundred Dollars ($400.00) per calendar year for
each Covered Person.
Section 3. COORDINATION OF BENEFITS
a) If an Covered Person is entitled to coverage under two or more plans, then the benefits
of this Agreement shall be coordinated with other plan benefits.
"PLAN" means any plan providing dental care benefits under group, blanket or
franchise coverage; or service type plans or other group pre -paid plans; or coverage
under any governmental plan or required by laws; or "No -Fault" motor vehicle
insurance.
b) Order of Benefit Determination if the other coverage is by a dental insurance policy or
prepaid dental care program:
1) The policy or program covering the patient as an employee shall be primary over
the policy or program covering the patient as a dependent;
2) For dependent children's expenses the order of benefit determination shall be as
follows:
(a) The policy of the parent whose birthday (excluding year of birth) occurs
earlier in the year shall be primary, or;
22
(b) If the parents are separated or divorced, the policy of the parent who is
ordered by court decree to take financial responsibility for dental expenses
shall be primary, or;
(c) The policy of the parent with custody is primary and if said parent has
remarried, the step -parent's plan is secondary and the plan of the parent
without custody pays third.
3) If the above rules do not establish an order of benefit determination, the plan that
has covered the person for the longer period of time shall be primary with the
following exception:
The plan covering the person as a laid -off or retired employee or dependent of
such person, shall be determined after the benefits of any other plan covering the
person or employee.
4) Any group plan that does not contain a coordination of benefits provision is
automatically primary.
If this plan is primary as provided above, this plan shall provide Benefits without regard
to benefits provided by any other plan. If this plan is secondary, this plan will provide
benefits which together with the other plan(s) will not exceed 100% of the covered
dental expense or this plan's maximum benefit whichever is less.
23
PART VII
CONDITIONS UNDER WHICH BENEFITS
SHALL BE PROVIDED
Section 1. PAYMENT OF CLAIMS
a) "Covered Services will not include, and no payment will be made for expenses incurred
for the performance of any dental service not provided for in this Agreement, including
any attached Appendix, Amendment, or Rider, unless Delta agrees to accept such
expenses as covered services. To submit the expenses to Delta for consideration, the
dental service must be identified in terms of the American Dental Association Uniform
Code on Dental Procedures and Nomenclature and/or by narrative description. If
expenses incurred for a dental service not provided for in this Agreement are accepted
by Delta, the Benefit for the dental service will be determined by Delta and will be
consistent with those for dental services listed in this Appendix and in PART V,
BENEFITS, LIMITATIONS AND EXCLUSIONS.
In any event, expenses incurred for dental services which do not have uniform
professional endorsement will not be accepted by Delta as Covered Services.
b) The Employer, or his designee(s) shall have authority for determination of Benefits in
any case involving disputed Benefits. The Covered Person may appeal this
determination by filing a written notice with the Dental Director, in which event the
matter may be submitted to the Executive Committee of Delta for determination of
Benefits. Any matter relating to the necessity, appropriateness or adequacy of covered
services provided or to be provided under this Agreement may be referred to a peer
review committee of the appropriate dental society or association which will accept
jurisdiction and Delta agrees to be bound by the decision of such a peer review
committee.
c) Payment for completed Covered Services:
I) provided by a Participating Dentist or a Preferred Option Dentist shall be made
directly to the Dentist upon receipt of claim or claims signed by the Dentist for
such services.
2) provided by a dentist who is not a Participating Dentist or a Preferred Option
Dentist shall be made to the Eligible Employee upon receipt of claim or claims
signed by the dentist for such services and shall not be assignable. Since Delta
does not pay a non -participating dentist, the Covered Person shall be liable to the
dentist for the cost of service.
24
3) provided by a dentist in another state or country shall be made directly to the
dentist, unless assigned to the employee, upon receipt of claim or claims signed
by the dentist for such services.
4) Delta shall not be obligated to pay claims submitted more than fifteen (15) months
after the date of providing the service. If a claim is denied due to a Participating
Dentist's failure to make timely submission, the Covered Person shall not be liable
to such dentist for the amount which would have been payable by Delta.
Section 2. EXTENDED COVERAGE
All Benefits shall terminate for any Covered Person in the event that this Contract is
terminated or such person ceases to be eligible under the terms of this Contract, and no
further care or services shall be provided under this plan except completion of any single
procedure in progress, where work has commenced prior to termination of coverage.
Delta shall authorize Attending Dentist's Statement for Benefits when satisfied from the
Attending Dentist's Statement and other data that:
a. the patient is a Covered Person hereunder, provided, however, that Delta may
determine such eligibility on the basis of the most current list of Eligible Employees
received by Delta;
b. the services proposed are Benefits under this Contract; and
c. the total fee to be charged for such services to both Delta and Covered Person do
not exceed the dentist's Usual, Customary and Reasonable fees. Such
authorization shall be for a reasonable period up to a maximum of sixty (60) days,
but shall not be required to extend beyond termination of the patient's eligibility and
may be revoked upon notice of such termination. In no event shall an authorization
period extend beyond the termination date of this Agreement.
Delta shall make no payment for any services provided to a patient who is not a
Covered Person hereunder at the time of providing the service, except to the extent of
services provided during unrevoked period of authorization issued by Delta pursuant to
Part III, section 7, r and Part IV of this Agreement, and except for completion of single
procedures which were commenced at the time a patient was eligible or was entitled
Benefits by reason of such authorization. Applicant shall reimburse Delta for any
erroneous payments made as a result of incorrect eligibility reporting by Applicant.
25
Section 3. AVAILABILITY OF DENTIST
While an Covered Person may elect the service of any licensed dentist, neither Delta
nor Applicant undertakes to guarantee the availability of any particular dentist.
Section 4. RIGHT TO INFORMATION AND RECORDS
As a condition precedent to determination of benefits hereunder, Delta shall be entitled
to receive, to such extent as may be lawful, from any attending or examining dentist, or
from any attending or examining dentist, or from hospitals or clinics in which a dentist's
care is provided, such information and records relating to attendance to or examination
of or treatment proposed or provided to an Covered Person as may be required by Delta
in the administration of such claims, or to require that an Covered Person be examined
by a dental consultant retained by Delta in or near his community or residence;
provided, however, that Delta shall in every case hold such information and records as
confidential.
Section 5. CLAIM FORMS
Delta shall prepare and furnish to each Participating Dentist and to any other Dentist or
Covered Person on request a standard form to complete and submit to Delta at the
address shown herein.
Delta shall advise Participating Dentists as follows:
a. to complete and submit a standardized Attending Dentist's Statement (ADS), prior
to providing service, showing the Covered Person's dental needs and the treatment
necessary in the professional judgement of the Dentist.
b. to notify the patient of all actions taken by Delta with respect to such Attending
Dentist's Statement, and
c. that such ADS need not be submitted prior to providing of services in the case of
emergency service or in the case of brief routine procedures normally completed in
one appointment.
Section S. SUBROGATION. Delta is entitled to enforce by its direct suit, or as co -plaintiff with
Eligible Employee, the Covered Person's claim against any third party to the extent of
benefit paid for, or on behalf of Eligible Employee by Delta. When Delta provides
benefit payments for injuries sustained by an Eligible Employee and the Eligible
Employee subsequently obtains a settlement from a third party which includes such
costs, the Eligible Employee is obligated to refund to Delta the amount equal to the
benefit payment made to, or on behalf of the Eligible Employee. The Eligible Employee
shall, upon request, execute and deliver such instrument or papers as may be required
and do whatever else is necessary to carry out this provision.
KEV
APPENDIX A - COVERED SERVICES
Covered Services include only those specific procedures listed
under each category. They do not include any or all procedures
which could be considered to fall under each category. Subject to
all contract limitations and exclusions.
Diagnostic
Clinical Oral Examinations
Initial
Periodic
Emergency
Radiographs
Complete Series (full mouth) -
Intraoral/Panoramic
Intraoral or Extraoral, Dental, Single
Film
Bitewings - not in addition to Complete
Series
Sialography
Cephalometric - only in conjunction with
covered orthodontic services
TMJ survey - single procedure including
all necessary films - only in
conjunction with covered TMJ/MPD
services
Tests and Laboratory Services
Diagnostic Casts - not in conjunction with
denture
Histopathologic Examination (microscopic
examination of biopsy specimen)
Pulp vitality tests - not in conjunction
with examination
It. Preventive
Dental Prophylaxis - to include removal of all
deposits and/or stains, and polishing as
a single complete service
Topical Fluoride Treatment - single office
procedure (through age fifteen (15) only)
Space Maintainer - passive appliance, including
recementation - primary teeth only
II. Preventive (Cont.)
Sealants - topically applied resin, composite or other
material used to seal developmental grooves
and pits in teeth for purpose of preventing
dental decay
III. Restorative (to include tooth preparation, any special
preparations, bases, liners, conditioning, finishing, polishing
or other related procedures as components of a single
complete service)
A. Restorative - Basic
Amalgam Restorations
One, two, three surface
four or more surface
Silicate Restorations - per tooth
Resin Restorations (filled or unfilled) -
anterior teeth
One, two, three surface
Four or more surface or incisal angle
Prefabricated Crown (resin or stainless
steel)
Sedative Filling - not in conjunction with
other restoration on same tooth
Pin Retention - per tooth, in addition to
Amalgam or Resin Restoration
Temporary (fractured tooth) - not in
conjunction with any laboratory
processed restoration
IV. Endodontics - excluding final restoration
Pulp Cap - direct - exposed pulp only
Pulpotomy or Pulpectomy - primary teeth only
Root Canal Therapy - with open/drain - single
procedure
One, two, three canal
Four or more canal
Apexification or Recalcification
Periapical Services
Apicoectomy - with or without retrograde
filling and/or apical curettage -
single procedure
Root Amputation - not in addition to hemisection
Hemisection - with removal of any roots - single procedure
Appendix A Page 2
V. Periodontics
Surgical Services
Gingivectomy or Gingivoplasty
Gingival Curettage - to include root
planing per quadrant - with or
without flap entry - single procedure
Osseous Surgery
Osseous Graft
Pedicle or Free Soft Tissue Graft
Apically Repositioned Flap Procedure
Adjunctive Services
Root Planing - per quadrant - not in
addition to curettage - to include
scaling/polishing as a single
complete service
Other Periodontal Services
Periodontal maintenance following active
therapy - single procedure
Unscheduled dressing change
VI. Oral Surgery
Extractions - including exposed residual roots
Surgical Extractions - including submerged
tooth fragments
Alveoloplasty - surgical preparation for
denture
Vestibuloplasty (ridge extension for denture) -
secondary epithelialization only - not to include grafts,
implants, augmentations, or any tissue reattachment
except mucosa
Excision of Oral Inflammatory Lesion, Tumor,
Cyst, Neoplasm, Exostosis, Hyperplastic Tissue or
Pericoronal Gingiva
Incision and Drainage - soft tissue - itraoral or extraoral -
oral lesion only
Treatment of Fractures - maxilla, mandible,
alveolus
Other Surgical Procedures
Maxillary sinusotomy or Fistula Closure
Removal of foreign body or sequestrum
Tooth Reimplantation and/or stabilization of
tooth or alveolus following trauma
Exposure of Tooth - aid eruption or
orthodontics
Appendix A Page 3
VI. Oral Surgery (Cont)
Frenulectomy or transseptal fiberotomy
Biopsy of Oral Tissue - soft or hard
Treatment of salivary gland or duct
Repair of traumatic wound
VII. Adjunctive General Services
Palliative (emergency) treatment - minor
procedure
Anesthesia and related services except local
anesthesia - only in conjunction with
covered oral surgery (Vill. Oral Surgery,
above)
General Anesthesia
Intravenous Sedation - in lieu of general
anesthesia associated with covered
oral surgery
Analgesia - in lieu of general anesthesia
with covered oral surgery
Desensitize root surface - except restoration
Treatment of unusual postsurgical complication
- following covered surgical service only
Consultation (other than practitioner providing
treatment) - when requested by
attending dentist or Delta
Appendix A Page 4
CONTINUED COVERAGE OPTION RIDER
in consideration of the payment specified in PART I, PREFERRED OPTION ADMINISTRATIVE
AGREEMENT, Section 3. of the Agreement, and subject to all of the terms and conditions thereof,
Delta agrees to provide benefits to persons who elect continued coverage pursuant to this Rider.
For the purposes of this Rider, each of the following shall constitute a "Qualifying Event":
(a) Termination of an Eligible Employee's employment with the Group (other than for gross
misconduct), or a reduction in the number of hours worked by the Eligible Employee to less
than the minimum number of hours required under PART IV, ELIGIBILITY, Section 1., a)
of the attached Agreement.
(b) Death of an Eligible Employee.
(c) Divorce or legal separation from an Eligible Employee.
(d) An Eligible Employee becoming entitled to Medicare benefits.
(e) A dependent child ceasing to meet the definition of a dependent child contained in PART
IV, ELIGIBILITY, Section 1., b) of the attached Agreement.
2. Eligible Employees whose coverage under this program is terminated by reason of Qualifying
Event described in paragraph 1. (a) of this Rider may elect to continue coverage for themselves
and their Eligible Dependents for up to eighteen (18) months following the month in which the
Qualifying Event occurs.
3. Eligible Dependents whose coverage under this program is terminated by reason of any of the
Qualifying Events described in paragraph 1. (b) through (e) of this Rider may elect to continue
their coverage for up to thirty-six (36) months following the month in which the Qualifying Event
occurs.
4. After COBRA coverage begins, the employee may add a newborn child, an adopted child or a
child who has been placed with the employee for adoption and for whom the employee has
financial responsibility. The employee must notify the employer in writing within thirty-one (31)
days of the birth or placement in order to add the child to the COBRA coverage. A child born,
adopted or placed for adoption and enrolled as indicated will have the same COBRA rights as
any other dependents covered.by the plan before the event that triggered COBRA coverage.
5. Any eligible employee or dependent who is eligible for COBRA continuation coverage who is
disabled and determined to be eligible for Social Security disability benefits at the time of
termination of employment or reduction of hours may elect to extend coverage for themselves
and their dependents for up to an additional eleven (11) months following the eighteen (18)
month extension allowed for the initial Qualifying Event. This right also applies if the eligible
employee or dependent is totally and permanently disabled at any time during the first sixty (60)
days of continuation coverage. The employee or dependent must notify the employer in writing
of the Social Security disability determination within sixty (60) days of the date it is issued, and
before the end of the initial eighteen (18) month COBRA coverage period. The employee or
dependent must also notify the employer within thirty (30) days of the date of any final
determination by the Social Security Administration that the employee or dependent is no longer
disabled.
PROPOSED PLAN AND MONTHLY RATES
DeltaPreferred Option
DPO NON-DPO
80% 60%
DIAGNOSTIC AND PREVENTIVE SERVICES
•
Routine periodic examinations twice in a twelve-month period.
•
Full mouth x-rays once in any sixty -month period, bitewing x-rays once in a twelve- month
period.
•
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more than twice in a
twelve-month period.
•
Topical fluoride applications as prescribed by the dentist for children through age 15, but not
more than once in any 12-month interval.
•
Emergency treatment for relief of pain.
•
Application of sealants for children through age 14 on unrestored, noncarious permanent
molars, but not more than once in any 36-month period.
60% 50%
BASIC SERVICES
•
Regular restorative services: amalgam, synthetic porcelain and plastic restorations (fillings).
•
Oral surgery provides for extractions and other oral surgery, including pre- and post -operative
care.
•
Periodontics which includes surgical and non -surgical treatment of the diseases of the
gingiva (gums) and bone supporting the teeth.
•
Endodontics includes pulpal and root canal therapy.
DEDUCTIBLE: $25.00 per person per calendar year. Limit $50.00 per family. The deductible is waived for
Diagnostic, and Preventive.
MAXIMUM BENEFIT: $400.00 per person per calendar year.
CURRENT DPO PLAN 2
SELF -FUNDED MONTHLY FEE
Efile:
Administrative Fee per Eligible net commissions
Paper:
Administrative Fee per Eligible net commissions
One Year Two Year
$3.41 $3.54
$3.65 $3.79
I►
6.,' Eligible Employees or Eligible Dependent whose coverage under this Continued Coverage
Option Rider would otherwise terminate due to their becoming covered under another group
plan, may continue coverage under this Rider if the new group plan would exclude coverage for
a pre-existing condition. Coverage under this Rider may be continued until the earlier of:
(a) The end of the Maximum Period of coverage for which the initial Qualifying Event provided
coverage; or
(b) The date on which the pre-existing condition becomes covered under the new group plan.
The new plan must count the months for which the Qualified Beneficiary had coverage under
COBRA for the pre-existing condition.
7. If a Qualifying Event described in paragraph 1. (b),(c),(d) or (e) occurs during the eighteen (18)
months after the date of the Qualifying Event described in paragraph 1. (a), a Qualified
Beneficiary may continue coverage until thirty-six (36) months after the initial Qualifying Event.
8. In the case of a Qualifying Event as described in paragraph 1. of this Rider, a Qualified
Beneficiary must notify the Employer within sixty (60) days of the occurrence of the Qualifying
Event. The Employer will then have fourteen (14) days to provide the Qualified Beneficiary with
information concerning continuation coverage and rates. The Qualified Beneficiary will then
have sixty (60) days to elect to continue coverage. The first monthly payment must be received
by the Employer within forty-five (45) days of the date the Qualified Beneficiary elects to
continue coverage; the payment must include all monthly payments due at that time. If notice
by the Employee is not received by the Employer within sixty (60) days of the Qualifying Event,
the otherwise Qualified Beneficiary will not be eligible for continuation coverage.
y. Continuation coverage elected by a person under this Rider shall also be effective as of the first
day of the month following the applicable Qualifying Event described in paragraph 1. above.
However, benefits shall not be available to a person electing continuation coverage before the
group furnishes Delta with the data about such person required in PART III, GENERAL TERMS
AND CONDITIONS, Section 6. "(p) of the Agreement, along with all dues then currently
payable for such person as stated in PART 1. PREFERRED OPTION ADMINISTRATIVE
AGREEMENT, Section 3. of the Agreement.
10. Continuation coverage as provided under paragraph 1. of this Rider will terminate on the earliest
of the following dates, as applicable:
(a) The period of continuation coverage specified in paragraphs 2. through 7. expires.
(b) This Agreement terminates.
(c) The Group fails to pay dues for the person as specified in PART I, PREFERRED OPTION
ADMINISTRATIVE AGREEMENT, Section 3. of the Agreement.
(d) The person becomes entitled to Medicare coverage.
(e) After election of COBRA, the person becomes first enrolled for dental benefits under
another group dental plan as an employee or dependent, except as described in paragraph
6., above.
Implementation Time Line
DELTA DENTAL PLAN OF COLORADO
IMPLEMENTATION SCHEDULE
In order to install Delta's dental program(s) and assure a successful transition of the dental
program, Delta Dental Plan would establish the following implementation plan:
-Account Executive to complete new group
application and submit to City of Fort
Collins for approval/sign-off
- Eligibility reporting and diskette
specifications to group for set up
- Account Executive to assign Service
Coordinators to assist with new group
implementation
- Solicitation typesetting and contract drafts
submittal to City of Fort Collins for
approval
- Printing of approved solicitation material
- Contract review
- Solicitation distribution/open enrollments
- Evidence of Coverage typesetting
(preparation dependent upon receipt of
approved Group Contract language)
- Printing of approved Evidence of
Coverage booklets
- Proposed effective date and delivery of
Administration manual
Within 3 business days after contract
awarded
2 Months prior to implementation
Within 10 business days after contract
awarded
Within 20 business days after contract
awarded
10 Business days after receipt from City of
Fort Collins
As necessary
To be determined by City of Fort Collins
Within 10 business days of finalization of the
plans(s) selected
30 Business days after approval by City of
Fort Collins
January 1, 2004 or implementation date
Please note that the above time frames are flexible and can be modified to meet schedule
requirements of City of Fort Collins. "Prospective participants" who choose not to enroll in
the initial open enrollment period may only enroll during the subsequent annual open
enrollment periods.
DELTA DENTAL PLAN OF COLORADO
Member Communication
DELTA DENTAL PLAN OF COLORADO
d DELTAPREFERRED OPTION 0
The DeltaPreferred Option (DPO) plan provides a higher
level of benefits if a preferred provider is chosen yet allows a free
choice of dentist. DeltaPreferred Option (DPO) places an emphasis
on diagnostic and preventive care that encourages patients to seek
routine preventive dental care and keep small problems from be-
coming large ones. Start routine dental care at your earliest
convenience and repeat your check-ups at least annually.
♦ HOW TO USE THE DELTA DENTAL PLAN
You may visit any dentist of your choice. If your dentist is a
participating memberof Delta Dental Plan, the claimformforbenefits
will be filed by your dentist. The patient should complete the top or
patient section of the claim form and sign the form to indicate that
he/she authorizes release of the information to Delta.
If you are treated by a DeltaPreferred Option (DPO) Dentist,
you will receive the highest benefits available on this plan. Delta
makes payment directly to the dentist and sends an Explanation of
Benefits to the employee indicating how much the dentist has been
paid and the amount which the employee is responsible for paying.
!"here is an amount not chargeable to the patient, that is shown on
Explanation of Benefits as well. DeltaPreferred Option Dentists
provide services at a reduced fee which means thatyour co -payment
based on that fee will be less.
Both DeltaPreferred Option Dentists and DeltaPremier Par-
ticipating Dentists have agreed to collect only the portion of your
charges for which you are ultimately responsible (i.e., deductible
and coinsurance). You will not be charged the entire fee at the time
services are rendered unless the service you receive is not covered
by your plan.
If you are treated by a DeltaPremier Participating Dentist
locally or nationwide you will receive the benefits indicated for
non-DPO Dentists.
Should you elect to receive treatment from a dentist who has
not enrolled with Delta as either a DPO or a Premier Participating
Dentist (i.e., a non -participating dentist), you will be fully respon-
sible for filing your claim and for payment to the dentist. Delta will
reimburse you for the services of a non -participating dentist. You
may obtain a claim form from your Human Resources/Personnel
office or from Delta by calling the number on the back cover. You
will be reimbursed on the basis of the lower level of benefits and the
prevailing fees within his/her area of the country for the covered
services you receive. By going to a non -participating dentist, you do
risk additional out of pocket costs.
Delta will not be obligated to pay claims submitted more than
twelve (12) months after the date the service was provided.
If the patient or employee encounters any problems relative
,0tee differences, possible excessive charges or refusal on the part
DPO or Premier Participating Dentist to cooperate with the
program, the employee should write a detailed letter explaining the
situation to Delta Dental Plan of Colorado. Prompt action can be
expected if all the information is submitted in writing.
♦ DeltaPreferred Option (DPO) Dentist
Patients who choose a DPO dentist receive the highest level
of benefits. A DPO dentist is a dentist who is licensed to practice
and has met the criteria for the DPO program. DPO dentists are
DeltaPremier Participating Dentists who have signed an additional
agreement with Delta to participate in the DPO program.
♦ DeltaPremier Participating Dentist
DeltaPremier Participating Dentist means a dentist who is
licensed to practice and who has signed an agreement with Delta
Dental Plan. Over 100,000 dentists, or 2 out of 3 dentists nationwide
are DeltaPremier Participating Dentists. Under the terms of a signed
agreement with Delta, Participating Dentists agree to render dental
care to eligible patients according to requirements established by
the Board of Trustees of Delta Dental Plan. Premier Participating
Dentists agree to:
• submit claim forms for their patients.
• accept direct payment from Delta; they may only charge the
patient for the portion of the treatment that is not covered by the
plan, i.e., the deductible and/or any coinsurance.
• file a listing of their usual fees, on a confidential basis. Payment
will be based upon the Participating Dentist's usual, customary
and reasonable fee as filed with and accepted by Delta.
♦ Non -Participating Dentist
Non -participating dentists have not signed participating
agreements or filed fees with Delta. If a non -participating dentist is
chosen, the patient may:
• have additional costs out of pocket. The benefit is based on the
prevailing fees of participating dentists.
• be responsible for the dentist's entire fee and for filing the claim
with Delta.
♦ WHO CAN BE COVERED?
If you meet your employer's eligibility requirements for dental
coverage you can enroll in the DeltaPreferred Option Program. You
can also include your lawful spouse and unmarried children, includ-
ing step -children, legally adopted and foster children, to the age
specified in your contract.
♦ DEDUCTIBLE CREDIT
Delta Dental Plan of Colorado will honor any portion of your
deductible which you have paid while insured under a prior plan of
this employer. The charges applied toward the deductible must have
been incurred since January 1 of this year.
In order to receive credit for each individual who has satisfied
all or part of the deductible, please do the following:
1. Provide a copy of your and/or members of your family's
Explanation of Benefits (EOB) from your previous carrier which
shows your deductible is either partially or completely satisfied.
Ask your dentist to send the EOB with your claim and you will
be immediately credited with the amount of deductible you have
met.
2. If you are treated by a non -participating dentist, you will be
sending in the claim yourself, and will need to attach the EOB
to the claim form prior to sending it to Delta.
3. If you or your family have dental treatment that is less than the
deductible amount, please submit a claim for proper credit. You
must have an Explanation of Benefits to submit to Delta in order
to be credited with the deductible.
4. If you do not send in the EOB with the first claim you have after
Delta begins providing benefits, you will still be credited with
your deductible at the time you do send in the EOB. If your EOB
is sent in and not attached to a claim, you will need to attach a
note asking for deductible credit and you will need to supply the
following identifying information:
a. Employee name
b. Patient name and birth date
c. Employee social security number
d. Group name and number
PREDETERMINATION
If you anticipate extensive dental services which would ex-
ceed $400.00, your dentist must submit the treatment plan to Delta
for review before any work is actually done. Predetermination of
benefits allows both you and your dentist to know exactly what is
covered and what your plan will pay. There is no additional charge
for having a predetermination done.
COORDINATION OF BENEFITS
If a person is covered by two (or more) group dental plans,
Delta coordinates benefits using the "birthday" rule for determination
of which parent's plan is primary for the child. The birthday rule
simply says that the parent whose birthday is earlier in the year,
month and day (not year), is primary for the children. In case of
divorce, special rules apply.
In all cases, the employee's coverage is primary for that
employee, i.e., husband's plan is primary for husband's expenses
and wife's plan is primary for the wife.
EXTENDED COVERAGE
If eligibility is lost, Delta will pay for services that were
preauthorized and started prior to the date of termination. The
extended coverage will not exceed sixty (60) days and applies only
to single covered services that are fixed or removable prosthodontic
appliances, crowns, jackets, cast, fused or other laboratory proc-
essed restorations and were installed or seated within sixty (60)
days after termination of coverage. This provision does not apply to
Orthodontic Services, if included in this program. This provision is
separate from the COBRA provision.
SUMMARY OF BENEFITS
The summary information enclosed describes in general
terms the main features of the program. The specific terms are set
forth in the Contract between Delta and your employer.
I�D
LIMITATIONS
a. Cleanings and oral examinations are a benefit twice in a 1
month period.
b. Complete mouth x-rays are a benefit once in a 5 year peri
Bite -wing x-rays are a benefit once in a 12-month period.
c. General anesthesia is not a benefit unless administered by a
dentist in his office in conjunction with oral surgery.
d. Topical fluoride application is a benefit for children through age
15 and is a benefit once in a 12-month period.
e. Sealants on intact permanent molar teeth are a benefit through
age 14.
f. In all cases in which the patient selects a more extensive plan
of treatment than is customarily provided, Delta will pay the
applicable percentage of the lesser fee. The patient is respon-
sible for the remainder of the dentist's fee.
g. Appliances for the replacement of the same natural teeth are a
benefit once in a 5 year period provided the existing appliance
is unsatisfactory and cannot be made satisfactory.
h. Specialized techniques, precious metals for removable
appliances, precision attachments, personalization, and char-
acterization are considered optional, and as such, are not
covered services. An allowance for a standard procedure will
be made toward the cost of a more complex procedure.
i. An allowance for implants and associated appliances will be
based on the cost of a covered standard removable complete
or removable partial denture. If benefit is made for such an
appliance, benefit will not be made for any replacement within
five years thereafter.
j. If an eligible person selects a service that is not provided for
under the terms of the Contract or specialized techniques, D
will pay the applicable percentage of the fee for the least co
commonly performed covered service and the patient is respon-
sible for the remainder of the dentist's fee.
k. Services involving veneers, facings, or any other cosmetic
services posterior to the first molar are considered optional and
are not a benefit. An allowance may be made for the covered
amount of the covered service without veneers, facings or
cosmetic components. The patient is responsible for the portion
of the dentist's fee in excess of the Delta allowance.
I. Pre- and post -operative procedures are considered part of any
covered service and are not benefits. Benefit shall be limited to
the covered amount for the covered service.
m. Local anesthesia is considered a component of any procedure
in which it is used.
n. Allowance for covered service started but not completed shall
be limited to the amount determined by Delta.
o. A temporary dental service will be considered an integral part
of a complete dental service rather than a separate service, and
separate payment shall not be made for a temporary service
unless otherwise included as a covered service on the Contract.
p. Allowance for assistant surgeon when determined by Delta to
be a covered benefit shall not exceed 20% of the surgeon's fee
for the same covered service.
q. Fixed bridges or cast metal framework partial dentures are not
a benefit for persons under the age of 16.
r. Reline or rebases of a prosthodontic appliance will be made
only once in a 36-month period. Reline or rebase at the tim
insertion or within 6 months of insertion is considered a c
ponent of the appliance. Separate payment for such reline or
rebase will not be paid.
DELTA DENTAL®
Delta Dental Plan of Colorado
PO Box 5468
Denver, Colorado 80217-5468
(303) 741-9300 (800) 233-0860 (Toll Free)
(303) 773-3880 (FAX)
www.deltadentalco.com
ENROLLMENT and STATUS CHANGE FORM
Please Print or TYPE
Be sure form is completed in full for Drover enrollment
1. GROUP NAME
2. GROUP NUMBER-
3. DATE OF HIRE:
4. EFFECTIVE DATE:
5. SOCIAL SECURITY NO.
16. LAST NAME (Subscriber):
8. PHONE,
1
9. HOME ADDRESS:
10. CITY:
11. STATE:
12. ZIP:
77 7�
Li on
13. PLAN: Select plan you are enrolling in OR plan you are currently enrolled in:
Ll DeltaPremier Ll DeRaPreferred Option (DPO)
Ej Exclusive Panel Option (EPO) L) DeltaCare *If sel.&Id, each subscriber& dependent must choose a DeltaCare Dentist.
EY
14. Requested:
L] New Enrollment
(j CHANGE Family Status
Add Dependent(s)
Delete Dependent(s)
C3 CHANGE Name
Q CANCEL Coverage
Q WAIVE Coverage"
(3 ADDRESS Change
0 CHANGE to COBRA
Q Late Enrollment (if applicable)
15. Reason for Change:
0 Marriage
Q Birth / Adoption
Ll Divorce
El Legal Separation
Q Death
Date of Event
from
Q CHANGE DeltaCare Dentist
Q Employment Terminated
to
❑ Return from leave
(j CHANGE to Full-time status
DATE:
(j No Longer Eligible
Q Spouse Lost Coverage
DATE:
❑ SWITCH my coverage to:
DeftaPremier
E] OTHER (explain below)
Ll Other.
16. Select Coverage:
DeftaPreferTed Option (DPO)
Q Employee Only
Exclusive Panel Option (EPO)
Q Employee and Spouse
❑ Employee and Children
DeltaCare
U Employee and Child
C] Employee, Spouse and Children
fto"JiWu
0001MIS
.0
17.
18. Last Name
(include if different)
19. First Name
20. Social Security #
Required
21. Date
of Birth
22. Sex:
M or F
4001
�*%MftlscO —7-ossiudolllil
7
23. Dentist & Provider#
Lj Q
Subscriber
#
Ell Lj
Spouse
#
Ll D
Child
#
J Ll
#
2.
Q Li
.3.
1#
4.
#
I understand that the terms of the contract between Delta Dental Plan and my employer may not allow late enrollment for me and my dependents, or the
contract may allow late enrollment but may require waiting periods or additional limitations.
I authorize payroll deduction, if applicable.
24. Signature of Employee
Date
It is unlawful to knowingly provide false, incomplete, or misleading facts to Delta Dental Plan of Colorado to defraud or attempt to defraud Delta Dental. Penalties may
include Imprisonment fines, denial of insurance and civil damages. Report any insurance company or agent thereof, who knowingly provides false, Incomplete or
misleading facts to Delta participants for the purpose of defrauding the participants regarding their Insurance benefits, to the Colorado Division of Insurance.
Group 0
Eff. Date Billing Code
Subgroup X
No Text
4 DELTA DENTAL®
Delta Plan of Colorado ENROLLMENT and STATUS CHANGE FORM
�� 56t8
Denver, Colorado 80217-5468 Please Print or TYPE
(303) 741-9300 (800) 233-0860 (Toll Free)
(303) 773-3880 (FAX)
www.deltadentalco.com Be sure form is completed in full for proper enrollment
'R J1 YVEE IN
1. GROUP NAME:
2. GROUP NUMBER:
3. DATE OF HIRE: 4. EFFECTIVE DATE:
5. SOCIAL SECURITY NO.,
LAST NAME (Subscriber):
8. PHONE:
16.
1
9. HOME ADDRESS,
10. CITY:
11. STATE:
-17-
ORN-
13. PLAN: Select plan you are enrolling in OR plan you are currently enrolled in:
❑ DeltaPremier Ll DeftaPreferred Option (DPO)
❑ Exclusive Panel Option (EPO) L] DeltaCare *If selected, each subscriber& dependent must choose DeltaGare Dentist.
14. Requested:
15. Reason for Change: Date of Event
Q New Enrollment U CANCEL Coverage
L] Marriage
Q CHANGE Family Status Q WAIVE Coverage"
L] Birth / Adoption
Add Dependent(s) Q ADDRESS Change
L] Divorce
Delete Dependent(s) Ll CHANGE to COBRA
L] Legal Separation
0 CHANGE Name L] Late Enrollment (if applicable)
Ll Death
from Ll CHANGE DeftaCare Dentist
Q Employment Terminated
to L] CHANGE to Full-time status
Return from leave DATE:
El No Longer Eligible
[I Spouse Lost Coverage
DATE: Lj OTHER (explain below)
L] Other:
❑ SWITCH my coverage to:
DeftaPremler
DeftaPreferred Option (DPO)
16. Select Coverage:
Ll Employee Only
Exclusive Panel Option (EPO)
L] Employee and Spouse El Employee and Children
I DeftaCare
Ll Employee and Child Ll Employee, Spouse and Children
MAMt
Lligr- A I 00
LL I.ilEls
N T A
'
1T
18. Last Name
19. First Name
20. Social Security #
21. Date
22. Sex:
(include if different)
Required
of Birth
M or F23.
Dentist Provider#
Subscriber
#
Spouse
#
Child
#
2.
%
#
3.
#
14
1
r
#
I understand that the terms of the contract between Delta Dental Plan and my employer may not allow late enrollment for me and my dependents, or the
contract may allow late enrollment but may require waiting periods or additional limitations.
I authorize payroll deduction, if applicable.
24. Signature of Employee Date
It is unlawful to knowingly provide false, Incomplete, or misleading facts to Defta Dental Plan of Colorado to defraud or attempt to defraud Delta Dental. Penalties may
include imprisonment, fines, denial of insurance and civil damages. Report any Insurance company or agent thereof, who knowingly provides false, incomplete or
misleading facts to Delta participants for the purpose of defrauding the participants regarding their insurance benefits, to the Colorado Division of Insurance.
00 4) WL
Group Of
Eff. Date
Billing Code -Subgroup
'1
No Text
d ® P.O. Box 173803
Denver, CO 80 '-3803 Customer Relations
DELTA DENTAL
303-741-9300 303-741-9305
Delta Dental Plan of Colorado 800-233-0860 800-610-0201
1. PATIENT NAME- PLEASE PRINT
2. RELATIONSHIP TO EMPLOYEE
SELF (SPOUSE I CHILD (OTHER
I I I
3. SEX
M I F
I
4. PATIENT BIRTHRATE
MO DAV VR
I I
5. IF FULL TIME STUDENT OVERAGE 18 CITY, STATE
SCHOOLNAME
6. E rEE/SUBSCRIBER NAME
7. EMPLOYEE/SUBSCRIBER
SOCIAL SECURITY NO.
10. NAME OF EMPLOYER, UNION OR TRUST FUND
-
FIR: LAST
8. EMPLOYEEISUBSCRIBER MAILING ADDRESS
9. EMPLOYEE/SUBSCRIBER
11. EMPLOYER ADDRESS
BIRTHDATE
;.
CITY
STATE
ZIP
a a
F
12. GROUP NUMBER
13. UNION LOCAL NO.
14. IS PATENT COVERED BY ANOTHER PLAN?
15. IF YES, ATTACH PRIMARY CARRIER PAYMENT EXPLANATION.
NO YES
NO YES
16. LIST OTHER FAMILY MEMBERS EMPLOYED WITH BENEFIT COVERAGE.
BIRTHDATE
DENTAL PLAN NAME
GROUP NO,
EMPLOYEE NAME RELATIONSHIP SOC. SEC. NO.
MO I DAY YR
.... .. ..... ----.......,r ,.,�...,...r,r.0 non, it uv namni u,emov rnnimm�el
I
no ToveTnlFtrr As
NEPHEW TO nFTERMINF RFNFFRS RFI ATED
TO THE DENTAL WORK FOR
WHICH THIS CLAIM IS MADE. I UNDERSTAND AND AGREE WITH THE TREATMENT RECOMMENDED AND SUBMITTED ON THIS FORM. I CERTIFY THAT THE INFORMATION IN BLOCKS 1 THROUGH 1715 TRUE AND CORRECT.
17.SIGNATURE OF PATIENT
(or parent or guardian) DATE
18. DENTIST NAME
26. IS TREATMENT
NO
YES
IF YES, ENTER BRIEF DESCRIPTION AND DATES.
RESULT OF
OCCUPATIONAL
ILLNESS OR INJURY?
19. MAILING ADDRESS
27. IS TREATMENT
RESULT OF
AUTO ACCIDENT?
CITY
STATE
ZIP
28. OTHER ACCIDENT?
20. DENTIST SOC. SEC. NO. OR TAX ID NO.
1 21. DENTIST LICENSE NO.
22. DENTIST PHONE NO.
29. IF PROSTHESIS,
IF NO, REASON FOR REPLACEMENT?
DATE OF PRIOR
IS THIS INITIAL
PLACEMENT.
STATE
(
)
PLACEMENT?
23. PREDETERMINATION
¢ „' a
25. RADIOGRAPHS OR
NO
YES
HOW
30. IS TREATMENT
IF SERVICES ALREADY COMMENCED
APPLIANCES PLACED.
MOS TREATMENT
REMAINING.
NO YES
❑ ❑
spar ne0.x «n
MODELS ENCLOSED?
MANY?
I
FOR ORTHODONTICS?
ENTER DATE
u>,« tia�pi �pwa
31, EXAMINATION
AND TREATMENT PLAN -USE CHARTING SYSTEM SHOWN
TOOTH
OR
SURFACE
DESCRIPTION OF SERVICE
DATE SERVICE
PERFORMED
PROCEDURE
NUMBER
DENTIST
FEE
IDENTIFY MISSING TEETH WITH -X'
FOR DELTA USE ONLY
QUAD
MO, DAY( VR
FACIAL
a «tkt }1
}
aQ
�ufm aP
2
I 1
E*4plJe 9w�
� 9 1
lt2
a u.11f +'}Kri,«vi,y'
5
3
I
4HN
4
aa¢a:,,m �umi
E F 1
11
2 LINGUAL 1 15
5
1 1
a 14a. t4aittn ros <�a t«
t A J 15
�' asT� Yr`"F
} >N n.ailX:nr
5
1
C 17
7
ROTH
W
RIGHT DLEFTZ
�..:k .,
R
I 1
3
J X® 17
10
31 LINGUAL I1�'�1 i9
ao
11
x n: .',{tr,k 1 a,'Ni
R M19
O P
12
6,
221
2
26�
13
�v
14
i
^", e`
FACIAL
,* ,i astrc�.z KI
15
I 1
I I
mR i rWe t'tsxs�
32 REMARKS FOR UNUSUAL SERVICES
I1
�,f4r 'xia to
mb�5t t�. xr:�
ipP.
ssett
I I
I I
� '✓nro-
t
:aai'"�6'6a
I HEREBY CERTIFY THAT THE PROCEDURES AS INDICATED BY DATE HAVE BEEN COMPLETED AND THATTHE FEES SUBMITTED
TOTAL
ARE THE ACTUAL FEES I HAVE CHARGED AND INTEND TO COLLECT FOR THOSE PROCEDURES.
FEE
33. DENTIST'S SIGNATURE DATE
CHARGED
It is unlawful to knowingly provide false, incomplete, or misleading facts to Delta Dental Plan of Colorado to defraud or attempt to defraud Delta Dental. Penalties may include imprisonment, fines, denial of
insuran-- and civil damages. Report any insurance company or agent thereof, who knowingly provides false, incomplete, or misleading facts to Delta participants for the purpose of defrauding the
partici-egarding their insurance benefits, to the Colorado Division of Insurance.
No Text
d DELTA DENTAL®
/^�
P.O. Box 173803
Denver, CO V"'�3803
Customer Relations
i 1
303-741-930(k
303-741-9305
Delta Dental Plan of Colorado
800-233-0860 '
800-610-0201
1. PATIENT NAME - PLEASE PRINT
2. RELATIONSHIP TO EMPLOYEE 1
SELF I SPOUSE CHILD (OTHER
I I I
3. SEX
M F
I
4. PATIENT BIRTHDATE
MO I DAY I YR
I I
15. IF FULL TIME STUDENT OVERAGE 18 CITY, STATE
SCHOOLNAME
FIRST
LAST
6. EE/SUBSCRIBER NAME
]. EMPLOYEEISUBSCRIBER
SOCIAL SECURITY NO.
10. NAME OF EMPLOYER, UNION OR TRUST FUND
y; r
";t�
FI LAST
„+
�T
B. EMPLOYEEISUBSCRIBER MAILING ADDRESS
9. EMPLOYEE/SUBSCRIBER
11. EMPLOYER ADDRESS
BIRTHDATE
rtik-
CITY
STATE
ZIP
n
12. GROUP NUMBER
13. UNION LOCAL NO.
14. IS PATIENT COVERED BY ANOTHER PLAN?
15. IF YES, ATTACH PRIMARY CARRIER PAYMENT EXPLANATION.
NO 11 YES
NO YES
16. LIST OTHER FAMILY MEMBERS EMPLOYED WITH BENEFIT COVERAGE.
BIRTHDATE
DENTAL PLAN NAME
GROUP NO.
EMPLOYEE NAME RELATIONSHIP SOC. SEC. NO.
.... _...._..._..... ..... ................_...-..,.................,,..T..�...,............., r......�....„o-....,......M�i.,.NC9Toc.r..caT
MO DAYI VR
I
AS
I
NEELEL TO nrrco�uuc ocucnre oci nrcn
�j
rn ruc ncnrrel uinee cno
WHICH THIS CLAIM IS MADE. I UNDERSTAND AND AGREE WITH THE TREATMENT RECOMMENDED AND SUBMITTED ON THIS FORM. I CERTIFY THAT THE INFORMATION IN BLOCKS 1 THROUGH 17 IS TRUE AND CORRECT.
17.SIGNATURE OF PATIENT
(or Parent or guardian) DATE
1B. DENTIST NAME
26. IS TREATMENT
RESULT OF
NO
YES
IF YES, ENTER BRIEF DESCRIPTION AND DATES.
OCCUPATIONAL
ILLNESS OR INJURY?
19. MAILING ADDRESS
27. IS TREATMENT
RESULT OF
AUTO ACCIDENT?
CITY
STATE
ZIP
28. OTHER ACCIDENT?
20. DENTIST SOC. SEC. NO. OR TAX ID NO.
21. DENTIST LICENSE
NO.
22. DENTIST PHONE NO.
29. IF PROSTHESIS,
IF NO, REASON FOR REPLACEMENT?
DATE OF PRIOR
)
IS THIS INITIAL
PLACEMENT?
PLACEMENT.
S1'Al"E
(
23. PREDETERMINATION
NO YES
❑ ❑
"XAj yjl
I a
'
25. RADIOGRAPHS OR
MODELS ENCLOSED?
NO
YES
HOW
MANY?
30. IS TREATMENT
FOR ORTHODONTICS?
IF SERVICES ALREADY COMMENCED
ENTER DATE APPLIANCES PLACED.
MOS TREATMENT
REMAINING.
31.
EXAMINATION
AND TREATMENT PLAN —USE CHARTING SYSTEM SHOWN
TOOTH
OR
QUAD
SURFACE
DESCRIPTION OF SERVICE
DATE SERVICE
PERFORMED
MO, DAY( YR
PROCEDURE
NUMBER
DENTIST
FEE
IDENTIFY MISSING TEETH WITH -X-
FOR DELTA USE ONLY
FACIAL
tr
3
4
5
v
g a
RIGHT an LEFT]"
Z
B
7
x+P i4 +t
R
I kli+a x
W D
< 2
0 �
'�
I I
nrfn rek
aN,tga#fit i+ri
T K(F'1�11]
iD
+ as
vAi'54 e
`(`2Y#YY1'
31 LINGUAL L tt
1i
tiaeth
3p R M 19
12
I
r,yµ{aiy
2! GP N
21
2322
13
I
het am '
14
a, n,Ny,.'
(29
LY tY
FACIAL
15
I
xlkM of Ix
I I
4 N4�9f r•h t
32 REMARKS FOR UNUSUAL SERVICES
lrnr s
1
I
Y=h'vfA'Y#x,f(�g it
t b# k
I
nkU fi 4x
I HEREBY CERTIFY THAT THE PROCEDURES AS INDICATED BY DATE HAVE BEEN COMPLETED AND THAT THE FEES SUBMITTED
ARE THE ACTUAL FEES I HAVE CHARGED AND INTEND TO COLLECT FOR THOSE PROCEDURES.
TOTAL
FEE
33. DENTIST'S SIGNATURE DATE
CHARGED
It is unlawful to knowingly provide false, incomplete, or misleading facts to Delta Dental Plan of Colorado to defraud or attempt to defraud Delta Dental. Penalties may include imprisonment, fines, denial of
insuranjw.Qnd civil damages. Report any insurance company or agent thereof, who knowingly provides false, incomplete, or misleading facts to Delta participants for the purpose of defrauding the
particV Ipgarding their insurance benefits, to the Colorado Division of Insurance.
No Text
DELTA Pi VERRED OPTION (DPO) DENT : PLAN
For Employees of
ABC COMPANY, INC.
Group Number: xxxx Effective Date: xxxxx
COVERED EXPENSES
DPO NON-DPO
100% 80% DIAGNOSTIC & PREVENTIVE SERVICES
• Exams - two in a twelve month period
• X-rays - bitewing, one in a twelve month period; full mouth, once per five years
• Cleanings - two in a twelve month period
• Fluoride applications - once per year for children under 16
• Emergency relief of pain
• Application of sealants for children through age 14 on unrestored, noncarious permanent molars,
but not more than once in any 36 month period.
80% 80% BASIC SERVICES
• Fillings (silver, plastic and silicate)
• Oral Surgery (extractions other surgery)
• Periodontal treatmei&W'r
tuE
• Endodontics (root c
SO% 50% MAJOR SERVICES
• Crowns, Jackets
• Gold restorations (gold fillings)
• Bridges
• Partial and full dentures
50% 50% ORTHODONTIC SERVICES
• Braces for dependent children under age 19
MAXIMUM BENEFIT
• $1,000.00 per patient per calendar year
• $1,000.00 Orthodontic lifetime maximum per patient
DEDUCTIBLE
• $50.00 per person per calendar year; maximum of $150.00 per family per calendar year. If a
DPO dentist is utilized the deductible applies to Basic and Major Services Only. If a NON-DPO
dentist is utilized the deductible applies to All Services except Orthodontic Services.
WHO CAN BE COVERED
• Full time active employee
• Lawful spouse of employee
• Unmarried dependent children, stepchildren, foster children or adopted children to age 19. Children
from age 19 to 24 are eligible if attending school full time and are dependent on the employee for
support.
• Children over 19 who are physically or mentally incapacitated and dependent on the employee for
support.
No Text
.WPORTANT NOTICE!
This is the only open enrollment period for this group plan.
• You may enroll yourself and dependents now with no benefit restriction.
• If you do not enroll your dependents now or when they are initially eligible (i.e., within 31
days of the date of your marriage or the date you acquire children through birth, adoption or
marriage), you will only be able to enroll them with a "late enrollment" benefit restriction as
explained below.
An exception for late enrollment of dependents (with no benefit restriction) will be made only for:
1) Employees and/or dependents who are covered by another group dental plan when they are
initially eligible; the employee may enroll themselves or their dependents within 31 days of
involuntary loss of the other group dental plan with proof of loss of the other, coverage, or
2) dependent children less than age 3, such child(ren) may be enrolled on any policy anniversary
(January 1 st) until the policy anniversary which coincides with or immediately follows the child's
third birthday.
LATE ENROLLMENT BENEFIT RESTRICTION
Eligible employees and eligible de endents that do not elect to enroll in the dental plan when initially
eligible will be required to be con u e le n e tal Enora consecutive twelve (12) month
period prior to becoming quali e f s o or thservices under the dental plan.
Likewise, any employee or any dependent that enrolls in the plan and subsequently drops coverage (while
the employee is still employed) will be required to be re -enrolled in the dental plan for a consecutive
twelve (12) month period prior to becoming re -qualified for any further Basic, Major or Orthodontic
services under the dental plan.
WHAT IS NOT COVERED
• Services covered by Worker's Compensation or Employer Liability Laws • Services provided by any
government agency • Services begun before the effective date of coverage; exception for Orthodontics
• General anesthesia unless administered by a dentist during oral surgery • Prescription drugs, speech
therapy, replacement of lost or stolen appliances • Charges for completion of forms (participating dentists
cannot charge Delta patients for completion of forms) • Charges for hospitalization and hospital visits •
Experimental treatment for which the prognosis is not good • Charges which the covered person would
not be required to pay in the absence of this coverage • Correction of congenital, developmental or
acquired malformations • Treatment for the disturbances of the temporo-mandibular joint • Procedures
necessary to alter or correct occlusion or vertical dimension or restoration of tooth structure lost through
attrition • Associated sedative procedures (Relative Analgesia, Hypnosis, Pre -medication) • Treatment
solely for cosmetic reasons • Plaque control programs • Orthodontic services for children over age 19
or for adults
No Text
WHAT IS NOT COVERED
• Services covered by Worker's Compensation or Employer
Liability Laws
Services provided by any government agency
• Services begun before the effective date of coverage; exception
for Orthodontics (if included in your plan)
• General anesthesia unless administered by a dentist during oral
surgery
• Prescription drugs, speech therapy, replacement of lost, stolen,
or damaged appliances
• Charges for completion of forms (participating dentists cannot
charge Delta patients for completion of forms)
• Charges for hospitalization and hospital visits
• Experimental treatment for which the prognosis is not good
• Charges which the covered person would not be required to pay
in the absence of this coverage
• Correction of congenital, developmental or acquired
malformations, except intraoral dental services for treatment of
a condition which is related to or developed as a result of cleft
lip and/or cleft palate, unless otherwise included as a covered
service of the Contract
• Treatment for the disturbances of the temporo-mandibular joint
(unless included in your plan)
• Procedures necessary to alter or correct occlusion or vertical
dimension or restoration of tooth structure lost through attrition
• Habit Appliances, bite registration or any related services
• Extraoral grafts, augmentations or implants
• Associated sedative procedures (Relative Analgesia, Hypnosis,
Pre -medication)
• Treatment solely for cosmetic reasons
Oral hygiene instructions or dietary instructions
Plaque control programs
• Orthodontic services (unless included in your plan)
• Any procedure performed on teeth retained in relation to an
overdenture
ORTHODONTIC BENEFITS ainciuded fn yourplan)
Orthodontic care (if included in your plan) provides the
procedures associated with oral surgery or appliance therapy for
movement and post -treatment retention of improperly aligned teeth
and/orjaws including any related diagnostic, preventive or intercep-
tive services except extraction of teeth. Group contracts which
include Orthodontic coverage specify that all Orthodontic treatment
must be predetermined.
Once records have been established and the total treatment
charge has been presented, Delta will determine Delta's share and
the monthly payments.
If a patient is in active orthodontic treatment when they
become eligible for Delta benefits, Delta will calculate the balance
to be paid based on the eligibility of the patient and the maximum
benefit remaining.
Orthodontic Limitations and Exclusions
a. Replacement or repair of appliances is a not a benefit.
b. Orthodontic care provided in the treatment of periodontal cases
or cases involving treatment or repositioning of the temporo-
mandibular joint or related conditions is not a covered service.
c. The obligation of Delta to make periodic payments for an
Orthodontic treatment plan shall cease upon termination of
treatment for any reason prior to completion of the case.
d. The obligation of Delta to make periodic payments for an
Orthodontic treatment plan begun prior to the eligibility date of
the patient shall commence with the first payment due following
the patient's eligibility date.
e. The obligation of Delta to make periodic payments for an
Orthodontic treatment plan shall cease upon termination of the
covered person's eligibility.
f. Delta's obligation to make periodic payments for Orthodon-
tics shall terminate on the date the eligible dependent
child(ren) reaches the maximum age specified in your group
dental contract.
g. Extended coverage provisions do not apply to Orthodontic
services.
NOTICE OF RIGHT
TO COBRA COVERAGE
Under the Consolidated Omnibus Budget Reconciliation Act
(COBRA) of 1985, as amended by Congress in 1986 and 1989 and
further amended by the Health Insurance Portability and Account-
ability Act of 1996, eligible persons who would lose coverage under
their employer sponsored group health plan (which includes dental
plan coverage) due to certain "Qualifying Events" are entitled to
elect continued coverage at their own expense.
Eligible employees and dependents losing coverage
due to either of the following Qualifying Events may elect to
continue coverage for eighteen (18) months following the
month In which the event occurs:
• An eligible employee's termination of employment
(other than for gross misconduct); or
• An eligible employee's reduction in work hours to less
than any minimum required to be eligible under the
contract.
Any eligible employee or dependent who is eligible for
COBRA continuation coverage who is disabled and determined to
be eligible for Social Security disability benefits at the time of
termination of employment or reduction of hours may elect to extend
coverage for themselves and their dependents for up to an addi-
tional eleven (11) months following the eighteen (18) month
extension allowed for the initial Qualifying Event. This right also
applies if the eligible employee or dependent is totally and perma-
nently disabled within sixty (60) days after termination of
employment or reduction of hours. The employee or dependent
must notify the employer in writing of the Social Security disability
determination within sixty (60) days of the date it is issued, and
before the end of the initial eighteen (18) month COBRA coverage
period. The employee or dependent must also notify the employer
within thirty (30) days of the date of any final determination by the
Social Security Administration that the employee or dependent is
no longer disabled.
Eligible dependents losing coverage due to any of the
following Qualifying Events may elect to continue coverage for
thirty-six (36) months following the month In which the event
occurs:
• An eligible employee's death;
• A divorce or legal separation from an eligible employee;
• A dependent child's ceasing to qualify as an eligible
dependent under this Program; or
• An eligible employee's entitlement to Medicare benefits.
Anyone who has elected continued coverage and becomes
covered under another plan may continue coverage if the plan
contains a pre-existing condition limitation. Coverage will be
continued until the earlier of: the expiration of the pre-existing
condition limitation of the new plan or the expiration of the original
continuation period. The new plan must count the months for which
you have had coverage under COBRA for the pre-existing condition.
It is the employee's or dependent's responsibility to consult with
their plan administrator to determine if this provision applies in their
case.
If a COBRA enrollee becomes entitled to Medicare before
the expiration of eighteen (18) months then any of his dependents
will be entitled to continuation of coverage for a total of thirty-six (36)
months from the date of the original Qualifying Event.
Anyone who is entitled to elect continued coverage based
on more than one Qualifying Event shall be limited to continued
coverage for a total of thirty-six (36) months following the date of
the first Qualifying Event.
You oryour dependent must notify your employer within sixty
(60) days after a divorce or legal separation, or if a dependent child
loses eligibility. Otherwise, the option of continued coverage based
on one of these events will be lost.
Once aware of a Qualifying Event, the employer will notify
affected persons about their right to elect continued coverage. This
notice will include the amount of monthly fees the employer will
charge them for continued coverage as permitted by law. Persons
desiring continued coverage must advise the employer within sixty
(60) days after receiving such notice, or within sixty (60) days after
losing coverage due to the Qualifying Event, whichever is later. You
or your dependent will then have forty-five (45) days to pay the initial
installment of fees which shall include fees for all months since the
Qualifying Event.
Continued coverage shall be the same as for eligible em-
ployees and their dependents. If coverage is modified for eligible
employees and their dependents, it shall also be modified in the
same manner for persons with continued coverage and an appro-
priate adjustment in fees may be made by the employer.
After COBRA coverage begins, the COBRA enrollee may
add a newborn child, an adopted child or a child who has been
placed with the employee for adoption and for whom the employee
has financial responsibility. The COBRA enrollee must notify the
employer in writing within thirty-one (31) days of the birth or place-
ment in order to add the child to the COBRA coverage. A child bom,
adopted or placed for adoption and enrolled as indicated will have
the same COBRA rights as any other dependents covered by the
plan before the event that triggered COBRA coverage.
A person's continued coverage elected under the Contract
will terminate at the end of the month in which any of the following
events first occurs:
1. The allowable number of months of continued coverage (r
18, 29 or 36 months) expires. -
2. The Contract terminates.
3. Fees are not paid for the person as required.
4. The person becomes enrolled for dental benefits under another
group dental plan (as an employee or otherwise).
5. The person becomes entitled to Medicare.
Once continued coverage terminates, It cannot be reinstated.
COLORADO INSURANCE LAW
Under Colorado law, employees and their dependents who
would lose coverage under the group dental contract held by their
employer due to termination of employment are entitled to elect
continued coverage for up to eighteen (18) months, provided the
employee has been covered for at least six (6) months preceding
termination under a plan provided by the employer.
The continued coverage will terminate on the last day of the
month in which any of the following events first occur:
• The allowable number of months of continued coverage (i.e.,
18 months) expires.
• The Contract terminates.
• Premium dues are not paid for the person(s) as required.
• The person becomes eligible for dental benefits under another
group plan (as an employee or otherwise) or the expiration of
the pre-existing condition limitation occurs.
• The person becomes entitled to Medicare, other than as an
end -stage renal disease (ESRD) beneficiary.
Continued coverage will also apply to employees who 6
required to work forty (40) hours per week to be eligible for dental
benefits and whose work hours have been reduced below thirty (30)
hours per week. Coverage will be continued if:
• The employee has been continuously covered for six (6) months
and,
• The employer imposed the reduction in hours due to economic
conditions and,
• The employer intends to restore the employee to a full forty (40)
hour work schedule as soon as economic conditions improve.
Once continued coverage terminates, it cannot be reinstated.
Visit Delta's website at: www.deltadentalco.com
You can obtain a list of dentists in your area or
verify if your dentist is a participating member with Delta
If you have questions or need additional Information call or write:
d DELTA DENTAL®
Delta Dental Plan of Colorado
P.O. Box 173803
Denver, Colorado 80217-3803
(303) 741-9300
(800) 233-0860
Customer Service
(303) 741-9305
(800) 610-0201
QUESTIONNAIRE
Group Dental Administrative Services Only
1. Do you agree to provide without limitation services to all employees/dependents enrolled as
of December 31, 2003?
Agreed.
2. Will you agree to replicate each of the current plan's provisions? If not, please list the
specific provisions you will not replicate, along with the reason you elect not to replicate the
provision(s). If you do not identify those specific provisions you cannot replicate and
you are selected as The City's dental services provider, you may be required to make
the necessary adjustments in order to achieve replication. Otherwise, your selection
may become void.
Agreed.
3. What is your monthly administrative fee, expressed in terms of dollars per month per
employee?
One Year Two Year
Dental Administration Fee for Electronic Eligibility $ 3.41 $ 3.54
Dental Administration Fee for Manual Eligibility $ 3.65 $ 3.79
4. For each geographic area in which you have a network applicable to employee population,
provide the following information:
• Geo-Access, using 2 dental providers in 10 miles; provide a map if available
• Most recent participating provider directory and summary of the number of participating
providers in each of the applicable areas (dentists, specialists, etc.) Also provide the
website where provider information can be found.
Please see Exhibit 8.
The Delta Dental of Colorado website address is www.deltadentalco.com.
5. For each network, describe the specific measures used by your organization to monitor
participating provider access. Provide the most recent corresponding statistics available for:
• Dentist to member ratios
• Average waiting period for an appointment
Dentists cannot "close" their practice to members. Their only option is to terminate
from the panel, which they can do once per year on January 1. These dentists have
no incentive to keep patients waiting for an appointment since they are not paid
unless they perform a service.
City of Fort Collins, RFP 2003
EOB Sample
DELTA DENTAL PLAN OF COLORADO
[� DELTA DENTAL
Delta Dental Plan of Colorado
P.O. 173803
Denver, CO 80217-3803
.xplanation of Benefits
This is not a bill.
Main Office: 303-741-9300 1-800-233-OB60
Customer Relations: 303-741-9305 1-800-610-0201
Please call between the hours of
8.00 a.m. and 4:30 p.m. Mountain
Time.
Website: wwwdeltadentalco. corn
The purpose of this form is to notify you of the recent
dental services submitted to Delta Dental.
Visit Information
®�
Patient Name
Relation
Dentist
Group Name
Delta Dental Member ID
Group Number
Date Paid/Denied
Claim Number
Tooth Description of Services Date Service Dentist Remarks Deductible/ Amount Percent Delta
No. Performed I Charged I (See Below) I CO -Pay I Approved I Paid I Share
Delta Dental Plan of Colorado is a non-profit dental benefits organization
dedicated to improving the oral health of the people of Colorado by improving
access to care through dental benefits.
For more information about your coverage, please visit our Colorado Delta Dental website at www.deltadentalco.com
Total Dentist Charges
Not Chargeable to Patient
I Total Patient Share I I
Total Delta Share
_ _... _ .. I— -.-,... ..__ __...__ _. _..., r.....o„r'o a„- y,,,, e,. W.'...—,u, r„x, uupa,u arrroum, you nave me ngnt to appeal to request a Iona$ first level appeal, you must submit
your appeal and any additional supporting information in writing within 180 days from the paid date of original Explanation of Benefits to PO. Box 172528, Denver,Colorado, 80217-2528. Adecision will be made within 30 days of the date we
receive your request. If your claim remains denied, it may quality for a second level review. If your claim is denied in whole or in pan after both appeals, you have the night to file a civil action in court within one year from the final denial.
Thank you for being a metriber of Delta Dental!
HIPAA
DELTA DENTAL PLAN OF COLORADO
NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
"Protected health information" means, with few exceptions, individually identifiable health information that is
transmitted or maintained in any form or medium. Delta Dental Plan of Colorado is committed to safeguarding
your protected health information. We restrict use and disclosure of protected health information to a limited
number of employees, business associates, and other individuals or entities that we have determined need to use or
disclose the information for treatment, payment, health care operations, and the other purposes described in this
notice.
We are committed to protecting our enrollees' rights as they relate to protected health information. We
acknowledge that, when and as permitted by law, you have a right to:
1. Adequate notice about the uses and disclosures of your protected health information and our legal duties with
respect to this information,
2. Request further restrictions on uses and disclosures of your protected health information, and
3. Access, amend, and receive an accounting of disclosures of your protected health information.
The following sections of this notice provide more complete information about our privacy practices, your rights,
and our rights and duties with respect to this information.
Uses and Disclosures of Protected Health Information
In almost all cases, we may use and disclose protected health information for treatment, payment, and health care
operations. For example, we may use and disclose protected health information:
1. To communicate with the dentist who provides, coordinates, or manages your care;
2. To determine how much or whom we should pay for covered services;
3. To assess the quality of care that our participating dentists provide.
When using or disclosing protected health information or when requesting protected health information from
another covered entity, we make reasonable efforts to limit the protected health information to the minimum
necessary to accomplish the intended purpose of the use, disclosure, or request.
In addition, we may use or disclose protected health information to individuals and entities for the purposes
described below:
1. To you and with your written authorization: We may disclose your protected health information to you in
the manner and for the purposes described in the "Your Rights" section of this notice. You may give us
written authorization to use your protected health information or to disclose it to anyone for any purpose. If
you give us written authorization, you may revoke it at any time by notifying us of your revocation in writing.
Your revocation will not affect any use or disclosure permitted by your prior authorization while it was in
effect. Without your written authorization, we may not use or disclose your protected health information to
any person or for any reason not permitted by law.
2. To your family and friends: We may disclose your protected health information to a family member, friend
or other person if (a) you provide us written authorization to do so, or (b) you are unable to provide the
required authorization because of a medical emergency, accident, or similar situation and we determine that
disclosure would be in your best interest. In these situations, we may disclose protected health information to
the extent necessary for your health care treatment or payment.
3. To your employer or other plan sponsor: We may disclose protected health information to your employer
or other sponsor of your dental benefits plan. Without amending the plan documents and without your written
authorization, we may disclose summary health information to your employer or other plan sponsor for the
purpose of responding to a request for a dental benefits plan proposal or to modify, amend, or replace your
dental benefits plan. In similar fashion, we may disclose to your plan sponsor information about whether you
have been enrolled, are participating, or are no longer enrolled in the dental benefits plan. Your plan sponsor's
plan document may require or permit other uses and disclosures. Please ask your plan sponsor for a more
complete explanation of the sponsor's uses and disclosures of protected health information.
4. For underwriting, enrollment, and similar activities: We may receive protected health information from
you, your insurance agent, your plan sponsor, or your plan sponsor's health benefits consultant and use that
information to underwrite, rate, enroll, renew, or respond to a request about your dental benefits plan from any
of these individuals or entities.
5. For marketing: We may use your protected health information for marketing in limited circumstances
permitted by law. For example, we may use your name and address to communicate with you about a health -
related product or service that we provide (or payment for that product or service). This means we may
communicate with you about changes in our dental care networks; replacement of, or enhancements to, your
dental benefits plan; and health -related products or services available only to dental benefits plan enrollees that
add value to your plan but are not part of the plan. We may send you newsletters, communicate with you face-
to-face, and send you promotional items of nominal value.
6. For research: We may use or disclose protected health information for research purposes in limited
circumstances permitted by law. We may disclose the information for research purposes if, for example, there
are plans in place to protect and destroy personal identifiers at the earliest possible moment, written assurances
on limiting the uses of protected health information, and evidence that the research could not be conducted
without access to and the use of protected health information.
7. For public health and safety: We may disclose protected health information to the extent necessary to avert
a serious and imminent threat to your health or safety or the health and safety of others. We may disclose
protected health information to a government agency authorized to oversee the health care system or
government programs or contractors, and to public health authorities for public health purposes. We may
disclose protected health information to appropriate authorities if we reasonably believe that you are a possible
victim of crime, domestic violence, abuse, or neglect.
8. Required by law: We may use or disclose protected health information in limited circumstances required by
law. For example, we may disclose your protected health information to the U. S. Department of Health and
Human Services if the department requests information to determine whether we are complying with federal
privacy laws. In addition, we may disclose protected health information to state insurance and health
regulatory authorities conducting state insurance or health examinations or when responding to a complaint
that you have filed with these or similar government agencies. We may also disclose protected health
information when authorized by workers compensation or similar laws and regulations.
9. Legal proceedings and similar processes: We may disclose protected health information in response to a
court or administrative order, subpoena, discovery request, garnishment, or other lawful proceeding under
certain circumstances required by law. We may disclose protected health information to law enforcement
officers in response to lawful processes like court orders, warrants, orders, and grand jury subpoenas.
10. Law enforcement: We may disclose limited protected health information to law enforcement officers about a
suspect, fugitive, material witness, crime victim, or missing person. We may disclose protected health
information about an inmate or other person in custody to a law enforcement officer or correctional officer
under circumstances required by law. We may disclose protected health information when necessary to assist
law enforcement officers to capture an individual who has admitted to participation in a crime or has escaped
from custody.
11. Military and national security: We may disclose to military authorities protected health information about
armed forces personnel under circumstances required by law. We may disclose protected health information
to authorized officers for lawful intelligence, counter -intelligence, and other national security activities.
-- Page 2 --
Your Rights
This section explains your rights to:
1. Request restriction of uses and disclosures of your protected health information: You may request that
we place additional restrictions on our use or disclosure of your protected health information. We are not
required to agree to these additional restrictions. However, if we agree, we will abide by our agreement,
except in situations in which the restricted information is needed for emergency treatment. To be effective,
our agreement to further restrictions must be in writing and signed by our privacy officer. We may terminate
an agreement to further restrictions if we inform you of our termination. The termination will be effective for
information created or received after we have informed you of our termination.
2. Access your protected health information: You have a right to inspect and obtain a copy of your protected
health information that we maintain in a designated record set, with limited exceptions. Your request to
inspect or obtain copies of your protected health information must be in writing. You must send your request
to our Customer Relations Department listed at the end of this notice. We have 30 days in which to respond to
your request. If additional time to respond is necessary, we will notify you. If we do not maintain the
protected health information that you have requested but we know where it is maintained, we will tell you
where to send your request for access. We may discuss the scope, format, and other aspects of the request
with you if the discussion is necessary for a timely response. If you request photocopies of protected health
information, we may charge a reasonable cost -based fee that includes only the cost of copying, staff time to
copy, postage, and preparing an explanation or summary of the requested information if you tell us in advance
that you only want a summary. You may request copies of protected health information that we maintain in a
format other than photocopies. We will respond in the format that you request if the protected health
information is readily producible in that format. If you request a format other than photocopies, we may
charge you a cost -based fee for providing the information in that format. You may get in touch with the
Customer Relations Department identified at the end of this notice for more information about access. You
may access your designated record set at the Delta Dental web site at www.deltadentalco.com.
3. Amend your protected health information: You have the right to have us amend protected health
information or a record about you in a designated record set for as long as the protected health information or
record is maintained in the designated record set. You must make the request in writing, direct it to the
Customer Relations Department listed at the end of this notice, and explain why your information should be
amended. We will act on your request for an amendment no more than 60 days after we receive it. We may
extend the time to respond by no more than 30 days if we do so in the manner permitted by law. If we accept
your request to amend the protected health information, we will make reasonable efforts to notify (a) people
you identify to us as having received the protected health information and need the amendment and (b) other
people, including business associates, that we know have the protected health information and may have
relied, or could foreseeably rely, on the information to your detriment. We may deny your request for
amendment if we did not create the protected health information that you wish to have amended or for other
reasons. We will provide you a written explanation of our reasons if your request is denied. You may respond
with a statement of disagreement. We will append your statement of disagreement to your protected health
information or record if you ask us to do so.
4. Request an accounting of disclosures of your protected health information: You have a right to receive
information about instances in which our business associates or we have disclosed your protected health
information, with limited exceptions. The exceptions include information we disclose for treatment, payment,
or health care operations and information we disclose to you or with your written authorization. You must
make your request in writing and direct it to the privacy officer identified at the end of this notice. We will
provide an accounting of disclosures from the effective date of the federal privacy rule (which is April 14,
2003) but for a period of no more than six years prior to the date on which the accounting is requested. The
information may include the date on which the disclosure was made, the name and address (if we know the
address) of the person or entity to which we disclosed protected health information, a description of the
information that was disclosed, the reason for the disclosure, or other information that, by law, we may
substitute for this information. We will act on your request for an accounting within 60 days after we receive
it, unless we extend the time for an additional 30 days in the manner permitted by law. We will provide the
first accounting in any 12-month period free of charge. We may impose a reasonable cost -based fee for any
-- Page 3 --
subsequent request for an accounting by the same individual within the same 12-month period. We will
inform you about the fee in advance and permit you to avoid or reduce the fee by withdrawing or modifying
your request for this subsequent accounting.
5. Receive confidential communications about your protected health information: You may request that we
communicate with you about your protected health information by alternative means or at alternative
locations. You must advise us that communication by this means or at this location is necessary to avoid
endangering you. You must make the request in writing and direct it to the Customer Relations Department
identified at the end of this notice. We will accommodate your request if it is reasonable, specifies the
alternative means or location, and permits us to collect premiums and pay claims required by your dental
benefits plan.
6. Receive printed notices of our privacy practices: If you obtained this notice only from our website or by
electronic mail, you have the right to a printed copy. Please get in touch with the Customer Relations
Department identified at the end of this notice to obtain a printed copy of this notice.
7. Obtain additional information about our privacy practices or file a complaint: If you wish to ask a
question about our privacy practices, or file a complaint about a privacy matter, you should contact the privacy
officer identified at the end of this notice. You may also submit a written complaint to the U. S. Department of
Health and Human Services. We will provide you with the appropriate address at the U. S. Department of
Health and Human Services upon request. We will not retaliate against you in any way if you choose to file a
complaint with us or with the department.
Our Rights and Other Duties
We are required by federal and state privacy law to make reasonable efforts to ensure the privacy of protected
health information that we maintain. We are also required to provide you this notice of our privacy practices, your
rights, and our rights and duties with respect to protected health information. We will adhere to the privacy
practices described in this notice while it is in effect. This notice takes effect on April 14, 2003 or your effective
date under our group dental benefits plan, whichever of the two dates is later.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided these
changes are required or permitted by law. Any new terms of our notice will be effective for all protected health
information that we maintain, including protected health information that we created before we make the changes.
Before we make any material change in our privacy practices, we will change this notice and send the new notice
to our dental services plan subscribers who are enrolled at the time of the change. You may request a copy of this
notice at any time.
Your Contact Person for Privacy Matters
To exercise your rights under this notice to amend, access, restrict, or receive confidential communications of your
protected health information or to request a printed copy of our Notice of Privacy Practices, contact us at:
Customer Relations Department
PO Box 173803
Denver Co 80217-3803
Phone: 303-741-9305, 800-610-0201
Fax:303-741-2116
Email: Customer—service@ddpco.com
To request an accounting of disclosures of your protected health information, to file a complaint about a privacy
matter, or for more information about our privacy practices, you should contact us at:
Privacy Officer
PO Box 5468
Denver Co 80217-5468
Phone: 303-741-9300, 800-233-0860
Fax:303-741-9338
Email: Privacy@ddpco.com
-- Page 4 --
GeoAccess
DELTA DENTAL PLAN OF COLORADO
City of Fort Collins
Managed Care Accessibility Analysis
August 20, 2003
A report on the accessibility of the
Delta USA Providers
for the employees of
City of Fort Collins
Delta USA Providers - City of Fort Collins
Table of Contents
Access standard comparison . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
City of Fort Collins
DeltaPreferred Option Providers
Accessibility summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
City of Fort Collins
DeltaPreferred Option Providers
2 Providers within 10 Miles
All
Accessibility summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
City of Fort Collins
DeltaPreferred Option Providers
2 Providers within 10 Miles
With
Accessibility summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
City of Fort Collins
DeltaPreferred Option Providers
2 Providers within 10 Miles
Without
ZIP Code access standard detail information . . . . . . . . . . . . . . . . . . . . 5
City of Fort Collins
DeltaPreferred Option Providers
QUESTIONNAIRE
Group Dental Administrative Services Only (Cont.)
6. What percentage of your providers has limited their practice to current patients?
None.
7. What is your organization's financial rating (e.g., Best & Co., S&P)?
Delta Dental Plan of Colorado was given an A Strong rating by Standard & Poor's.
Delta has not been rated within the last 5 years by any other rating services.
8. Please describe your credentialing procedures.
DeltaPreferred Option dentists must first be a DeltaPremier participating dentist
before they are eligible to participate in the DPO program. DeltaPremier and
Preferred Option dentists are credentialed based on the following criteria prior to
being accepted as a provider by Delta:
1. Geographic location
2. Date of application received
3. Practice scope coincident with panel needs
4. Satisfactory billing pattern history
5. Satisfactory utilization review
6. Fee level and filed fees
7. Need for panel members
Delta's contracts with our providers are reviewed on an annual basis to ensure that
the dentists continue to meet Delta's credentialing requirements. In addition to the
annual review, Delta Dental has many checks and balances in place to ensure
ongoing compliance. Examples are: in office contract compliance audits, patient
grievances that are taken to the Professional Review Committee, and post treatment
review audits.
9. What type of reimbursement/payment method(s) is used to reimburse participating
providers? Please provide a breakdown by method of review.
Delta reimburses our Preferred Option dentists on a discounted fee for service basis.
10. In addition to routine reimbursement and any withholding provisions, can your providers
increase the total reimbursement received from your plan, e.g., by provider incentive
programs? If so, please explain.
No, there are no provider incentive programs or other means of increasing total
reimbursement from Delta.
City of Fort Collins, RFP 2003 2
Delta USA Providers - City of Fort Collins
Access standard comparison
100%
80
w
0 60
a
E
m
w
0
c
m
m
40
IL
20
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Miles to a choice of providers
II
1 provider 2 providers 3 providers 4 providers 5 providers
1
Delta USA Providers - City of Fort Collins
Accessibility summary
Delta USA Providers - City of Fort Collins
Accessibility summary
Delta USA Providers - City of Fort Collins
Accessibility summary 4
FORT COLLINS
WELLINGTON
993
57
6
11.5
WINDSOR
55
36
65
11.1
LAPORTE
50
32
64
11.0
LIVERMORE
28
12
43
12.0
BELLVUE
11
11
100
30.8
CHEYENNE
17
7
41
11.5
NUNN
7
7
100
47.3
PIERCE
4
4
100
33.9
SEVERANCE
3
3
100
16.0
3
3
100
11.1
Delta USA Providers - City of Fort Collins
5.1
ZIP Code access standard detail information
r-ruvruer group: uenavreterrea option rroviaers
Delta USA Providers - City of Fort Collins
ZIP Code access standard detail information
rroviaer group: ueitarreterred Uption Providers
5.2
Provider Directories
DELTA DENTAL PLAN OF COLORADO
d DELTA DENTAL 0
Delta Dental Plan of Colorado
Dentist Listing
for
DeltaPremier Plans
DeltaPreferred Option Plans
No Text
TA6LE OF CONTENTS
AJ49ON..................................... 1
A. MOSA.................................
1
ANTON ITO................................
1
A RVA DA....................................
1
ASPEN......................................
1
AULT..........................................
1
AURORA ...................................
1
BAILEY ......................................
3
BASALT .....................................
3
BAYFI ELD..................................
3
BENNETT..................................
3
BERTHOUD ...............................
3
BOULDER .................................
3
BRECKENRIDGE ......................
4
BRIGHTON................................
4
BROOMFIELD ...........................
4
BRUSH ......................................
4
BUENA VISTA ...........................
4
BURLINGTON ...........................
4
CANON CITY ............................
4
CARBONDALE ..........................
4
CASTLE ROCK .........................
4
CEDAREDGE ............................
5
C' TENNIAL .............................
5
CENTER....................................
5
COLORADO CITY .....................
5
COLORADO SPRINGS .............
5
COMMERCE CITY ....................
8
CONIFER..................................
8
CORTEZ....................................
8
CRAIG.......................................
8
DEL NORTE ..............................
8
DELTA ........................................
8
DENVER....................................
8
DILLON...................................
11
D U RANGO ..............................
11
EAGLE .....................................
11
EATON.....................................
11
-ELIZABETH .............................
11
ENGLEWOOD .........................
12
ERIE........................................
12
ESTES PARK ...........................12
EVERGREEN ..........................
12
FAIRPLAY................................
13
FEDERAL HEIGHTS ...............
13
FLORENCE .............................
13
FORT COLLINS ......................
13
FORT LUPTON .......................
14
FORT MORGAN......................
14
FOUNTAIN ..............................
14
FRANKTOWN ..........................
14
FREDERICK ............................
14
FRISCO...................................
14
GEORGETOWN ......................
14
GLENWOOD SPRINGS ..........
14
GOLDEN .................................
14
GRAND JUNCTION ................
14
GREELEY................................
15
GREENWOOD VILLAGE ........
15
GUNNISON .............................
15
GYPSUM .................................
15
HAYDEN..................................
15
HIGHLANDS RANCH ..............
15
HOTCHKISS ............................
16
IDAHO SPRINGS ....................
16
IGNACIO.................................
16
JOHNSTOWN ..........................
16
LA JARA..................................
16
LA JUNTA ................................
16
LA SALLE................................
16
LAFAYETTE .............................
16
LAKEWOOD ............................
16
LAMAR....................................
17
LEADV I LLE ..............................
17
LIMON.....................................
17
LITTLETON .............................
17
LONETREE ............................
18
LONGMONT ...........................
19
LOUISVILLE ............................
19
LOVELAN D ..............................
19
LYONS.....................................
20
MONTE VISTA .........................
20
MONTROSE ............................
20
MONUMENT ...........................
20
MORRISON ............................
20
NIWOT....................................
20
NORTHGLENN ........................
20
NUCLA....................................
20
PAGOSA SPRINGS .................
20
PALISADE ...............................
20
PAONIA...................................
20
PARKER ..................................
20
PENROSE ...............................
20
PUEBLO ..................................
20
PUEBLO WEST .......................
21
RANGELY................................
21
RI DGWAY................................
21
RIFLE ......................................
21
ROCKY FORD .........................
21
SALIDA....................................
21
SANLUIS................................
21
SILVERTHORNE .....................
21
SOUTH FORK .........................
21
SPRINGFIELD .........................
21
STEAMBOAT SPRINGS ..........
21
STERLING ..............................
21
STRASBURG ..........................
21
SUPERIOR ..............................
21
TELLURIDE .............................
22
THORNTON ............................
22
TRINIDAD................................
22
VAIL.........................................
22
WALSENBURG .......................
22
WALSH....................................
22
WESTMINSTER ......................
22
WHEAT RIDGE .......................
22
WINDSOR ...............................
23
WINTER PARK ........................
23
WOODLAND PARK .................
23
WRAY......................................
23
YUMA......................................
23
This listing is for informational purposes only. Delta Dental Plan of Colorado will update the list of DeltaPremier participating
and DeltaPreferred Option (DPO) dentists periodically.
• Dentists who are shown in black text are DeltaPremier participating dentists.
• Dentists who are shown in red text are both DPO and DeltaPremier participating dentists.
• The participating status of a dentist can change at any time. Delta does not guarantee current Premier or DPO
participating status.
When making an appointment with your dentist, please verify that he/she continues to be a DeltaPremier participating dentist or a
DeltaPreferred Option dentist.
QUESTIONNAIRE
Group Dental Administrative Services Only (Cont.)
11. If provider discounts are used, state the basis of the agreement. Are discounts based on
provider charges or actual cost of service?
The discounted fees for Preferred Option dentists are based on a fee schedule to
which the dentists agree to limit their fees.
12. Is there a formal committee that sets quality assurance policy and review the outcome on a
regular basis?
Delta's Professional Services department is responsible for monitoring the quality of
care provided by network dentists and specialists. The department is under the
direction of the Vice President of Professional Services.
13. Do you capture all utilization data?
Delta captures all utilization data and all reports are available to the client.
14. What claims experience and utilization reports are available? If there is additional cost,
please specify.
Two reports are provided monthly. In addition, year-end reports are provided with the
renewal. The year-end reports indicate month -by -month enrollment, premium, claims
and number of claims. Please see Exhibit 8.
15. Describe patient satisfaction surveys that you perform.
Delta Dental has a contract with an independent consultant to conduct telephone
interviews of our current subscribers. In this process they will track patient
satisfaction on an ongoing basis to help Delta understand our patients' level of
satisfaction so that we may respond to their needs.
16. Do you have an agreement that prohibits providers from billing or collecting from patients
more than the designated coinsurance or co -payment in the plan design?
Yes, no Delta provider may collect more than the designated coinsurance from the
patient. All Delta providers have signed an agreement to that effect and Delta
conducts routine dental office audits to verify they are doing just that.
17. Please describe your method for calculating renewal rates.
The ASC fee is evaluated based on changes in Delta's operational expenses, the
group's utilization, and service requirements.
City of Fort Collins, RFP 2003 3
Akron - General
Arvada -Gelb )
Arvada - General
Arv�,�t;aneral
Arvada - Orthodontist
Wright DDS, Peggy
482 Adams
Akron 80720
(970) 345-2677
Alamosa - General
` Valley Wide Health Services
201 Carson Ave
Alamosa 81101
(719)589-9691
Antiel DDS, Robert
906 Main St
Alamosa 81101
(719) 589-2257
Ramirez DDS, Salvador
201 Carson Ave
Alamosa 81101
(719) 589-9691
Schiffer DDS, Stephen
100 Edison
Alamosa 81101
(719)589-4946
Vandewalle DDS, Denise
815 West Ave
Alamosa 81101
(719)589-4771
Warrington DDS, Tom
100 112 Edison Ave
Alamosa 81101
(719) 5894963
Welch DDS, Frank
206 Creston Ave
Alamosa 81101
(719) 589-6629
Williams DDS, Richard
315 Edison Ave
Alamosa 81101
(719)589-3686
Antonito - General
Christensen DMD, Eugene
10th 8 Dahlia St
Antonito 81120
(719) 376-2295
Arvada - General
Atha DDS, Jason
5730 Ward Rd # 205
Arvada 80002
(303)425-9278
Bauman DDS, Jon
7578 Sheridan Blvd
Arvada 80003
(303) 657-9006
Bennett DDS, David
7745 Wadsworth Blvd # F
Arvada B0003
(303)422-9172
Bennett DDS, Stuart
7745 Wadsworth Blvd # F
Arvada 80003
(303)422-9172
' Bueltel DDS, Allen
12380 W 64th Ave
Arvada 80004
(303)421-7000
Bunched DDS, Christopher
8749 Wadsworth Blvd
Arvada 80003
(303)421-9444
` Carpenter ODS, John
5310 Ward Rd # 101
Arvada 80002
(303)421-6165
Cox DDS, Vallory
6425 Wadsworth Blvd # 201
Arvada 80003
(303) 940-0125
` Dean DDS, Mark
12380 W 64th Ave
Arvada 80004
(303)421-7000
Datong DDS, Gary
8725 Wadsworth Blvd # 8
Arvada 80003
(303)420-2004
' Ellis DDS, Dana
10229 W 58th Ave
Arvada 80002
(303)422-2502
Emily DDS, Peter
6010 Kipling Pkwy
Arvada 80004
(303)420-1199
Eyer DDS, Robert
9999 W 60th Ave
Arvada 80004
(303)422-2395
Flower DDS, Brett
7850 Vance Or # 245
Arvada 80003
(303)422-3303
' Friedman DDS, Mitchell
8795 Ralston Rd # 210
Arvada 80002
(303)422-8942
Fuhr DDS, Richard
8795 Ralston Rd # 104
Arvada 80002
(303) 424-2222
Fujita DDS, Dana
7310 W 52nd Ave # F
Arvada 80002
(303)422-8748
Green DDS, William
6425 Wadsworth Blvd # 102
Arvada 80003
(303)422-7610
Gutzmann DDS, David
6355 Ward Rd # 410
Arvada 80004
(303)420-7100
Hendrickson DMD, Brian
8609 Ralston Rd
Arvada 8DO02
(303)425-5100
Jabour DDS, Dodenne
8410 Wadsworth Blvd # G
Arvada 80003
(303)463-8570
Jack DDS, James
7523 W BOth Ave
Arvada 80003
(303)421-7611
Johnson DMD, Ted
7310 W 52nd Ave # F
Arvada 80002
(303) 422-8748
Johnstone DMD, Dennis
8725 Wadsworth Blvd # B
Arvada 80005
(303)420-2004
Kinard DDS, Mark
7502 W 80th Ave # 250
Arvada 80003
(303)425-1000
Kish DMD, Michael
9950 W 80th Ave # 12
Arvada 80005
(303)424-6226
Kraft DDS, Brian
5730 Ward Rd # 205
Arvada 80002
(303)425-9278
Lodi DDS, Jeffrey
5730 Ward Rd #204
Arvada 80002
(303)424-0767
Luce DDS, William
8749 Wadsworth Blvd
Arvada 80003
(303)421-9444
Ludden DMD, William
7502 W 80th Ave # 250
Arvada 80003
(303)425-1000
Marold DDS, Joseph
8605 Ralston Rd
Arvada 80002
(303)422-1220
Materon DDS, Juan
8390 W 80th Ave
Arvada 80005
(303)42M419
Medaugh DDS, Peter
7400 Wadsworth Blvd # 102
Arvada 80003
(303)423-0860
Morehead DDS, James
8721 Wadsworth Blvd # A
Arvada 80003
(303)425-7686
Morehead DDS, Jonathan
8721 Wadsworth Blvd # A
Arvada 80003
(303)425-7686
Moss DDS, Jack
7970 Sheridan Blvd 3rd FI
Arvada 80003
(303) 427-0730
` Mulheran DDS, Thomas
7970 Sheridan Blvd 3rd FI
Arvada 80003
(303)427-0730
Nakamura DDS, Ann Okimoto
6475 Wadsworth Blvd #217
Arvada 80003
(303) 4254253
Nakamura DDS, Michael
6475 Wadsworth Blvd #217
Arvada 80003
(303)4254253
Niemi DDS, Thomas
5730 Ward Rd # 205
Arvada 80002
(303)425-9278
Olson DDS, Robert
6355 Ward Rd # 201
Arvada 80004
(303)420-3310
Parish Jr DDS, Dural
7627 W 88M Ave
Arvada 80005
(303)425-6565
Peterson DMD, Glen
8721 Wadsworth Blvd # B
Arvada 80003
(303) 420-2061
Peterson DDS, Tyr
7913 Allison Way # 202
Arvada 80005
(303) 424-6483
` Porco Jr DDS, Raymond
5169 W 54th Ave
Arvada 80003
(303) 4264050
Powers DDS, Robert
8660 Ralston Rd
Arvada 80002
(303)425-4775
Rlnaldis DDS, Patrick Ward
8390 W 80th Ave
Arvada 80005
(303)425-6419
Rotolo DDS, Gary
8390 W 801h Ave
Arvada 80005
(303) 425-6419
` Rygg DDS, Paul
12660 W 64th Ave # J
Arvada 80004
(303)423-90DO
` Scarffe DDS, Charles
7903 Allison Wy # 103
Arvada 80005
(303) 423-4492
Simon DMD, Jonathan
14715 West 64th Ave # F
Arvada 80004
(303)940-7166
Simon DDS, Randall
8770 Wadsworth Blvd # H
Arvada 80003
(303)422-2020
Singer DOS, Stuart
7400 Wadsworth Blvd #202
Arvada 80003
(303)425-6200
Spence DDS, Jaclynn
5730 Ward Rd # 205
Arvada 80002
(303)425-9278
Taylor DDS, Stephen
9800 W 59th PI
Arvada 80004
(303) 422-0011
Thomas DMD, Michael
7578 Sheridan Blvd
Arvada 80003
(303)657-9006
Trujillo DDS, Dana
9056 W 881h Ave
Arvada 80005
(303)423-5989
Uremovich DDS, Mark
11890 West 64th Ave
Arvada 80004
(303)422-0094
Uremovich DDS, Milan
11890 West 641h Ave
Arvada 80004
(303)422-0094
Urich DDS, Daniel
7913 Allison Wy # 203
Arvada 80005
(303)420-1114
Van Wagenen DDS, Jason
5730 Ward Rd # 205
Arvada 80002
(303)425-9278
Vedi DDS, Anita
9122 W 88th Ave # G
Arvada 80005
(303)422-0836
Walsh DDS, Pamela
5715 Wadsworth Bypass
Arvada 80002
(303) 4204001
Ward DDS, Larry
11005 Ralston Rd # 201
Arvada 80004
(303) 423-4198
' Waters DDS, Gregory
8850 Ralston Rd # 104
Arvada 80002
(303) 420,3233
Weber DDS, John
12380 W 64th Ave
Arvada 80004
(303)421-7000
' Webster DDS, Kelvin
5169 W 64th Ave
Arvada B0003
(303)4264050
Winter DMD, Stuart
8605 Ralston Rd
Arvada 80002
(303)424.4567
Winter Jr DDS, Waller
8605 Ralston Rd
Arvada 80002
(303)424-4567
` Zimmet DDS, Neil
12380 W 64th Ave
Arvada 8DO04
(303) 421-7000
Arvada - Oral
Surgery/Extractions
Ingalls DDS, Gregory
8025 Club Crest Drive
Arvada 80005
(303) 431-0033
Lesnick DDS, Julie
8025 Club Crest Drive
Arvada 80005
(303)431-0033
Newman DDS, Richard
7913 Allison Wy # 101
Arvada 80005
(303)422-2990
Oday DDS, Richard
8025 Club Crest Drive
Arvada 80005
(303)431-0033
Arvada - Orthodontist
Callender DDS, Galen
5715 Wadsworth Bypass
Arvada 80002
(303) 421A984
Colledi DDS, Laurence
8749 Wadsworth Blvd
Arvada 00003
(303)421-9444
Gallagher DMD MS, James
11890 Ralston Rd
Arvada 80004
(303)422-3419
` Hamersky DDS, Paul
8723 Wadsworth Blvd # B
Arvada 80003
(303)422-6752
` Lee DMD, Eunice
7502 W 80th Ave # 150
Arvada 80003
(303)421-5437
` Lee DMD, Eunice
8749 Wadsworth Blvd
Arvada 80003
(303)421-9444
Mason Jr DDS, James
6390 Gardenia St # 200
Arvada 80004
(303)421-2616
Nelson DDS, Bryan
8723 Wadsworth Blvd # B
Arvada 80003
(303)422-6752
Arvada - Pediatric Dentist
Asher DDS MS, Randall
8749 Wadsworth Blvd
Arvada 80003
(303) 421-9444
Hague DDS, Donald
5730 Ward Rd # 202
Arvada 80002
(303)422-3746
Sexton DDS MS, John
7502 W 80th Ave # 150
Arvada 80003
(303)421-5437
Wilkoff DDS, Jesse
7578 Sheridan Blvd
Arvada 80003
(303)427-9779
Arvada - Periodontist
Denny DMD, Robert
12191 Ralston Rd # 202
Arvada 80004
(303)425-6022
' Reissner DDS, Marc
9800 W 59th Place
Arvada 80004
(303) 431-2825
Snow DDS, Stevens
7502 W 80th Ave # 250
Arvada 80003
(303)425-10DO
Spillman DDS, Kent
7502 W 801h Ave # 100
Arvada 80003
(303)424-7757
` Wright Jr DDS. Raymond
8749 Wadsworth Blvd
Arvada 80003
(303)421-9444
Aspen - General
Alter ODS, Scott
126 W Main St
Aspen 81611
(970) 92&1178
Aspen - Periodontist
Drezek DOS MSD, John
215 S Monarch #301
Aspen 81611
(970) 925-5658
Ault - General
Jordan Jr DDS, Robert
210 tat St
Ault 80610
(970)834-2887
Aurora -General
C
Ames ODS, William
1977 Haven St
Aurora 80014
(303) 750-103131
And. DDS, Susan
14991 E Hampden Ave # 390
Aurora 80014
(303)690-6662
Page 1 'means DPO Dentist at the time of publication 0124103
Aurora - General
Augustine DDS, Lisa
2900 S Peoria # C
Aurora 80014
(303) 751-3321
3dlelt DDS, James
331 E Cornell Ave # 20
.urom 80014
(303)745-7777
Bednarczyk DDS, Daniel
4321 S Buckley Rd
Aurora 80015
(303)690-1812
Belschner Jr DDS, Louis
800 Peoria St
Aurora 80011
(303)366-9450
Biel DDS, Timothy
15425 E Iliff Ave
Aurora 80013
(303) 755-5768
Bowden DDS, Clyde
14591 E Alameda Ave
Aurora 80012
(303) 343-7072
` Bowers DDS, Soledad
10700 E Bethany Or If 210
Aurora 80014
(303)745-8828
Brown DDS, Jennie
1344 S Chambers Rd # 203
Aurora 80017
(303)755-6700
Browning DDS, Robed
11275 E Mississippi Ave #12 S6
Aurora 80012
(303)343-3910
Bujanda-wagner DDS, Sandra
1344 S Chambers Rd If 104
Aurora 80017
(303)873-0755
Burkett DDS, John
1344 S Chambers Rd # 202
Aurora 80017
1303)696-7333
Aterman DDS, Daniel
3035 S Parker Rd # 558
Aurora 80014
(303)752-0600
`Chamond DMD, Won.
14251 E 6th Ave
Aurora 80011
(303)343-3133
Chawla DMD, Pmthima
14001 E Iliff Ave # 303
Aurora 80014
(303) 337-7994
` Chol(m DDS, Stuart
15270 E 6th Ave # 3
Aurora 80011
(303)340-3994
Christiansen DDS, Harold
2530 S Parker Rd #201
Aurora 80014
(303)750-2460
Corson DDS, G Michael
1400 Chambers Rd # 1
Aurora 80011
(303)364-7491
Damico DDS, Nick
3131 S Vaughn Wy # 422
Aurora 80014
(303)745-1400
` Daniel DDS, Thomas
1101 Havana
Aurora 80010
(303) 366-3577
Davis DDS, Joshua
14221 E 4th Ave # 222
Aurora 80011
(303)344-1227
Deeg DOS, Deborah
4991 E Hampden Ave # 390
rora 80014
J3)690-6662
Deeg Jr DDS, Miles
14991 E Hampden Ave # 390
Aurora 80014
(303) 690-6662
Aurora- General t
Dilizis DMD, Camillo
16981 E Quincy Ave If D 1
Aurora 80015
(303)617-8400
` Duff DDS, Joyce
3005 S Peoria St # B
Aurora 80014
(303)368-1409
` Edwards DMD, Gerald
1050 S Peoria
Aurora 80012
(303) 367-2273
Engel DDS, Neal
1710 S Buckley Rd # 8 A
Aurora 80017
(303)696-6763
Evans DDS, Raymond
2993 S Peoria # 250
Aurora 80014
(303) 306-1382
` Fanning DDS, Cyrus
12101 E 2nd Ave # 105
Aurora 80011
(303) 364-6659
Farbod DMD, Farhad
14991 E Hampden Ave # 270
Aurora 80014
(303)699-9880
Finks DDS, Donald
14001 E Iliff Ave If 303
Aurora 80014
(303)337-7994
Ford DDS, Michael
18525 E Smoky Hill Rd # D
Aurora 80015
(303)617-9090
Gatz DDS, James
4258 S Chambers Rd
Aurora 80011
(303) 699-0300
` Gibson DDS, Sarah
12200 E Cornell Ave # E
Aurora 80014
(303) 337-0304
`Gillam ODS, Brant
1732 S Chambers Rd
Aurora 80017
(303) 751-6916
` Gilliam DOS, Jeffrey
1050 S Peoria
Aurora 80012
(303) 367-2273
Gioia DDS, Michael
15250 E Orchard Rd
Aurora 80016
(303)680-9990
Goodwin DDS, Cara Lynn
14251 E 61h Ave
Aurora 80011
(303) 343-3133
` Haberstroh DDS, Julie
12101 E 2nd Ave # 206
Aurora 80011
(303) 343-2161
Hammon DMD, Kenneth
730 Potomac St # 308
Aurora 80011
(303) 3644322
Haney DMD, David
18541 E Hampden Ave # 120
Aurora 80013
(303)680-3308
` Hawkins ODS, Darrell
11275 E Mississippi # 1 W5
Aurora 80012
(303) 3414663
` Hedrick DDS, David
12357 E Cornell Ave # 10
Aurora 80014
(303)337-5800
`Henderson DDS, Scott
15250 E Orchard Rd
Aurora 80016
(303)680-9990
`Hohsffeld DMD, Richard
1700 S Chambers Rd
Aurora 80017
(303)337-0789
Aurora - General
Hom DDS, Phillip
800 N Peoria St
Aurora 80011
(303) 364-0965
Hopkins DMD, Tracy
2993 S Peoria St # 210
Aurora 80014
(303)696-6979
Honuchi DDS, Paul
3131 S Vaughn Wy It 422
Aumra 80014
(303) 745-1400
Ipson DDS, Jerolyn
5616 S Gibraltar Wy # E
Aurora 80015
(303) 6274884
Jones DMD, Dennis
15425 E Iliff Ave
Aurora 80013
(303)755-5768
Jon DMD, Nelson
14364 E Evans Ave # 281
Aurora 80014
(303)671-0305
Kelm DDS, Gunjan
11275 E Mississippi Ave # 2 N
Aurora 80012
(303) 3414878
Kana DDS, Himesh
14001 E Iliff Ave # 303
Aurora 80014
(303)337-7994
Karden DDS, Steven
11275 E Mississippi Ave # 1 E3
Aurora 80012
(303) 366-2115
Kendig DDS, Robed
1000 S Uvalde St
Aurora 80012
(303) 364-2641
Kern DDS, Renee
601 Salida Way # 1311
Aurora 80011
(303) 340-3330
Kneller DDS, Timothy
12101 E Iliff Ave If U
Aurora 80014
(303)696-9364
Lander DMD, Todd
11275 E Missippi Ave # 2wl
Aurora 80012
(303) 364-7631
Larson DDS, Robed
15101 E Iliff Ave # 280
Aurora 80014
(303) 696-1899
` Lee DDS, Kye
1930 S Havana St # 202
Aurora 80014
(303)337-5385
Leins DDS, Leo
2993 S Peoria # 306
Aurora 80014
(303) 671-0761
Lemke DDS, Timothy
13701 E Mississippi Ave # 310
Aurora 80012
(303) 366-1592
Lee DDS, Kimbal
3100 S Parker Rd # 103
Aurora 80014
(303) 337-2794
` Look DDS, Harley
560 Geneva St
Aurora 80010
(303)364-3353
Looze DDS, Richard
22970 E Smoky Hill Rd
Aurora 80016
(720)886-0606
Loustalet DDS, Lorraine
2131 S Chambers Rd
Aurora 80014
(303) 750-2273
Maley DDS, Mark
16629 E Smoky Hill Rd
Aurora 80015
(303)699-8788
Aurora - Gen,
Miller DDS, Rodger
15425 E Hill Ave
Aurora 80013
(303)755-5768
Mingle DDS, Michael
13731 E Rice PI # 100
Aurora 80015
(303) 6904000
Miyamoto DDS, Paul
2530 S Parker Rd # 201
Aurora 80014
(303) 750-2460
Murray DDS, Rhett
2530 S Packer Rd # 200
Aurora 80014
(303) 337-1338
Najjar DDS, Elites
1450 S Havana # 204
Aurora 80012
(303)755-3637
Neal DDS, Chad
15462 E Hamptlen Ave
Aurora 80013
(303)766-1915
Nguyen DDS, Huy
1076 S Sable Blvd
Aurora 80012
(303) 369-5517
Norrie DDS, Daniel
18525 E Smoky Hill Rd # D
Aurora 80015
(303) 617-9090
Pantleo DDS PHD, Paul
941 S Havana # 200
Aurora 80012
(303)341-5313
Pasternak DMD, Mark
1000 S Uvalde St
Aurora 80012
(303) 364-2641
Pharr DDS, David
4321 S Buckley Rd
Aurora 80015
(303) 690-1812
Phelan DDS, Sean
2131 S Chambers Rd
Aurora 80014
(303) 750-2273
Porzio-dilizia DDS, Paulette
1050 S Peoria
Aurora 80012
(303) 367-2273
Pruckler DDS, Robed
10700 E Bethany Or # 210
Aurora 80014
(303) 745-8828
Pyo DMD, Han Seung
12393 E Correll Ave
Aurora 80014
(303)755-1168
Quiller DDS, Margaret
11175 E Mississippi Ave # 110
Aurora 80012
(303) 343-9313
Ramsey DDS, Peggy
2900 S Peoria St Unit A
Aurora 80014
(303) 368-3636
Rankin DDS, Jennifer
13731 E Rice PI If 100
Aurora 80015
(303)6904000
Rausa DDS, Jana
2161 S Chambers Rd
Aurora 80014
(303) 369-7735
Reynolds DDS, James
11275 E Mississippi #2 S3
Aurora 80012
(303)364-6455
Riesselman DDS, Phillip
1000 S Uvalde
Aurora 80012
(303) 364-7463
Romig DOS, Greg
12090 E Alameda
Aurora 80012
(303) 360-8366
Aurora - General
Rones DDS, Jonathan
13701 E Mississippi Ave # 360
Aurora 80012
(303) 341-6961
` Rowan DDS, Matthew
1050 S Peoria
Aurora 80012
(303) 367-2273
Rowe DDS, Merril
1400 Chambers Rd # 3
Aurora 80011
(303)366-8660
Rush DDS, Steven
1450 S Havana # 200
Aurora 80012
(303)755-8388
Sahman DDS, Ronald
941 S Havana # 201
Aurora 80012
(303) 341-2473
Sanders Jr DDS, Randall
3100 S Parker Rd # 103
Aurora 80014
(303) 337-2794
Schuelke DOS, Mark
2675 S Abilene St #135
Aurora 80014
(303)750-7990
Schuler DDS, Darrell
400 S Potomac Way
Aurora 80012
(303)363-7777
Scott DDS, Daniel
11175 E Mississippi Ave # 110
Aurora 80012
(303) 343-9313
Sellers Jr DMO, R Kent
14991 E Hampden Ave # 370
Aurora 80014
(303)693-1215
Slack DOS, N Curtis
12610 E Iliff Ave # 305
Aurora 80014
(303) 695-0102
Smith DMD, Larry
11275 E Mississippi# 1 S4
Aumm 80012
(303)361£668
Stapleton DDS, Carole
2530 S Parker Rd #200
Aurora 80014
(303) 7514762
Stolcis DDS, Robed
1000 S Uvalde
Aurora 80012
(303)364-7463
Thousand Ili DDS, John
16981 E Quincy Ave # D 1
Aurora 80015
(303) 617-8400
Toriggino DDS, Dominic
15425 E Hill Ave
Aurora 80013
(303) 755-5768
Wahl DDS, Dale
14001 E Iliff Ave # 303
Aurora 80014
(303)337-7994
Wallace DDS, Richard
14991 E Hampden Ave # 300
Aurora 80014
(303) 690-7778
Ward DMD, Nicole
2131 S Chambers Rd
Aurora 80014
(303)750-2273
Wilson DDS. Gary
11175 E Mississippi Ave # 110
Aurora 80012
(303)343-9313
Wilson DDS, Kenneth
13764 E Quincy Ave
Aurora 80015
(303)690-0877
Wohlgemuth DDS, Barry
1450 S Havana # 200
Aurora 80012
(303)755-8388
Page 2 'means DPO Dentist at the time of publication 01/24/03
Aurora - General
Yaros DDS, Ronald
2900 S Peoria St # C
Aurora 80014
(303) 751-3321
Yarns DDS. James
2530 S Parker Rd # 224
Aurora 80014
(303) 750-4250
Yi DDS, Woon
1344 S Chambers Rd # 101
Aurom 80017
(303) 873-7180
Zelenka DDS, Rodney
11275 E Mississippi Ave # 1 W 1
Aurora 80012
(303)344-9862
Zipfel DDS, Jennifer
14001 E Iliff Ave # 303
Aurora 80014
(303) 337-7994
Aurora - Oral SutgerylExtractlons
Catalano DDS, Joseph
14991 E Hampden Ave # 260
Aurora 80014
(303)699-1964
Floyd DOS MS, Carlton
1344 S Chambers Rd # 201
Aurora 80017
(303) 368-7402
Keogh MD, Barry
14991 E Hampden Ave If 260
Aurora 80014
(303)699-1964
Peace Jr DMD, Louie
2900 S Peoria Unit D
Aurora 80014
(303) 755,3353
Shultz DDS, Brandon
15250 E Orchard Rd
Aurora 80016
(303)690-5037
White DDS, Jeffery
13701 E Mississippi Ave #300
Aurora BOD12
(303) 344-2705
Aurora - EndociontistlRoot
Canals
Chalian DDS MS, G Garo
11200 E Mississippi Ave
Aurora 80012
(303)696-1919
Holtzman DMD, David
11200 E Mississippi Ave
Aurora 80012
(303) 6WI919
' Parsons DDS, Joseph
11200 E Mississippi Ave
Aurora 80012
(303)696-1919
` Stein DDS, Arlene
11200 E Mississippi Ave
Aumra 80012
(303)696-1919
Aurora - Orthodontist
Haskins DDS MS, Jaffrey
15454 E Orchard Rd
Aurora 80015
(303) 699-1703
Lauson DOS, S Kant
167M E Smoky Hilt Rd
Aurora 80015
(303)6BO-0020
Lorenz DMD MS, Roy
14991 E Hampden Ave If 320
Aurora 80014
(303)690-2333
` Mason Jr DDS, James
2993 S Peoria # 260
Aurora 80014
(303) 751-5700
Munholland DDS, Thomas
18860 E Hampden Ave
Aurora 80013
(303) 337-2200
�,.
Aurora -Orth st
' Nieberg-baskin DDS, Hilary
15403 E Hampden Ave
Aurora 80014
(303)680-3295
Nielson DDS, Kirk
16756 E Smoky Hill Rd
Aurora 80015
(303)680-0020
Reed DDS, Charles
20971 E Smoky Hill Rd # 200
Aurora 80015
(303)617-3333
Shaver DDS, Theresa
14001 E Iliff Ave # 201
Aurora 80014
(303)751-1313
Springer DDS MS, Joseph
11275 E Mississippi Ave 1s3
Aurora 80012
(303)340-1233
Witzel DDS MSD, David
2900 S Peoria Bldg B
Aurom 80014
(303)696-6119
' Zinkann DDS MS, Keda
1700 S Chambers Rd
Aurora 00017
(303) 337-0789
' Zinkann DDS MS, Kara
1977 S Havana
Aurora 80014
(303) 750-1031
Aurora - Pediatric Dentist
Carlson Marks DDS, Lisa
730 Potomac # 306
Aurora 80011
(303)537-0234
Cohen DMD, Irwin
2900 S Peoria St # B
Aurora 80014
(303) 750-7750
Fereydouni DDS, Amir
14251 E 6th Ave
Aurora 80011
(303) 343-3133
' Harbaugh DDS, Phaedra
14251 E 6ih Ave
Aurora 80011
(303)343-3133
Hams MD, Meredith
730 Potomac If 306
Aurora 80011
(303) 537-0234
Hayutin DDS, David
5657 S Himalaya St # 200
Aurora 80015
(720) 886-0808
Hazlett DDS MSD, Douglas
390 S Potomac Wy # A
Aurora 80012
(303)367-1502
Lewis DDS, Lucinda
390 S Potomac Way If A
Aurora 80012
(303) 367-1502
` Mueller DMD, William
14251 E 6th Ave
Aurora 80011
(303)343-3133
Walter DDS, Philip
1550 S Potomac St If 255
Aurora 80012
(303)369-5437
Aurora - Periodontist
Heller DMD, Douglas
2900 S Peoria St Bldg # D
Aurora 80014
(303) 7554500
Huber DDS MS, Michael
11200 E Mississippi Ave
Aurora 80012
(303)696-1747
McCain DDS, Pamela
11200 E Mississippi Ave
Aurora 80012
(303)696-7885
Aurora - Perlcdordlat
Sandoval DDS MS, Elivinlo
12090 E Alameda
Aurora 80012
(303)360-8365
Schellhorn DDS MS, Robert
11200 E Mississippi Ave
Aurora 80012
(303)696-7885
Versman DDS, Kenneth
2900 S Peoria St Bldg # D
Aurora 80014
(303) 7554500
Aurora - Proathodontist
Clear DDS, Keith
11275 E Mississippi Ave #2 E2
Aurora 80012
(303)364-5217
Lee DDS, Seung
11275 E Mississippi Ave If 2n
Aurora 80012
(303) 3414878
Bailey - General
Nichols DDS, Richard
460 Park County Rd 43 # 3
Bailey 80421
(303) 838-0311
Basalt - General
Began DDS, Terry
23264 Two Rivers Rd
Basalt 81621
(970) 927-3776
Fishman DDS, David
23264 Two Rivers Rd
Basalt 81621
(970)927-3776
Sayfleld-General
Nicholson DDS, Stephen
30 W MITI St
Bay6eld 81122
(970)B84-9306
Baylleld - Pedlaft Dentist
Vogelsberg DDS MS. Gary
30 W Mill St
BayBeld 81122
(970)884-9306
Bennett - General
Avery DDS, Paul
280 Colfax
Bennett 80102
(303)644-3386
Berthoud - General
Beckwith DDS, Carmen
408 10th St
Berthoud 80513
(970) 5324477
Deschene DDS, James
430 Simeon Ave
Berthoud 80513
(970)5324209
Newby DMD, Nic
430 Simeon Ave
Berthoud 80513
(970) 5324209
Boulder - General
Adelman DMD, Ira
1840 Folsom St#100
Boulder 80302
(303) 417-9401
Adler DDS, Michael
1810 30th St or A
Boulder 80301
(303)449-1119
Aber DDS, Marc
2919 Velmom Rd If 106
Boulder 80301
(303)449-3132
Barry DDS, Shawn
1750 301h St # 2
Boulder B0301
(303)44D4777
Bold DDS. Robert
2727 Pine St If 2
Boulder 80302
(303)442-6142
Bentz DDS, Michael
$000 Pearl St # 110
Boulder 80301
(303)449-8783
Birnbaum DDS, Anne
1000 Alpine Ave If 270
Boulder 80304
(303) 4444166
Bishop DDS, John
1750 30th St if 2
Boulder 80301
(303)440-4777
Bogen DDS, Thomas
1150 Maxwell Ave
Boulder 80304
(303)447-1122
Brachvogel DDS, William
1840 Folsom If 301
Boulder 80302
(303) 4434 146
Brown DDS, Julia Ann
2601 N Broadway
Boulder 80304
(303)447-1042
Buffer DDS, Steven
385 Broadway
Boulder 80305
(303)4424846
` Danzer-webb DMD, Kimberly
1 B40 Folsom # 201
Boulder 80302
(303)443-5133
Davis DDS, Terry
2919 Valmont Rd # 106
Boulder 80301
(303)449-3132
Davis DDS, Walter
1610 Canyon Blvd
Boulder 80302
(303)442-5000
De La Paz It DDS, Emmanuel
2300 Canyon Blvd # 7
Boulder 80302
(303)4424235
Donaghy DDS, Frederick
3093 N Broadway
Boulder 80304
(303)443-1703
` Evans Jr DDS, David
1455 Yarmouth Ave # 116
Boulder 80304
(303)442-0990
Fiscus DDS, Andrew
3400 Penrose PI # 202
Boulder 80301
(303)442-5748
Fresques DDS, Gary
2525 Arapahoe Ave B-1
Boulder 80302
(303)442-1600
Fridrich DDS, Scott
1120 Alpine Ave # C
Boulder 80304
(303) 4434416
Gage DDS, Danner
75 Manhattan Or If 101
Boulder 80303
(303)494-3760
Greene DDS, David
1840 Folsom St If 303
Boulder 80302
(303)444-2734
Groves DDS, Forrest
3000 Center Green Or # 240
Boulder 80301
(303)4424895
Harwood DDS. Phillip
2525 Arapahoe Ave B-1
Boulder B0302
(303)442-1600
Herschleb DDS, Stuart
2824 Broadway
Boulder 80304
(303) 4424857
Howard DDS, Brian
2300 Canyon Blvd
Boulder 80302
(303)444-5025
Boulder- General
Hulse DOS, Gary
1844 Pearl St
Boulder 80302
(303) 4424555
Ikeda DDS, Jane
805 S Broadway # 210
Boulder 80305
(303)499-0558
Jackson DDS, David
6525 Gunpark Or # 370
Boulder 80301
(303) 652-3500
Kammer DDS, Robert
1440 28th St If 3
Boulder 80303
(303)443-2441
Kupka DMD, Carolyn
3100 Arapahoe # 303
Boulder 80303
(303)444-2884
Medlin DDS, Kristine
3400 Penrose PI /f 105
Boulder 80301
(303)449-3131
Malodor DDS, David
6525 Gunpark Or If 370
Boulder 80301
(303) 652-3500
Messer DDS, Gavin
6700 Lookout Rd # 1
Boulder 80301
(303) 530-7525
Mickens li DDS, Kenneth
3400 Penrose PI # 101
Boulder 80301
(303)442-8700
Mohelicki DDS, Arlo
1150 Maxwell Ave
Boulder 80304
(303) 443-0998
Monk DDS, James
805 S Broadway # 205
Boulder 80303
(303)543-7615
Murphy DDS, F Robert
2601 N Broadway
Boulder 80304
(303)447-1042
Perry DDS, Stephen
2525 28th St # 140
Boulder 80301
(303)443-0070
Pinkner DDS, Jay
4155 Dadey # F
Boulder 80303
(303)499-9700
Poulson DDS. Kenneth
3400 Penrose PI If 105
Boulder 80301
(303) 449-3131
Rathburn DDS, Kirk
27091ds Ave
Boulder 80304
(303)786-9673
Roberts DDS, Martin
1900 Folsom St # 111
Boulder 80302
(303) 4424810
Roper ODS, Raymond
1900 Folsom Street If 202
Boulder 80302
(303) 447-2281
Saggio DDS, Mark
3400 Table Mesa Or # 102
Boulder $0305
(303)494-2213
Schaffer DDS, Joel
2880 Folsom If 202
Boulder B0304
(303)44BA792
Sasso DDS, Kevin
4410 Arapahoe # 230
Boulder 80303
(303) 449-8165
Sica DDS, Paul
2601 N Broadway
Boulder 80304
(303)447-1042
Page 3 'means DPO Dentist at the time of publication Ol 24103
Boulder - General
Simeral DDS, Robe"
1 B40 Folsom # 200
Boulder 80302
(303)440-5533
'meson DOS, Thomas
93 Broadway
,oulder 80304
(303)442-4437
Singer DMD, Larry
3093 N Broadway
Boulder 80304
(303)544-9636
Skromme DDS, Allan
6700 Lookout Rd
Boulder 80301
(303) 530-0300
Sollman Adkins DMD, Fran
1840 Folsom St# 100
Boulder 80302
(303)417-9401
Summers DDS, Corbett
737 29th St
Boulder 80303
(303)442-6141
Takemoto DDS, Susan
1750 301th St If 2
Boulder 80301
(303) "0-4777
Travis DDS, S Michael
350 Broadway # 10
Boulder 80305
(303)494-8200
Wasserman DDS, Alan
2503 Walnut St If 200
Boulder 80302
(303)443-9565
Weissman DDS, John
3400 Table Mesa Or #102
Boulder 80305
(303) 494-0101
Walker DDS, David
3400 Penrose PI # 202
Boulder 80301
'303)442-5748
elton DDS, Made
2880 Folsom # 202
Boulder 80304
(303)449-1792
Wilkman DDS, Stephen
1200 281h St If 300
Boulder 80303
(303)444-1813
Winquist DDS, Heidi
2897 Valmont Rd # 200
Boulder 80301
(303)449-8299
Boultler - Oral
Surgery/Extractions
Foley DDS, Daniel
1440 28th St If 2
Boulder 80303
(303)444-2255
Hought DMD, Roman
3450 Penrose PI # 120
Boulder 80301
(303)447-9735
Raposo DMD, Victor
3450 Penrose PI # 120
Boulder 80301
(303)447-9735
Sibley DDS, Lonnie
1840 Folsom #304
Boulder 80302
(303) 449-9840
Boulder - EndociontistiRoot
Canals
Douglas DDS, G Bruce
3100 Arapahoe Ave If 300
Boulder 80303
(303)449-6621
Jski DDS, Cad
J Broadway # 201
boulder 80305
(720) 304-2600
Theiss DDS, Edward
3100 Arapahoe Ave # 300
Boulder 80303
(303) 449-6621
Boultler- Orthodontia
- Bellon DDS, Michael
6525 Gunpark Or If 370
Boulder 80301
(303) 652-3500
- Fronczak DDS, Richard
2300 Canyon Blvd
Boulder 80302
(303)447-0393
Markowitz DDS, Steven
3400 Penrose PI # 203
Boulder 80301
(303)444-6680
Norris DDS, Gregory
2669 Spruce St
Boulder 80302
(303)442-8657
Tuenge DDS, Rodney
3400 Penrose PI If 201
Boulder 80301
(303)444-1960
- Walker DMD, John
350 Broadway # 120
Boulder 80303
(303)494-3535
Wong DDS, Jeffrey
3400 Penrose PI If 203
Boulder 80301
(303) 4 1-6680
Boulder - Pediatric Dentist
Jones DDS, Michael
3400 Penrose PI If 107
Boulder 80301
(303)443-8250
Levin DDS, Stanley
3400 Table Mesa Or # 201
Boulder 80305
(303)499-7133
Boultler- Periodontist
Dodge DMD, John
1440 28th St # 1
Boulder 80303
(303)447-0460
Forman DDS MS, Roger
1840 Folsom Ave If 302
Boulder 80302
(303)938-8300
Rogers DDS, Gregg
1"0 281h St # 1
Boulder 80303
(303)447-0460
Boulder - Prosthodontist
Gales DDS MSD, Gordon
350 Broadway # 201
Boulder 80305
(303)494-7110
Breckenridge - General
Nary DDS, Timothy
235 S Ridge St
Breckenridge 80424
(970) 4534244
Brighton - General
Brodie DDS, Leon
15 South 8th Ave
Brighton 80601
(303)659-1920
Cope DDS, George
2700 E Bridge St # 101
Brighton 80601
(303)659-5185
Ehrhardt DDS, Mark
27 S IOth Ave
Brighton 80601
(303) 659-1825
Luhrs DDS, F Robert
481 S 8th Ave
Brighton 80601
(303)669-1851
Peterson DDS, Bruce
1790 E Bridge St
Brighton 80601
(303)659-1064
- Uyeham DDS, Kenneth
30 S 20th Ave # D
Brighton 80601
(303) 659-3062
Brighton - Orthodontist
Johnson DDS, Rex
481 S 81h Ave
Brighton 80601
(303) 659-2142
Brighton - Pediatric Dentist
Sexton DOS MS, John
2700 E Bridge St #201
Brighton B0601
(303)669-7700
Broomfleld - General
Ayers DDS, William
8 Garden Center
Broomfield 80020
(303)466-1451
Bolak DDS, Kimberly
6650 W 1201h Ave # A-6
Broomfield 80020
(303)469-1970
Bowling DMD, Franklin
5015 W 120th Ave
Broomfield 80020
(303) 466-2935
Bowling DMD, Nina
5015 W 120th Ave
Broomfield 80020
(303) 466-2935
Davis DDS, William
2 Garden Center # 201
Broomfield 80020
(303) 460-7830
Douglas-broten DMD, Sarah
80 Garden Center # 320
Broomfield 80020
(303)466-4784
Fleischmann DDS, David
1010 Depot Hill Rd
Broomfield 80020
(303) 465-2341
Garry DDS, Leroy
14 Garden Center
Broomfield 80020
(303) 466-7306
Houser DDS, Javan
1140 Us Highway 287 If 200
Broomfield 80020
(303) 438-9899
Jarvis DDS, B Thomas
6363 W 1201h Ave # 205
Broomfield 80020
(303) 4664660
Mackie li DDS, William
925 Main St
Broomfield 80020
(303)466-2221
Maier ODS, Thomas
8 Garden Center
Broomfield 80020
(303)466-1451
Marogil DMD, Hand
340 E 1 at Ave #202
Broomfield 80020
(303) 4664646
Mate DDS, Lyndon
6363 W 1201h Ave # 230
Broomfield 80020
(303)635-0100
Nale DDS, Thomas
80 Garden Center # 24
Broomfield 80020
(303)469-5301
Novak DDS, Samuel
14 Garden Center
Broomfield 80020
(303)466-7306
Peebles -turner DDS, Mary
80 Garden Center # 38
Broomfield 80020
(303) 460-9366
Polke DDS, Kenneth
11550 N Sheridan # 101
Broomfield 80020
t303)465-0922
Pollard Jr DDS, George
88 Lamar St # 108
Broomfield 80020
(303)466-7309
Broomfield -
Simeon DDS, William
1010 Depol Hill Rd #201
Broomfield 80020
(303)465-2341
Songer DDS, Debra
300 Nickel St If 10
Broomfield 80020
(303) 635-1816
Wilson DDS, Cindy Sue
80 Garden Center North If D
Broomfield 80020
(303)635-2640
Broomfield - Oral
Surgery/Extractions
Pryor DMD, David
80 Garden Center #23
Broomfield 80020
(303)465-2308
Broomfield - Orthodontist
Biety DDS, Christopher
925 Main St # D
Broomfield 80020
(303) 469-4191
Donkey DDS, Joseph
10 Garden Office Ctr
Broomfield 80020
(303)469-7874
Broomfield - Prosthodontist
Olson DDS, Lee
925 Main St
Broomfield 80020
(303)469-3600
Broomfield - Pathologist
Greer Jr MD, Robert
180 Adams St #250
Broomfield 80038
(303) 32D-6827
Brush - General
Kingsley DDS, Monty
242 Cambridge St # 2
Brush 80723
(970)842-2494
Schonberger DDS, Charies
302 Cameron St
Brush 80723
(970)842-2858
Buena Vista - General
Hanford DDS, J Edward
715 Cedar St
Buena Vista 81211
(719)395-2402
Steinauer DDS, Jerome
24 Oak
Buena Vista 81211
(719)395-2240
Burlington - General
Hawkins DDS, William
340 141h St
Burlington 80807
(719) 346-8266
Canon City - General
Giammo DDS, Lynn
608 Yale Place
Canon City 81212
(719) 275-7227
Icabone DDS, Rudolph
1204 Main St
Canon City 81212
(719) 275-3859
Kearney DDS, John
610 Yale Place
Canon City 81212
(719)275.4474
Micheli DDS, Gregory
831 Forest
Canon City 81212
(719)275-7740
Moll DDS, Terry
1201 N 15th St
Canon City 81212
(719) 2758950
Rich DDS, Terry
608 Yale Place
Canon City 81212
(719)275-7227
Canon City -General
Sandoval DDS, Dean
1215 N 15th St
Canon City 81212
(719)275-5933
Schluter DDS, Craig
210 N 19th St
Canon City 81212
(719)275-2454
Smith DMD, Jared
608 Yale Place
Canon City 81212
(719)275-0661
Carbondale - General
Covello DDS, Eugene
289 Main St
Carbondale 81623
(970)963-3010
Doherty DDS, Michael
580 Main St # 200
Carbondale 81623
(970) 9634882
Nicholson DDS, Bradford
889 Main Ct
Carbondale 81623
(970)963-1616
Walker DDS, Edward
889 Main Cl
Carbondale 81623
(970)963-1616
Castle Rock - General
Bennett DDS, Ernest
610 Hwy 86
Castle Rock 80104
(303)688-3008
Bolton DDS, William
390 S Wilcox St # D
Castle Rock 80104
(303) 660-6000
Fern DMD, Paul
361 Village Square Ln # 100
Castle Rock 80104
(303)660-0782
Gerbholz DDS, Alan
610 Hwy 86
Castle Rock 80104
(303) 688-5705
Gimher DDS, Stefan
1001 5 Perry St If 105 A
Castle Rock 80104
(303)688-0252
Heidbreder DDS, Jan
3 Oakwood Professional Ctr
Castle Rock B0104
(303)688-3860
Houser DDS, Jamin
610 E Hwy 86
Castle Rock 80104
(303)6634366
- Mellor DDS, Craig
390 S Wilcox St # D
Castle Rock 80104
(303) 660-6000
Moroni DDS, Michael
755 S Perry St If 200
Castle Rock 80104
(720)733-3440
Parascand DDS, Michael
1 Oakwood Park Prof Ctr # 200
Castle Rock 80104
(303)688-9519
Patel DDS, Denman
755 S Perry St # 200
Castle Rock 80104
(720)733-3440
Rolfson DDS, Matthew
361 Village Square Lane
Castle Rock 80108
(303) 660-0782
Vanorman DDS,J Matthew
62 Founders Pkwy #62 C
Castle Rock 80104
(303)660-8540
Vieregger DDS,. Catherine
610 Hwy 86
Castle Rock 80104
(303)688-5705
Page 4
'means DPO Dentist at the time of publication 01/24/03
Castle Rock - Orthodontist
i
Centennial -S
Colorado Springs - General
Cok _!Springs -General
Colorado Springs - General
Dunbar DDS, Andrew
361 Village Square Ln # 100
Castle Rack 80108
(303) 688-3838
Nelson DDS, Bryan
62 Founders Pkwy # C
Castle Rock 80104
(303)688-8777
Cadaredge- General
Bhasker DDS, Deborah
610 S Grand Mesa Or
Cedaredge 81413
(970)856-3313
Mcadams DDS, Lee
130 S Grand Mesa Or
Cedaredge 81413
(970)856-6168
Centennial - General
Allen DDS, Brian
6650 S Vine # 250
Centennial 80121
(303)795-3005
Anderson DDS, Roger
14000 E Arapahoe Rd # 200
Centennial 80112
(303)632-3638
Brantes DDS, Lilian,
6979 S Holly Cir # 225
Centennial 80112
(303) 779-1305
Bredbeck DDS, Bruce
7600 E Arapahoe Rd If 311
Centennial 80112
(303) 773-2273
Disse-pfeifer DDS, Scarlet
6979 S Holly Cir # 150
Centennial 80112
(303)850-7614
Gibbs DDS, Micaela
7400 E Arapahoe Rd # 203
Centennial 80112
(303) 770-5040
Gilmore DDS, Shauna
6881 S Holly Cir # 206
Centennial 80112
(720)493-9242
Hopkins DDS, Steven
7400 E Arapahoe Rd If 200
Centennial B0112
(303) 759-9535
Lee DDS, Bruce
20971 E Smoky Hill Rd # 202
Centennial 80015
(303)400-9700
Minnis DDS, Robed
6950 S Holly Circle # 202
Centennial 80112
(303)770-2252
Nelson DDS, Ruth
8211 S Holly St
Centennial 80122
(303) 2906006
Nickell Jr DDS, Phillip
6834 S Yosemite
Centennial 80112
(303) 771-7266
Nielsen DDS, Kurt
8010 S Holly # 100
Centennial 80122
(303)694-6400
Pfeifer DDS, William
6979 S Holly Cir # 150
Centennial 80112
(303)850-7614
Schcles DDS, Landis
8010 S Holly # 100
Centennial 80122
(303)694-6400
Smith DDS, Vem
5657 S Himalaya St # 270
Centennial 80015
(303)690-5658
Troop DDS, J Michael
15430 E Orchard Rd
Centennial 80015
(303)699-4822
Vanicek DDS, Peter
6979 S Holly Cir If 225
Centennial 80112
(303)779-1305
Wellman DDS, Robed
14000 E Arapahoe Rd # 200
Centennial 80112
(303) 632-3638
York Johnson DDS, Kimberly
14000 E Arapahoe Rd # 200
Centennial 80112
(303)632-3638
Centennial - Oral
Surgery/Extractions
Tannyhill In MD, Richard
14000 E Arapahoe Rd # 320
Centennial 80112
(303)493-1933
Centennial - Orthodontist
Carpenter DDS MS, Christopher
9094 E Mineral Ave If 220
Centennial 80112
(303)799-7733
Elton DDS, Roger
5657 S Himalaya # 110
Centennial 80015
(303)3646433
Centennial - Pediatric Dentist
Weisenfeld DDS, Andrew
14100 E Arapahoe Rd # 300
Centennial 80112
(303)627-8300
Centennial - Periodontist
Wright Jr DDS, Raymond
8211 S Holly St
Centennial 80122
(303)290-6006
Center -General
Valley Wide Health Services
220 S Worth
Center 81125
(719)754-3584
Colorado City - General
Evans DDS, Robert
4490 Bent Brothers
Colorado City 01019
(719) 676-3361
Colorado Springs - General
Albers DDS, Mark
801 N Cascade Ave # 33
Colorado Springs 80903
(719) 634-8458
Allan DDS, Roger
5125 Centennial Blvd # 100
Colorado Springs 80919
(719) 5316711
Anaraki DDS, Hengameh
3505 Austin Bluffs Pkwy # 306
Colorado Springs 80918
(719)599-0665
Anderson DMD, Erick
6020 Erin Perk Or # C
Colorado Springs 80918
(719) 593-0988
Anderson DDS, Jackson
6459 Omaha Blvd
Colorado Springs 80915
(719)597-9057
Anderson DDS, Richard
3505 Austin Buffs Pkwy It 302
Colorado Springs 80918
(719) 598-0946
Armstrong DDS, Raymond
2575 Montebello Or W # 102
Colorado Springs B0918
(719) 598-0906
Arnold DDS, Julia Ann
701 Citadel Or E
Colorado Springs 80909
(719) 574-7288
Barnes DDS, Bruce
1424 N Hancock # 2 W
Colorado Springs 80903
(719)636-1246
Baron DDS, Bernard
830 Tenderfoot Hill Rd # 210
Colorado Springs 80906
(719) 576-5566
Baron DDS, Raymond
513 Kiva Or
Colorado Spnngs 80911
(719) 392-5300
Baros DDS, Ryan
513 Kiva Or
Colorado Springs 80911
(719) 392-5300
Barreto DMD, Nally
1050 S 8th St
Colorado Springs B0906
(719)633-8455
Bashi DOS, Vahid
6531 N Academy Blvd
ColoradoSprings 80918
(719) 528-8292
Bates DDS, Troy
559 E Pikes Peak Ave # 208
Colorado Springs 80903
(719)636-3311
Beasley DDS, Michael
1855 S Nevada Ave
Colorado Spdngs 80906
(719)471-1717
Beene li DDS, John
7560 Rangewood Or # 300
Colorado Springs 80920
(719)272-9009
Behr DDS, Nolan
5770 Flintridge Or # 200
Colorado Springs 80918
(719) 591-2050
Bertsch DDS, William
3605 Star Ranch Rd
Colorado Springs 80906
(719)576-3276
Bird DDS, Philip
7222 Commerce Center Or It 247
Colorado Springs 80919
(719) 593-0403
Blackley DDS, David
6430 Brook Park Or # 100
Colorado Springs 80918
(719)268-9777
Brady DDS, Chris
425 W Rocknmmon Blvd If 204
Colorado Springs 80919
(719) 528-6100
Brower DDS, Kathleen
703 N Tejon St It A
Colorado Springs 80903
(719)633-0770
Brown DDS, Michael
2120 Academy Cir # C
Colorado Springs 80909
(719) 596-0212
Buhrmann DDS, Scott
655 Southpointe Cl # 101
Colorado Spdngs 80906
(719) 576-1355
Sullen DDS, Benjamin
13784 Gleneagle Or
Colorado Springs 80921
(719)488-2222
Burton DDS, Matthew
3755 Brargate Blvd If 200
Colorado Springs 80920
(719)593-9025
Cady DDS, James
5731 Silverstone Terr # 200
Colorado Springs 80919
(719)632-7778
Caldwell DDS, Jay
3890 Village Seven Rd
Colorado Springs 80917
(719)574-3240
Calendine DDS, Stephen
1512 N Union Blvd It 101
Colorado Springs 80909
(719) 633-2266
Calvin DDS, James
1512 N Union Blvd # 101
Colorado Spnngs 80909
(719)633-2266
Carlson DDS, Steven
2575 Montebello Or W # 203
Colorado Springs 80918
(719) 598-a886
Carter DDS, Richard
3204 N Academy Blvd # 210
Colorado Springs 80917
(719)591-0750
Carter DDS, Steven
1634 York Rd
Colorado Springs 80918
(719)522-0800
Castillo DDS, Steven
1910 Vindicator Or It 103
Colorado Springs 80919
(719)268-9030
Cea DDS, Richard
2872 N Powers Blvd
Colorado Springs 80922
(719) 637-1 772
Charity DMD, Ronald
3100 N Academy Blvd If 103
Colorado Springs 80917
(719) 574-1705
Christiansen DDS, Ed
1685 Bnargate Blvd
Colorado Springs 80920
(719)528-7016
Cimino DDS, Michael
721 N Cascade Ave
Colorado Springs 80903
(719)633-3366
Cockrell DDS, Ronald
3225 W Carefree Cir
Colorado Springs 80917
(719)597-5748
Colvin DDS, Douglas
7770 N Union Blvd If C
Colorado Springs 80920
(719)599-0110
Couchman DDS, Donald
5145 Centennial Blvd # 100
Colorado Springs 80919
(719)593-0263
- Cullum DDS, Arnold
685 Citadel Or East #300
Colorado Springs 80909
(719) 591-2004
Culler DDS, Richard
6914 N Academy Blvd If 1 B
Colorado Springs 80918
(719) 266-9868
Daugherty DDS, David
1634 York Rd
Colorado Springs 80918
(719) 522-0800
Derlien DDS, Donald
7970 N Academy Blvd
Colorado Springs 80920
(719)598-5411
Dobbin DDS, Monica
730 Cheyenne Blvd # 200
Colorado Springs 80906
(719)473-5122
Dobbin DDS, Richard
730 Cheyenne Blvd # 200
Colorado Springs 80906
(719) 473-5122
Doolittle DMD, Charles
1705 N Weber St
Colorado Springs 80907
(719)471-1900
Dunn DDS, Jack
1714 N Circle Or
Colorado Springs 80909
(719)632-6001
Durbin DDS, Charles
413 Security Blvd # A
Colorado Springs 80911
(719) 392-3389
Ellingson DDS, Gary
5925 Lehman Or # 5
Colorado Springs 80918
(719)594-9198
Enos DDS, Steven
6375 Lehman Or # 200
Colorado Springs 80918
(719) 3BM700
Field DDS, Gary
1685 Bnargate Blvd
Colorado Springs 80920
(719) 598-0872
Fitzwater DDS, Kevin
5010 El Camino Or
Colorado Springs 80918
(719)599-5185
' Fleming DMD, Jahn Carl
827 Cheyenne Meadows Rd
Colorado Springs 80906
(719) 579-8799
Fogarty DDS, Todd
2918 Austin Bluffs Pkwy
Colorado Springs 80918
(719)593-1177
Frisbie DDS, Kent
2575 Montebello Or W # 202
Colorado Springs 80918
(719)593-0045
Gable DMD MS, James
5925 Lehman Or
Colorado Springs 80918
(719)598-4080
Gasper If DDS, Kenneth
6020 Erin Park Or # B
Colorado Springs 80918
(719)599-0700
Gentile DDS, Joseph
3100 N Academy Blvd # 107
Colorado Springs 80917
(719)5974660
Geoghan DDS, Randolph
5525 N Union Blvd If 200
Colorado Springs 80918
(719)528-1711
Gilbert DDS, Michael
2504 E Pikes Peak Ave It 202
Colorado Springs 80909
(719) 473-9222
Glueckert DDS, Mylene
3100 N Academy Blvd # 113
Colorado Springs 80917
(719) 5976300
Goldsmith DDS, Andrew
595 Chapel Hills Or It 105
Colorado Springs 80920
(719)528-5577
Golomb DDS, Sheldon
5426 N Academy Blvd # 201
Colorado Springs B0918
(719) 5286441
Gorsky DDS, Michael
2965 Broadmoor Valley Rd
Colorado Springs 80906
(719) 632-7636
- Grant DDS, James
3605 Star Ranch Rd
Colorado Springs 80906
(719)576-3276
Greer DDS, William
320 E Fontanero # 302
Colorado Springs 80907
(719) 634-4803
Greer Boyle DDS, Leigh Ann
320 E Fontanero # 302
Colorado Springs 80907
(719)634-4803
Guerra DDS, Catherine
1768 W Uintah St
Colorado Springs 80904
(719)632-8006
Guerra Jr DDS, Frederick
5925 Lehman Or
Colorado Springs 80918
(719) 5984080
Guerra Jr DDS, Frederick
4185 Centennial Blvd
Colorado Springs 80907
(719)590-8895
Hall DDS, Owayne
Citadel E # 02 Col J/rA
Colorado Springs
8
80909
(719)596-1011
Hall DDS, Kimra
1104 W Colorado Ave
Colorado Springs 80904
(719)633-8766
Page 5 'means DPO Dentist at the time of publication 0124103
Colorado Springs - General
Hansen DDS, Jason
3920 N Union Blvd # 380
Colorado Springs 80907
(719) 598-0851
'aram DDS, Phillip
130 N Circle Or # 211
.;olorado Springs 80909
(719)471-8111
Harris DDS, Michael
685 Citadel Or E # 302
Colorado Springs 80909
(719) 596-1011
Harrison DDS, Jeffrey
3468 Briargate Blvd
Colorado Springs 80920
(719) 528-6222
Hastings DDS, Rage
559 E Pikes Peak Ave # 100
Colorado Springs 80903
(719)633-3717
Hennegan DDS, Paul
3208 N Academy Blvd # 140
Colorado Springs 80917
(719) 596-7000
Henry DOS, James
2575 Montebello Or W
Colorado Springs 80918
(719) 598-8887
Hickenlooper DDS, Gary
3755 Briargate Blvd # 200
Colorado Springs 80920
(719) 632-2952
Hill DDS, Ann
6685 Delmonico Or # A
Colorado Springs 80919
(719) 535-8049
Hohnstein DDS, Tyetus
5426 N Academy Blvd # 202
Colorado Springs 80918
(719)266-5420
Holden DOS, Philip
620 Southpointe Ct # 290
Colorado Spnngs 80906
719) 576-1222
j1derbaum DDS, William
1870 Dublin Blvd # D
Colorado Springs 80918
(719) 528-8282
Holsteen DDS, Daniel
1045 Garden/the Gods Rd # N
Colorado Springs 80907
(719)598-3502
Hom DDS, Gary
320 E Fontanero # 302
Colorado Springs 80907
(719) 6344805
House DMD, Mark
1104 W Colorado Ave
Colorado Springs 80904
(719)633-8766
Huffman DDS, Thomas
5780 N Carefree Cir # A
Colorado Springs 80917
(719) 597-9737
Humphreys DDS, Roger
685 Citadel Or E # 302
Colorado Springs 80909
(719) 596-1 011
Jeleniauskas DDS, Raimundas
1714 N Circle Or
Colorado Springs 80909
(719)632-6001
Jennings DDS, Thomas
7730 N Union Blvd If 101
Colorado Springs 80920
(719) 590-7100
Johnson DDS, Branon
620 Southpointe Ct # 210
Colorado Springs 80906
(719)527-9098
Johnson DDS, Davitl
-p0 Sou(hpointe Ct # 210
lorado Springs 80906
�9) 527-9098
Jordeth DDS, William
1710 Briargate Blvd # 847
Colorado Springs 80920
(719) 531-0636
Colorado Springs - Gi.
` Kanchanlal DMD, Vikash
2130 S Academy Blvd # 100
Colorado Springs 80907
(719) 380-5733
Kearney DDS, James
2918 Austin Bluffs Pkwy # 100
Colorado Springs 80918
(719)593-8488
Keller DDS, Brian
6760 Corporate Or # 270
Colorado Springs 80919
(719)5286822
Keller DDS, Tracie
6760 Corporate Or # 270
Colorado Springs 80919
(719)5286822
Kimmelman DDS, Seth
801 N Cascade Ave # 12
Colorado Springs B0903
(719)447-1199
Klein DDS, Joel
3123 W Colorado Ave
Colorado Springs 80904
(719)475-1715
Kneupper DDS, Darrel
1768 W Uintah St
Colorado Springs 80904
(719) 632-8006
Krum Jr DDS, Nelson
5140 N Union Blvd
Colorado Springs 80918
(719) 260-6093
Lanzisera DMD, Paul
5925 Lehman Or
Colorado Springs 80918
(719)5986966
Lavin DMD, Dan
5925 Lehman Or
Colorado Springs 80918
(719) 598-6966
Lawrence DDS, Jagger
3225 W Carefree Cir
Colorado Springs 80917
(719) 597-5737
Laycack DDS, Stephen
3605 Star Ranch Rd
Colorado Springs 80906
(719)576-3276
Levasseur ODS, Dennis
6375 Lehman Or # 200
Colorado Springs 80918
(719)593-9182
Ley DOS, John
2575 Montebello Or W # 203
Colorado Springs 80918
(719)598-8886
Lodes DDS, Gene
685 Citadel Or E If 302
Colorado Springs 80909
(719)596-1011
Longo DMD, Norma
15435 Gleneagle Or # 200
Colorado Springs 80921
(719) 481-6788
Look DDS, Kim
2850 S Academy Blvd # 101
Colorado Springs 80916
(719) 392-3448
Levato DDS, Michael
1235 Lake Plaza Or # 251
Colorado Springs 80906
(719) 5768840
Lucero DDS, Odando
1855 Austin Bluffs Pkwy # A
Colorado Springs 80918
(719) 599-5980
Lucero DDS, Toni
1855 Austin Bluffs Pkwy # A
Colorado Springs 80918
(719)599-5980
Lydian DDS, John
6665 Delmonico Or # C
Colorado Springs 80919
(719)599-5700
Mass DDS, Leroy Les
2859 E Fountain Blvd
Colorado Springs 80910
(719)442-0071
Colorado Springs - General
Maestrelll DOS, Raymond
403 Elm Cir
Colorado Springs 80906
(719) 576-1355
Mahay DDS, John
1516 N Academy Blvd #203
Colorado Springs 80909
(719) 596-6466
Malivuk DMD, Michael
5780 N Carefree Cir # A
Colorado Springs 80917
(719) 597-9737
Marshall DDS, Carol
6025 Erin Park Or
Colorado Spnngs 80918
(719) 531-7111
Martinez DDS, Daniel
1733 Main St
Colorado Springs 80911
(719) 390-4946
Mastin DDS, Jessie
1430 S 21 st St
Colorado Springs 80904
(719) 633-2828
Matthews DMO, W John
7608 N Union # A
Colorado Springs 80920
(719) 598-0907
Mcculloch DOS, Edward
3585 Van Teylingen Or # F
Colorado Springs 80917
(719) 597-7111
Mcintyre DDS, Peter
5925 Lehman Or # 3
Colorado Springs 80918
(719)475-2511
Mdarty DDS, F Larry
4020 Palmer Park Blvd
Colorado Springs 80909
(719) 596-4013
Mcnamara DDS, Thomas
7970 N Academy Blvd
Colorado Springs 80920
(719) 5986411
Mcwilliams DDS, Kell
1870 Dublin Blvd # D
Colorado Springs 80918
(719)582-8282
Mediavilla DDS, Eric
2859 E Fountain Blvd
Colorado Springs 80910
(719) 442-0071
Meyer DDS, Robert
730 Cheyenne Blvd # 200
Colorado Springs 80906
(719)473-5122
Meyer DDS, Roger
6665 Delmonico Or # C
Colorado Springs 80919
(719) 599-5700
Mjos DDS, David
1710 Briargate Blvd If 847
Colorado Springs 80920
(719) 531 -0636
Mock DDS, Gregory
2504 E Pikes Peak Ave # 202
Colorado Springs 80909
(719)473-9222
Moeglein DDS, Richard
1711 N Murray Blvd
Colorado Springs 80915
(719) 596-3481
Mollner DDS, Mark
685 Citadel Or E # 313
Colorado Springs 80909
(719)574-2424
Moore DOS, Gregory
559 E Pikes Peak Ave # 319
Colorado Springs 80903
(719) 6334028
Morrissey DMD, Donald
5780 N Carefree Cir # A
Colorado Springs 80917
(719) 597-9737
Musolf DDS, Melissa
4329 Centennial Blvd
Colorado Springs 80907
(719) 592-1600
Colorado Sp. General
Mutchler DDS. Richard
202 E Cheyenne Mtn Blvd # E
Colorado Springs 80906
(719) 576-6551
Neel DDS, Janet
2859 E Fountain Blvd
Colorado Springs 80910
(719)442-0071
Nelson DDS, Donald
3505 Austin Bluffs Pkwy # 215
Colorado Springs 80918
(719) 593-1116
Nelson Jr DDS, James
721 N Cascade Ave
Colorado Springs 80903
(719)632-5756
Olsen DDS, Lonnie
3612 Galley Rd If D
Colorado Springs 80909
(719) 596-7716
Oneal DDS MS, Kelly
415 W Rockrmmon Blvd # 200
Colorado Springs 80919
(719) 599-5340
` Ostrom DDS, Ted
5929 Constitution Ave
Colorado Springs 80915
(719)638-1986
Palmer DDS, Ronald
2575 Montebello Or W # 202
Colorado Springs 80918
(719) 593-0045
` Park DDS, W Eric
6165 Lehman Or # 100
Colorado Springs 80918
(719)536-0599
Parkin DMD, Ralph
1803 B St
Colorado Springs 80906
(719)576-1730
Parfet DDS, Craig
1675 Briargate Blvd # C
Colorado Springs 80920
(719)528-6200
Patton DDS, Nual
3605 Star Ranch Rd
Colorado Springs 80906
(719) 576-3276
Payne DDS, Randall
1819 N Circle Or # 1
Colorado Springs 80909
(719) 63&1933
Platt DDS, Jeffery
425 W Rockrimmon Blvd # 204
Colorado Springs 80919
(719) 5286100
Punnsh DDS, Mary
2501 W Colorado Ave # 211
Colorado Springs 80904
(719)633-0999
Rahimpour DDS, Navid
1855 S Nevada Ave
Colorado Springs 80906
(719) 471-1717
Rack DDS, Diane
7560 Rangewood Dr# 220
Colorado Springs 80920
(719)266-4848
Redfern DDS, Rand
4585 Hilton Parkway #101
Colorado Springs 80907
(719) 599-9090
Reid DDS, Douglas
232 E Cache La Poudre St
Colorado Springs 80903
(719) 473-7441
` Reinicke DDS, Mark
1539 S 8th St# 101
Colorado Springs 80906
(719) 634-5864
Rich DDS, Terry
218 E Willamette Ave
Colorado Springs 80903
(719) 633-3711
Richardson DDS, Steven
5865 Lehman Or # 200
Colorado Springs 80918
(719) 598-8118
Colorado Springs - General
Richardson DDS, Tom
1235 Lake Plaza Or # 124
Colorado Springs 80906
(719)576-1566
Rikli DDS, Thomas
5478 Tomah Or
Colorado Springs 80918
(719)598-6680
Robbins DMD, Roy
214 E Cheyenne Mtn Blvd
Colorado Springs 80906
(719) 579-8323
Robison-knox DDS, M Lathe
3235 Templeton Gap Rd
Colorado Springs 80907
(719)630-7727
Rodriguez DDS, Leo
1304 N Academy Blvd # 104
Colorado Springs 80909
(719) 596-2165
Rodriguez DDS, Paul
703 N Tejon St # 0
Colorado Springs 80903
(719) 633-5501
Rogers DDS, Starting
3208 N Academy Blvd # 110
Colorado Springs 80917
(719)597-3700
Rogers DDS, William Todd
5575 Tech Center Or # 103
Colorado Springs 80919
(719)528-6450
Rohleder DMD, Julia
15435 Gleneagle Dr # 200
Colorado Springs 80921
(719)4816788
Root DDS, Christopher
3890 Village Seven Rd
Colorado Springs 80917
(719) 596-3610
Schenk DDS, Robert
4020 Palmer Park Blvd # 105 A
Colorado Springs 80909
(719) 597-1630
Schope DDS, Betty Jo
3464 Briargate Blvd
Colorado Springs 80920
(719)260-8089
Schwab DMD, Tommy
1516 N Academy Blvd # 202
Colorado Springs 80909
(719)596-9220
` Scimo DDS, Thomas
801 N Cascade Ave # 38
Colorado Springs 80903
(719)632-1211
Seiler DDS, Stephen
1580 E Cheyenne Mtn Blvd # C
Colorado Springs 80906
(719) 5764247
Setting DDS, Wayne
2918 Austin Bluffs Pkwy
Colorado Springs 80918
(719) 593-1177
Short DMD, Howard
5739 Constitution Ave
Colorado Springs 80915
(719) 574-7631
Slack DDS, Thomas
2504 E Pikes Peak Ave # 201
Colorado Springs 80909
(719)392-8596
Sletten DDS, Christina
6685 Delmonico Or # C
Colorado Springs 80919
(719)599-9700
Sieben DOS, Paul
6685 Delmonico Or # C
Colorado Springs 80919
(719)599-9700
Smith DDS, Lloyd
320 E Fontanero #302
Colorado Springs 80907
(719) 6344803
Smith DDS, Paul
5780 N Carefree Cir # A
Colorado Springs 80917
(719)597-9737
Page 6 'means DPO Dentist at the time of publication 01124/03
Colorado Springs - General
Smith li DDS, L Lee
2160 Hollow Brook Dr # A
Colorado Springs 80918
(719) 633-0D49
Solich DDS, Gregory
5426 N Academy Blvd # 105
Colorado Springs 80918
(719)548-9393
Sommer DDS, Craig
111 S Tejon St # 310
Colorado Springs 80903
(719) 632-3591
Scarier, DDS, Ouynh Dung
523 N Nevada Ave
Colorado Springs 80903
(719) 635-5815
Specter, DDS, Stephen
523 N Nevada Ave
Colorado Springs 80903
(719) 635-5815
Spade DDS, Andrew
4020 Palmer Park Blvd # 103 A
Colorado Springs 80909
(719) 597-6100
Spicciati DDS, Louis
3233 W Carefree Cir
Colorado Springs 80917
(719)597-2400
Stacey DDS, Timothy
6165 Lehman Dr # 104
Colorado Springs 80918
(719) 599-0949
Stephens DDS, Jeffrey
3208 N Academy Blvd # 140
Colorado Springs 80917
(719)596-7000
Swing DDS, Sandra
2512 N Cascade
Colorado Springs 80907
(719)635-0558
Tabberson DDS, Bruce
1516 N Academy Blvd # 201
Colorado Springs 80909
(719) 574-2121
Tafolla DDS, Jerome
5478 Tomah Or
Colorado Springs 80918
(719) 598-6680
Tao DDS. Clara
7770 N Union Blvd # C
Colorado Springs 80920
(719) 59"110
Thomas DMD, Abraham
5929 Constitution Ave
Colorado Springs 80915
(719)638-1986
Thompson DDS, Bill
5780 N Carefree Cir If A
Colorado Springs 80917
(719)597-9737
` Thompson DMD, Glenn
1711 N Murray Blvd
Colorado Spnngs 80915
(719) 574-2211
Thompson DDS, Larry
1711 N Murray Blvd # 202
Colorado Springs 80915
(719)574-2211
Thresh DMD, Frederic
4390 N Academy Blvd
Colorado Springs 80918
(719) 590-1616
Thurman DDS, Lon
6035 Erin Park Or # 102
Colorado Springs 80919
(719)532-0707
Tritsch DDS, Thomas
685 Citadel Dr E If 313
Colorado Springs 80909
(719)574-2424
Ulke DDS, Calvin
5770 Flintridge Dr # 210
Colorado Springs 80918
(719)593-8701
Vanness DMD, Marc
5925 Lehman Or
Colorado Springs 80918
(719)598-6966
Colorado Spl1, General
Varner Jr DDS, Harve
26 E Monument St
Colorado Springs 80903
(719)633-5870
Vessel DDS, Allen
685 Citadel Dr E # 313
Colorado Springs 80909
(719) 574-2424
Vessel Sinn DMD, Alice
685 Citadel Dr E # 313
Colorado Springs 80909
(719) 574-2424
' Vieth DDS, Harvey
559 E Pikes Peak Ave #208
Colorado Springs 80903
(710)636-3311
Wagle li DDS, F William
218 E Willamette Ave
Colorado Springs 80903
(719) 633-3711
Wahl DDS, Michael
1104 W Colorado Ave
Colorado Springs 80904
(719) 633-8766
Webb DDS, David
1911 Lelaray St # 1
Colorado Springs 80909
(719)633-7774
Weenig DDS, Val
5010 El Camino Dr # B
Colorado Springs 80918
(719)599-7453
While DMD, Winston
1705 N Weber St
Colorado Springs 80907
(719)471-1900
` Wiedey DDS, Richard
1819 N Circle Or # 6
Colorado Springs 80909
(719)520-5884
Williams DDS, Amy
5426 N Academy Blvd # 201
Colorado Springs 60918
(719)528-6441
Wilson DDS, Joseph
4185 Centennial Blvd
Colorado Springs 80907
(719) 5908895
Wilson DDS, Robert
6634 Delmonico Or
Colorado Springs 80919
(719) 593A313
Winkler DDS, Robert
595 Chapel Hills Or # 105
Colorado Springs 80920
(719) 528-5577
Wittenberg DDS, Edd
7222 Commerce Center Or # 247
Colorado Springs 80919
(719) 593-D403
Wolf DDS, Steven
1685 Briargate Blvd
Colorado Spnngs 80918
(719) 590-7277
Wood DDS, Christopher
2160 Hollow Brook Or # A
Colorado Springs 80910
(719)633-0049
Woods DMD, Joseph
559 E Pikes Peak Ave # 208
Colorado Springs 80903
(719)636-3311
Wonham DDS, Roy
7750 N Union Blvd # 101
Colorado Springs 8D920
(719)598-1293
Woyda DDS, Charles
6455 Union Blvd If 101
Colorado Springs 80918
(719)590-8820
Wright DDS, Mark
930 N Cedar St
Colorado Springs 80903
(719)635-1622
Zahedi DDS, Nazy
1785 N Academy # 104
Colorado Springs 80909
(719)596-1230
Colorado Springs - Oral
Surgery/Extractions
Baker DDS, James
5014 El Camino Dr
Colorado Springs 80918
(719) 599-0500
Bandrowsky DDS, Timothy
5014 El Camino Dr
Colorado Springs 80918
(719) 59MSOO
Berwick DDS, James
3100 N Academy # 213
Colorado Springs 80970
(719) 5974060
Billingsley DDS, Michael
5014 El Camino Dr
Colorado Springs 80918
(719) 599-0500
Crichton lit DDS, David
1625 Medical Ca Point # 260
Colorado Springs 80907
(719)473-2650
Dombrowski MD, Jeffrey
3475 Briargate Blvd # 102
Colorado Springs 80920
(719)264-6070
Hebda DDS, Thomas
7730 N Union Blvd # 103
Colorado Springs 80920
(719)590-1500
Hildebrandt DDS, John
1625 Medical Ctr Point # 260
Colorado Springs 80907
(719)473-2650
Igo DDS, Robert
1304 N Academy Blvd #205
Colorado Springs 80909
(719) 5968440
Mcmunn In DDS, William
5014 El Camino Dr
Colorado Springs 80918
(719) 599-0500
Nassimbene DDS, Leo
5014 El Camino Dr
Colorado Springs 80918
(719) 599-0500
Onstad DDS, Michael
5014 El Camino Dr
Colorado Springs 80918
(719) 599-0500
Quist DDS, Rhea
3100 N Academy # 213
Colorado Springs 80970
(719) 597-4060
Reck DDS, Steven
5014 El Camino Or
Colorado Springs 80918
(719) 599-0500
Salvo DDS, Joseph
5014 El Camino Or
Colorado Springs 80918
(719) 599-0500
Vetter DDS, James
5014 El Camino Or
Colorado Springs 80918
(719)599-0600
Zwclensky DMD, John
1675 Briargate Blvd # A
Colorado Springs 80920
(719)593-2850
Colorado Springs -
EndodontistfRoot Canals
Griffin Jr DDS MS, Robert
3775 E La Salle
Colorado Springs 80909
(719)597-0556
Ishley DDS, David
5745 Erindale Dr # 200
Colorado Springs 80918
(719)599-7665
Johnson DMD MS, Scott
5745 Erindale Or # 200
Colorado Springs 80918
(719)599-7665
Kennedy DMD, Wade
5745 Erindale Or # 200
Colorado Springs 80918
(719) 599-7665
Cali^bprings-
Endodontl Ali ot Canals
Meyers DDS, John
5745 Erindale Dr # 200
Colorado Springs 80918
(719)599-7665
Minnich DDS, Scott
5745 Erindale Dr # 200
Colorado Springs 80918
(719) 599-7665
Roth DDS, William
2116 Hollow Brook Or
Colorado Spnngs 80918
(719) 597-0038
Wolcott DDS, James
5745 Erindale Or # 200
Colorado Springs 80918
(719) 599-7665
Colorado Springs -
Orthodontist
Andrews DMD ME, Stephen
1750 Telstar Dr # 100
Colorado Springs 60920
(719)596-3138
Atha DDS MS, Eric
15 Wideeeld Blvd
Colorado Springs 80911
(719)390-7926
` Augspurger DDS MS. Ead
1785 N Academy Blvd # 126
Colorado Springs 80909
(719) 233-7181
Avant DDS MSD, Daniel
685 Citadel Dr E # 312
Colorado Springs 80909
(719)596-1363
Banning DDS, Allen
415 W Rockrimmon
Colorado Springs 80919
(719)598-7700
Ciborowski DDS, Philip
3466 Briargate Blvd
Colorado Springs 80920
(719) 548-9270
Foy DDS ME, Michael
7608 N Union # G
Colorado Springs 80920
(719) 597-6800
Gaworski DDS, Matthew
3245 W Carefree Circle
Colorado Springs 80917
(719) 596-2477
George DDS, Marc
2130 S Academy Blvd #101
Colorado Springs 80916
(719) 5974774
George DDS, Mark
7770 N Union Blvd # B
Colorado Springs 80920
(719)594-9797
Hamula DDS, David
1539 S 8th St # 200
Colorado Springs 80906
(719)471-3942
Killebrew DDS, James
703 N Tejon St # E
Colorado Springs 80903
(719)635-9610
Mills DDS, Mark
2190 Academy Cir
Colorado Springs 80909
(719)596-3081
Nelson DMD, L Spence
5731 Silverstone Terr # 230
Colorado Springs 80919
(719)278-5005
Ordahl DDS MS, John
1711 N Murray Blvd
Colorado Springs 80915
(719)596-3098
Poremba DDS MSD, Edgar
2997 Broadmoor Valley Rd
Colorado Springs 80906
(719)576-0149
Roth DDS, Justin
5929 Constitution Ave
Colorado Springs 80915
(719) 638-1986
Colorado Springs -
Orthodontist
Schroeder DDS MSD, David Hedges
1694 E Cheyenne Mt Blvd
Colorado Springs 80906
(719)5384671
Shaver DDS MS, William
2575 Montebello Or # 101
Colorado Springs 80918
(719) 599-5107
Suter DDS MS, Scott
3100 N Academy Blvd #200
Colorado Springs 80917
(719) 550-0222
Timmins DDS MS, Gerard
3455 Briargate Blvd If 103
Colorado Springs 80920
(719)260-1514
Wilhelm DDS, Robert
7560 Rangewood # 200
Colorado Springs 80920
(719) 596-3113
Youngquist DDS MS, H Warren
6010 Erin Park Dr
Colorado Springs 80918
(719)593-7942
Colorado Springs - Pediatric
Dentist
George DDS, Theodore
7770 N Union Blvd # A
Colorado Springs 80920
(719)598-0012
Haman DDS, Michelle
1711 N Munay Blvd
Colorado Springs 80915
(719)596-6920
Leech DDS, John
6025 Erin Park Or
Coloratlo Spnngs 80918
(719)531-7111
Roska DDS, Lawrence
1516 N Academy Blvd # 204
Colorado Springs 80909
(719) 5974259
Souza DMD, Edward
3466 Briargate Blvd
Colorado Springs 80920
(719)260-1600
Thorned DDS, Robert
1304 Academy Blvd # 105
Colorado Springs 80909
(719) 596-2097
Colorado Springs - Periodontist
Allen DDS ME, William
5426 N Academy Blvd # 100
Colorado Springs 80918
(719) 548-1711
Degeare DDS MSD, Dan
1819 N Circle Dr # 5
Colorado Springs 80909
(719) 473-9277
Finkbeiner DDS ME, R Lamy
625 N Cascade Ave # 350
Colorado Springs 80903
(719)630-144D
Groat DDS, Jack Eugene
1050 S 8th St
Colorado Springs 80906
(719)633-8455
Lynch DDS, Thomas
1675 Briargate Blvd
Colorado Springs 80920
(719)598-7797
Reich DDS, Gregory
5929 Constitution Ave
Colorado Springs 80915
(719)638-1986
Reich DOS MS, Gregory
1050 S 8th St
Colorado Springs 80906
(719) 633-8455
Wilson DDS, Steven f ]{
320 E Fonlanero St # 307 1�
Colorado Springs 80907
(719) 475-9023
Page 7 `means DPO Dentist at the time of publication 0124103
Del Norte - General -•,
Denver -General
Denver - Go.
Denver - General
Colorado Springs -
Prosthodotnist
Allen DDS, Mark
1155 Kelly Johnson Blvd #210
Colorado Springs 80920
(719) 534-9445
lolden DDS, Richard
620 Southpointe CI
Colorado Springs 80906
(719) 576-1222
Seaman DDS MS, Frank
6020 Earn Park Or # A
Colorado Springs 80918
(719) 593-0005
Wiley DDS, Michael
6020 Erin Park Or # A
Colorado Springs 80918
(719)593-0005
Commerce City - General
Rodgers DDS, James
7230 Locust St
Commerce City 80022
(303)289-2831
Tomassetti DDS, Gabriel
7270 Magnolia St
Commerce City 80022
(303)287-7552
Willis Jr DDS, Lawrence
6537 E 72nd PI
Commerce City 80022
(303) 288-6877
Conifer - General
Linn DMD, Stephen
11873 Spring Rd # 7
Conifer 80433
(3031674-0648
Cortez - General
Carlson DDS, Kenneth
115 N Beech St
Cortez 81321
(970)565-4448
Haspels DDS, Charles
115 N Beech St
ortez 81321
J70) 565-4449
Kest DOS, William
212 W Montezuma
Cortez 81321
(970) 565-9569
Layton DDS, C Craig
43 W Montezuma Ave
Cortez 81321
(970) 565-7521
Patana DDS, Curtis
115 N Beech St
Cortez 81321
(970) 565-7275
Vestal In DDS, John
232 W North St
Cortez 81321
(970) 565-3612
Corte - Orel Surgery/Extractions
Bar DDS, Ronald
22 W Noah St
Cortez 81321
(970)565-2424
Cortez - Orthodontist
Schafer DMD MSD, Alan
101 S Maple
Cortez B1321
(970)565-3531
Corte - Periodontist
Blue DDS, Mark
101 S Maple # B
Cortez 81321
(970) 566-9601
Craig - General
Fenton DDS, Neal
580 Pershing St # 100
•aig 81625
70)824-9785
Beyer DMD, Andrew
825 61h St
Del Norte 81132
(719) 657-2430
Delta - General
James DDS, David
1004 Main St
Delta 81416
(970) 874-8071
Yost DDS, Lyle
1025 Main St
Delta 81416
(970) 874-8227
Delta - Orthodontist
Clark DDS, James
507 Dodge St
Delta 81416
(970)874-8051
Denver -General
Abrams DDS. John
7150 E Hampden Ave # 201
Denver 80224
(303)759-3336
Afford DDS, Annette
910 16lh St # 700
Denver 80202
(303)534-7797
" Ambida DMD, Sandra
4800 Happy Canyon Rd
Denver 80237
(303) 757-8446
Ambrose DMD, Julika
300 S Jackson St # 510
Denver 80209
(303)388-5222
Anderson DDS, Robert
155 Cook St # 251
Denver 80206
(303)321-1323
Archer DDS, Raymond
4441 W 29th Ave
Denver 80212
(303)477-7776
Armstrong DOS, J Craig
1040 S Gaylord St # 103
Denver 80209
(303)777-6202
Bassett DDS, John
8181 E Tufts Ave # 550
Denver 80237
(720)488-9090
Batliner DDS, Donald
390 University Blvd
Denver 80206
(303) 333-6016
Batliner DDS, Terrence
390 University Blvd
Denver 80206
(303) 333-6016
Beer DDS, Paul
50 South Steele # 395
Denver 80209
(303) 322-7270
" Berry DDS, Kary
3525 S Tamarac Or # 330
Denver 80237
(303) 759-5652
Berry DDS, Kevin
3525 S Tamarac Dr # 330
Denver 80237
(303) 759-5652
Berry DDS, Thomas
4200 E 91h Ave
Denver 80262
(303) 315A966
Sevens DDS. Gregory
6740 E Hampden Ave # 300 A
Denver 80224
(303) 758-5747
Birkel DDS, Richard
121 S Madison St # E
Denver 80209
(303) 355-1645
Birell DDS, Malcolm
5590 E Yale Ave #104
Denver 80222
(303) 7593305
Bissell DDS. William
1660 S Albion St # 607
Denver B0222
(303)757-6139
Bloom DDS, Gene
4301 E Amherst Ave # 100
Denver 80222
(303)758-5058
Bonbright DDS, Thomas
7201 E 8th Ave
Denver 80220
(303)333-5148
Boone li DDS, Malcolm
1727 Gilpin St
Denver 80218
(303)388-1661
Boxwell DDS, Court
55 Madison St # 320
Denver 80206
(303)355-3080
Bramwell DDS, Donald
3865 Cherry Creek N Or #312
Denver 80209
(303)321-2566
` Bravo DMD, Luis
2465 S Downing St If 208
Denver 80210
(303)733-0138
Brewick DDS, Terry
700 E 9th Ave #102
Denver 00203
(303)832-7300
Brichacek DDS, Michelle
4200 E 9th Ave
Denver B0262
(303)315-4966
Brockman Jr DDS, John
3773 Cherry Creek Or N # 120
Denver 80209
(303) 355-8670
` Brown DDS, Richard
8585 N Huron
Denver 80260
(303) 4284314
Brown DDS, Ronald
6000 E Evans Ave Bldg 2 # 231
Denver B0222
(303) 753-9916
Burger DMD, Brandon
700 E Speer Blvd
Denver 80203
(303)733-1010
Cahn DOS MS, Ellis
4101 E Wesley Ave # 8
Denver 80222
(303) 759-8684
` Calderon-kidd DMD, Joesolyn
3488 S Willow St
Denver 80231
(303)338-8181
' Causal DMD, Gary
1000 S Broadway
Denver 80250
(303)744-5000
Cardoso DDS, Luiz
700 E 91h Ave # 102
Denver 80203
(303) 832-7300
Carlson DMD, Kendal
3865 Cherry Creek Or N # 230
Denver 80209
(303)355-2373
" Coast DDS, Colleen
850 E Harvard Ave # 375
Denver 80210
(303) 765-2824
' Casement DDS, Russell
1355 S Colorado Blvd # C320
Denver 80222
(303) 75B-0866
` Charnond DMD, Warin
1400 Grove St
Denver 80204
(303) 825-2295
` Chavez DDS. Manuel
4200 W Cousins PI#324
Denver 80204
(303) 6854644
Chen DDS, William S
3865 Cherry Creek N Or #240
Denver 80209
(303) 355-4840
Char DDS, Sheldon
695 S Colorado Blvd # 300
Denver 80246
(303) 722-3900
Clement DDS, Charles
4380 S Syracuse St # 502
Denver 80237
(303) 694-0585
Collett DDS, Miles
7550 W Yale # A 201
Denver 80227
(303) 969-0636
Collins DOS, Claire
4200 E 9th Ave
Denver 80262
(303) 315-4966
Collins DDS, Lawrence
2121 S Downing St
Denver 80210
(303) 722-7482
Connor DMD, Donald
6460 E Colfax Ave
Denver 80220
(303)388-1155
Connors DDS, Charles
2210 S Federal Blvd
Denver 80219
(303) 935-3574
Couchman DMD MS, Robert
850 E Harvard Ave # 485
Denver 80210
(303) 757-2080
Coveyduck DDS, Graham
6825 E Hampden Ave # 202
Denver 80224
(303) 759-9487
Craiger DDS, John
7090 E Hampden Ave
Denver 80224
(303) 758-5252
Crichlow DDS, Kenneth
6795 E Tennessee Ave # 350
Denver 80224
(303)322-9501
Croghan DDS, Thomas
4624 E 23rd Ave
Denver 80207
(303)377-8662
Dahm DDS, Quentin
850 E Harvard Ave If 445
Denver 80210
(303)722-9504
Daniels DDS, Walter
1633 Fillmore St #112
Denver 80206
(303) 388-0989
Delauro DDS, Leo
2210 S Federal Blvd
Denver 80219
(303)935-3574
Devilliers DDS, Patricia
2480 W 26th Ave # 320 B
Denver 80211
(303)4774075
Dewitt DDS, Michael
155 Cook St # 421
Denver 80206
(303) 321-5656
Dinsmore DDS. David
201 University Blvd # 101
Denver 80206
(303) 321-2233
Doi DDS, Bradley
1800 Vine St
Denver 80206
(303) 377-2345
Colds DDS, S
1800 Vine St
Denver 80206
(303)377-2345
Dmckman DDS, Roger
90 Madison St # 506
Denver 80206
(303) 691-2860
Dunker DDS, Inna
2121 S Oneida St It 321
Denver 80224
(303) 796-8767
Dunn DOS, Michael
1315 Kramena St
Denver 80220
(303) 3223272
Egert DDS, Terry
3955 E Exposition Ave # 218
Denver 80209
(303)744-3636
Farmer DDS, Dale
1601 S Federal Blvd # 201
Denver 80219
(303) 934-0232
" Feldges DDS, Jennifer
4521 E Virginia Ave
Denver B0246
(303) 388-5501
Ferdani DDS, Elio
2200 S Federal Blvd # 2
Denver 80219
(303) 934-4042
Ferrell DDS, Bonnie
125 Rampart Way # 240
Denver 80230
(303) 341-2500
Foley DDS, Michael
1633 Fillmore St # 200
Denver 80206
(303)452-4142
Foley DDS, Patrick
1516 Locust St
Denver 80220
(303)377-5646
Frank DDS, Mark
3955 E Exposition Ave it 412
Denver 80209
(303)722-2686
" Frey DDS, Ron
7060 E Hampden Ave # 101
Denver 80224
(303) 758-2066
" Friedman DDS, Stephen
155 Cook St If 441
Denver 80206
(303) 321-0055
Frisch DDS, Michael
496 S Dayton St
Denver 80231
(303) 341-5703
Fuller DDS, D Diane
7060 E Hampden Ave # 201
Denver 80224
(303) 7584900
Gabler DDS, Lawrence
4101 E Wesley Ave # 9
Denver 80222
(303) 758-3935
Gadziala DDS, Thomas
2223 S Monaco Pkwy # F
Denver 80222
(303) 6393279
Gander DDS, Debm
4200 E 91h Ave
Denver 80262
(303)315-4966
Gatseas li DDS, George
4200 E 91h Ave
Denver 80262
(303) 3154966
Gillespie DDS, Wayne
1905 Lawrence St # D
Denver 80202
(303)2964080
Glenn DDS, Dewayne
3600 S Beeler St # 120
Denver 80237
(303) 779-2592
" Glenn DDS, Falona
5901 E Colfax Ave #200
Denver 80220
(303) 393-72"
" Glenn DDS, Gerald
5901 E Colfax Ave #200
Denver 80220
(303) 393-7244
Page g
'means DPO Dentist at the time of publication 01/24103
Denver - General
Golinvaux DDS, Michael
1400 Glenann PI # 200
Denver 80202
(303) 534-2626
Gottlieb DDS, Stanley
3838 W 38th Ave
Denver 80211
(303)433-1515
Greene DOS, Jerome
303 Josephine # 202
Denver 80206
(303) 322-8600
Greenstein DMD, Per!
965 S Colorado Blvd # 104
Denver 80246
(303)733-7399
Grossman DDS, Gregory
910 16th Street # 711
Denver 80202
(303)825-5527
Gurm m DDS, Alan
8585 N Humn St
Denver 80260
(303) 4286367
` Hakala DDS, Catherine
121 S Madison St # B
Denver 80209
(303) 321-8967
Hakala DDS, Joseph
121 S Madison St # B
Denver 80209
(303) 321-8967
Hamidi DMD, Eric
4380 S Syracuse St # 504
Denver 80237
(303)741-1011
Harris DDS, Heather
201 University Blvd # 203
Denver 80206
(303) 393-0039
Hartman DDS, David
5050 Cherry Creek So Or
Denver 80246
(303) 758-5811
Harvan DDS, J Christophe
4200 E 9th Ave
Denver 80262
(303) 3154966
Haws DDS, L Travis
3525 S Tamarac Or 0330
Denver 80237
(303) 796-8919
Hayes DDS, Jerry
3361 Holly St
Denver 80207
(303) 320-1 971
Heiken DDS, Jason
10200 E Girard Ave Bid C # 249
Denver 80231
(303)745-1430
` Hekkert DOS, Ertk
1955 Arapahoe St # A
Denver 80202
(303)296-0888
Herring DDS, D Todd
3525 S Tamarac Or #330
Denver 80237
(303)796-8919
Hoag DMD, David
2465 S Downing St # 208
Denver 80210
(303) 733-0138
` Hoch DDS, Donald
303 Josephine St # 202
Denver 80206
(303) 777-4421
Hohod DDS, Chandra
3955 E Exposition # 218
Denver 80209
(303) 744-3636
Hudson DDS, Dale
3525 S Tamarac Or # 320
Denver 80237
(303)773-2695
Huskey DDS, David
2465 S Downing St # 104 A
Denver 80210
(303) 722-0204
Denver -Genik J
Hutchinson DDS, Larry
5021 Happy Canyon Rd
Denver 80237
(303) 757-1525
Ito DDS, Richard
1905 Lawrence St # A
Denver 80202
(303) 296-1825
Johnson DDS, Dennis
2780 S Wadsworth Blvd
Denver 80227
(303) 989-0416
Johnson Jr DDS, Collis
1756 Vine St
Denver 80206
(303)322-1177
Jolstad DDS, Mark
201 University Blvd # 101
Denver 80206
(303) 321-2233
Kass DDS, Jeffrey
7200 E Hampden Ave # 303
Denver 80224
(303) 504-4000
Kajiwara DDS, Henry
1633 Fillmore St # 212
Denver 80206
(303) 355-0743
Kampfe DDS, Tom
5150 E Yale Cir # 405
Denver 80222
(303) 756-6931
Kong DDS, Ruth
496 S Dayton St
Denver 80231
(303)360-5660
Kawano DDS, Richard
1751 Williams St
Denver B0218
(303)388-5645
Kilroy DDS, Thomas
5400 W Jewell Ave # 2 B
Denver 80232
(303)985-7450
Kirchner DDS, Thomas
820 Clermont St #110
Denver 80220
(303)399-7106
Klekamp DDS, David
6000 E Evans Ave #1-130
Denver 80222
(303) 759-2807
Klodnicki DDS, Walter
6825 E Tennessee Ave # 515
Denver 80224
(303)522-8004
Koch DDS, Richard
10101 E Hampden Ave #100
Denver 80231
(303) 671-0101
Kowalchuk DDS, Gregory
7515 W Yale Ave # A
Denver 80227
(303)988-3319
Kreider DDS, Beth
700 Broadway If 1133
Denver 80203
(303) 863-1177
Kurtz DDS, Susan
300 S Jackson St If 510
Denver 80209
(303) 388-5222
Lafonte DDS, Bret
7150 E Hampden Ave # 201
Denver 80224
(303)759-3336
Lage DDS, Gregg
7475 Dakin St # 335
Denver 80221
(303) 4274552
Langenfeld DDS, Brian
102M E Girard Ave # A207
Denver 80231
(303)695-0611
Langley DDS, Donald
5031 S Ulster St # 100
Denver 80237
(303)779-8587
Denver -General
` Lauffenburger DMD, Jerome
2560 Sheridan Blvd # 1
Denver 80214
(303)477-7700
Law DDS, Steven
1400 Glenarm PI # 200
Denver 80202
(303) 534-2626
Lee DDS, Christina
5031 S Ulster St # 100
Denver 80237
(303) 779-8587
Legg DDS, Paul
1560 Broadway # 1 D60
Denver 80202
(303) 832-9090
Levin DDS, Alen
6825 E Tennessee Ave If 621
Denver 80224
(303) 333-2221
Levin DMD, Brett
6825 E Tennessee Ave # 621
Denver 80224
(303)333-2221
Light DDS, Todd
201 University Blvd # 101
Denver 80206
(303) 321-2233
Link DDS, Michael
3838 W 38th Ave
Denver 80211
(303)455-3838
Linkow DDS, Ronald
6825 E Tennessee Ave # 641
Denver 80224
(303)388-3651
Lips DDS, Cad
6825 E Hampden # 201
Denver 80224
(303)744-0600
Long DDS, Kyle
3955 E Exposition Ave # 110
Denver 80209
(303)722-1690
Lowers DDS, Robert
1860 Lorimer St # 375
Denver 80202
(303) 296-2059
Lowery DDS, Teresa
4101 E Wesley Ave # 1
Denver 80224
(303) 753-0922
Lyons DDS, Juliann
4101 E Wesley Ave # 1
Denver 80222
(303) 7566862
Madden DDS, William
4101 E Wesley Ave # 4
Denver 80222
(303) 758-3230
Madlang DDS, Cesar
4380 S Syracuse #502
Denver 80237
(303) 779-0622
Makowski DDS, James
1220 S Parker Rd # 104
Denver 80231
(303) 751-5558
` Monied. DDS, James
2601 E 3rd Ave
Denver 80206
(303)399-1650
` Maniatis DDS, Peter
2601 E 3rd Ave
Denver 80206
(303)399-1650
Manus DDS, Erik
655 Broadway St If 100
Denver 80203
(303)592-7472
` Manshadi DDS, Davood
1400 Grove St
Denver 802N
(303) 825-2295
Marschner DDS, Thomas
4901 W 38th Ave
Denver 80212
(303)455-2273
Den; _ ,eneral
Marsico DOS, Gerald
1501 $ Gaylord St
Denver 80210
(303) 722-1115
Martin DDS, Douglas
303 Josephine St # 202
Denver 80206
(303)322-8600
Martinez DDS, Efren
1940 S Broadway
Denver 80210
(303)733-7533
` Maul DDS, Robed
2005 Franklin St # 590 Bldg 2
Denver 80205
(303)592-1133
Mcauliffe DDS, Kevin
5150 E Yale Cir # 406
Denver B0222
(303)758-3284
` Mcintosh DDS, Korean
121 S Madison St # 8
Denver 80209
(303) 321-8967
` Mcveigh DDS, Adam
2210 S Federal Blvd # 2
Denver 80219
(303) 935-3574
Mentzer DDS, Richard
4624 E 23M Ave
Denver 80207
(303) 377-8662
Mayer DDS, Gene
910 16th St # 700
Denver 80202
(303) 534-7797
` Miller DDS, Eric
4200 E 91h Ave
Denver 80262
(303)315-6323
` Morgan DDS, Dennis
1660 S Albion St# 727
Denver 80222
(303) 782-5188
Moses DDS, James
6000 E Evans Ave Bldg 3 # 200
Denver 80222
(303)7566411
Mullane DDS, John
1660 S Albion St # 625
Denver 80222
(303)782-0490
Murdoch DDS, Richard
1315 Kramerla St
Denver 80220
(303)355-6340
Murry DDS, Stephen
303 Josephine St # 202
Denver 80206
(303)322-8600
` Nassimbene DDS, Bradley
303 Josephine # 202
Denver 80209
(303)322-8600
Nassimbene DDS, R Don
303 Josephine St # 202
Denver 80206
(303) 322-8600
` Nassimbene DDS, Raymond
1000 S Broadway
Denver 80250
(303)744-5000
Nelson DDS, William
4101 E Wesley Ave # 10
Denver 80222
(303) 7575473
Newman DDS, Steve
360 S Monroe St # 340
Denver 80209
(303) 388-2886
` Nguyen DDS, Lan T Phuong
805 S Federal Blvd
Denver 80219
(303)935-2353
Nishimura DDS, Roger
155 Cook St # 341
Denver 80220
(303)399-0400
Denver -General
Nordstrom DDS, W Bruce
2100 S Lincoln St
Denver 80210
(303)733-1900
Norris DDS, Garth
1000 S Broadway
Denver 80250
(303) 744-5000
Noyes DDS, Jennifer
4590 Lowell Blvd
Denver 80211
(303) 455-8962
Obana DDS, Caoneliza
7150 Leetsdale Or # 110a
Denver 80224
(303) 321-1700
` Ofallon DMD, M Timothy
4441 W 29Ih Ave
Denver 80212
(303)477-7776
` Osuga DDS, Stephen
1633 Fillmore St # 212
Denver 80206
(303) 355-0743
Ouellette DDS, Thomas
1905 Lawrence St # C
Denver 80202
(303)296-1402
Owens DDS, Justin
496 S Dayton St
Denver 80231
(303)341-5703
Pain! DOS, William
2005 Franklin St # 300
Denver 80205
(303) 246-0100
Pare DDS, Henri
1660 S Albion St #611
Denver 80222
(303)782-0633
Parkinson DDS, Cynthia
55 Madison St # 320
Denver 80206
(303)355-3080
Pascoe DMD, Gary
1400 Grove St
Denver 80204
(303) 825-2295
Passon DDS MS, J Craig
4200 E gth Ave
Denver 80262
(303)315-4966
Patnlla DDS, Stanley
910 161h St #621
Denver 80202
(303) 623-7463
Pearce DDS, David
6460 E Colfax Ave
Denver 80220
(303)388-1155
Perk DDS, Stuart
2005 Franklin St # 255
Denver 80205
(303)832-8586
Petersen DDS, R Kelly
2223 S Monaco Pkwy # F
Denver 80222
(303) 639-3279
Peterson DDS, Ronald
7090 E Hampden Ave
Denver 80224
(303)758-9414
Peterson DDS, Scott
7090 E Hampden Ave
Denver 90224
(303) 758-9414
` Pfalzgraf DDS, John
4800 Happy Canyon Rd
Denver 80237
(303) 757-a446
` Pham DDS, Thien Chi
1400 Grove St
Denver 80204
(303)825-2295
Pizer DDS, Scott
2250 S Oneida St # 300
Denver 80224
(303) 753-1868
Page 9 'means DPO Dentist at the time of publication 01/24/03
Denver - General
Denver - General
Denver - General
Denver -Ge
Pyre DOS, Thomas
12075 E 45th Ave # 333
Denver 80239
(303) 371-9131
9uandl DDS MS, John
55 Cook St # 201
Denver 80206
(303)320-0734
Raabe DDS, John
155 Cook St # 351
Denver 80206
(303) 320-0160
Raabe DDS, Max
155 Cook St # 351
Denver 80206
(303) 320-0160
Radz DDS, Gary
999 181h St # 235
Denver 80202
(303) 298-1414
` Raiser DDS, Mark
2020 S Parker Rd # F
Denver 80231
(303) 752-2777
' Raizen DOS, Michael
1717 York St
Denver 80206
(303) 394-0231
Randolph DDS, David
3955 E Exposition Ave #505
Denver 80209
(303)777-9090
Redford li DMD, David
910 16lh St # 700
Denver 80202
(303) 534-7797
' Read DDS, Thomas
1000 S Broadway
Denver 80250
(303) 744-5000
Reiakvam DDS, Per
3540 S Poplar St #300
Denver 80237
(303)759-3969
<ein DDS, Gary
155 Cook St # 351
Denver B0206
(303) 321-4805
` Revoir DDS, Jeffrey
3540 S Poplar St # 301
Denver 80237
(303) 758-2980
Rice DDS, Donald
2216 Kearney St
Denver 80207
(303)399-4444
` Robbins DDS, Arthur
155 Cook St # 141
Denver 80206
(303)329-0505
Robbins DDS, Kristin
400 S Colorado Blvd # 720
Denver 80222
(303) 388-2400
Robertson DDS, Stephen
3401 S Oneida Wy
Denver 80224
(303) 756-2914
Rolfes DOS, Robert
3865 Cherry Creek Or N # 200
Denver 80209
(303) 321-1181
Follow DDS, John
3488 S Willow St
Denver 80231
(303)338-8181
` Rose DDS, Anthony
2103 W 32nd Ave
Denver 80211
(303)4774467
Rosseao DDS, Dawn
1400 Gleason PI # 200
saver 80202
103) 534-2626
` Remain DDS, Pamela
155 Cook St If 221
Denver 80206
(303)377-0699
Runnings DDS, Steven
4590 Lowell Blvd
Denver 80211
(303)455-8962
Russell DDS, Sharon
155 Cook St # 441
Denver 80206
(303)320-1640
` Ruvins DDS, Edward
9450 E Mississippi Ave # A
Denver 80231
(303) 755-4000
Saddler DDS, Aurora Roman
3488 S Willow St
Denver 80231
(303)338-8181
` Saddler DDS, Gary
4901 W 381h Ave
Denver 80212
(303)455-2273
Sadler DMD, Norris
3025 W 381h Ave
Denver 80211
(303)458-7051
` Sakamaki DDS, Cad
1717 York St
Denver 80206
(303) 394-0231
Sarnia DDS, Frank
695 S Colorado Blvd #210
Denver 80246
(303) 744-3939
Sanchez DDS, Fortune Ben
1601 S Federal Blvd # 201
Denver 80219
(303) 934-0232
` Sanderson DDS, Stuart
5220 W Evans Ave
Denver 80227
(303) 989-1970
` Sandoval DDS, Gilbert
4525 E Colfax Ave
Denver 80220
(303) 331-1699
` Scheich DDS, Jeffrey
7515 W Yale Ave # A
Denver 80227
(303)988-3319
` Schwab DMD, Michael
4800 Happy Canyon Rd
Denver 80237
(303)757-8446
` Schwartz DDS, Marc
965 S Colorado Blvd #101
Denver 80246
(303)698-0476
Schwartz DDS, Timothy
2030 S Federal Blvd
Denver 80219
(303) 936-8204
` Schwerdt DDS. Janne
240 St Paul St #206
Denver 80206
(303)333-1844
Seiler DDS, Canny
100 Acorns St
Denver 80223
(303) 778-6703 -
Seiner DDS, Daniel
8181 E Tufts Ave # 550
Denver 80237
(720) 488-9090
Sennett DDS, Michael
4380 S Syracuse St # 504
Denver 80237
(303)741-1011
Shayevsky DDS, Michael
7561 E Harvard Ave 11302
Denver 80231
(303)751-7282
` Sidon DDS, Myron
4521 E Virginia Ave
Denver 80246
(303) 388-5501
` Siegrist DMD, G Bryan
965 S Colorado Blvd # 201
Denver 80246
(303)871-9179
Smedley DDS, John
5055 E Kentucky Ave
Denver 80246
(303) 7584367
' Smegowski DDS, Thomas
7475 Dakin St # 309
Denver 80221
(303) 429-2727
Spanjer DDS, W Scott
720 S Colorado Blvd # 444 S
Denver 80246
(303) 759-0731
Spencer DDS. Daniel
1501 S Gaylord St
Denver 80210
(303) 722-1115
Sperling DDS, Morton
240 St Paul St # 200
Denver 80206
(303) 399-7166
Stambaugh DDS, James
965 S Colorado Blvd #202
Denver 80222
(303) 744-1281
Steeghs DDS, Brigitte
5800 E Evans Ave # 202
Denver 80222
(303)756-0723
Shanahan DDS, Patrick
1540 S Holly # 2
Denver 80222
(303)757-5885
Sunshine DDS, Irwin
4301 E Amherst Ave
Denver 80222
(303) 758-5858
Swain DDS, Thomas
390 University Blvd
Denver 80206
(303) 333-0771
Swanson DDS, Peggy
1860 Larimer St # 240
Denver 80227
(303)292-3366
Tappan DDS, Major
1717 York St
Denver 80206
(303) 394-0231
Topelson DMD, Ian
1860 Lorimer St If 205
Denver 80202
(303)296-8525
` Tran DDS, Hung Mang
1013 S Federal Blvd
Denver 80219
(303)935-0496
` Tran DDS, To
1400 Grove St
Denver 80204
(303)825-2295
Trembley DDS, Robert
4200 E 9th Ave
Denver 80262
(303) 315-4966
Trembley DDS, Robert
4200 E 91h Ave
Denver 80262
(303) 315-6323
Tsumura DDS, Kurt
1800 Vine St
Denver 80206
(303) 377-2345
Utberg DMD, Robert
2005 Franklin St If 300
Denver 80205
(303) 839-5109
Uy DDS, Mary Joyce
3525 S Tamarac # 170
Denver 80237
(303) 773-1211
' Valuck DDS, Paul
6825 E Tennessee Ave # 515
Denver 80209
(303) 331-1650
Vanzylveld DDS, Eric
1905 Lawrence St # B
Denver 80202
(303)296-3851
Venuto DDS, Nick
1633 Fillmore St # 200
Denver 80206
(303)452-4142
Vigil DDS, Gilbert
1777 W 381h Ave # 102
Denver 80211
(303)458-3838
` Vilner DDS, Leon
2121 S Oneida St # 321
Denver 80224
(303) 796-8767
` Wachuta DDS, Timothy
2709 S Colorado Blvd
Denver 80222
(303) 756-2770
Wallace DDS, Gerald
8181 E Tufts Ave # 550
Denver 80237
(720)488-9090
Weimar DDS, William
100 Acoma St
Denver 80223
(303)778-6703
Welch DDS, Chad
2660 S Monaca Pkwy
Denver 80222
(303) 757-7175
Werner DDS, Sarah
5055 E Kentucky Ave
Denver 80246
(303)377-7744
' Whalley DDS, Daniel
3865 Cherry Creek N Or # 300
Denver 80209
(303)388-5599
White DDS, Kelly
1050 W Colfax If G
Denver 80204
(303) 573-5533
' Wilk DDS, Steven
3540 S Poplar St # 301
Denver 80237
(303)758-2980
Wilson DDS, Daniel
4200 E 9th Ave
Denver 80262
(303) 315 1966
Winter DDS, Dennis
91016th St # 700
Denver 80202
(303) 534-7797
Wolff DDS, Tracy
4380 S Syracuse St If 504
Denver 80237
(303) 773-8666
Youssef DDS, Hesham
2480 W 26th Ave # 320 B
Denver 80211
(303) 477-4075
Zelkind DMD, Glen
4545 E 9th Ave # 130
Denver 80220
(303) 3774823
` Zervas DOS, Steven
3865 Cherry Creek Or N # 200
Denver 80209
(303) 321-1181
Zone DDS, Robert
1000 S Broadway
Denver 80250
(303) 744-5000
Denver - Oral
Surgery/Extractions
` Armstrong DDS, William
965 S Colorado Blvd # 205
Denver 80246
(303)744-1369
Bottenbley DMD, Cecil
1776 Lincoln St If 820
Denver 80203
(303) 839-5639
Carver DDS, Douglas
6850 E Hampden Ave # 202
Denver 80224
(303) 758-6850
Denver - Oral
Surgery/Extractions
Clark DDS, Morris
1860 Larimer St # 245
Denver 80202
(303) 296-9653
' Cosby MD, Michael
180 Adams St If 100
Denver 80206
(303) 321-0333
Garel DDS, Howard
2223 S Monaco Pkwy # F
Denver 80222
(303) 639-3279
James DDS, Randal
180 Adams St # 100
Denver 80206
(303) 321-0333
' Magid DMD, Mitchell
965 S Colorado Blvd If 205
Denver 80246
(303)744-1369
Utz DDS, Richard
965 S Colorado Blvd # 205
Denver 80246
(303)744-1369
Nelson DDS, Richard
6850 E Hampden Ave # 202
Denver 80224
(303) 758-6850
Nelson DDS MS, Steven
6850 E Hampden Ave # 202
Denver 80224
(303) 758-6850
Patterson DDS, Kevin
180 Adams St # 100
Denver 80206
(303) 321-0333
Renehan DDS MD, Bradley
6850 E Hampden Ave If 202
Denver 80224
(303) 758-6850
Reliant DDS, Michael
6850 E Hampden Ave If 202
Denver 80224
(303)758-6850
Savage DDS, Michael
4200 E 9th Ave
Denver 80262
(303) 3154966
Sedhom DMD, Ashraf
965 S Colorado Blvd # 205
Denver 80246
(303) 7441369
Sipamky DMD, Martin
155 Cook St If 241
Denver 80206
(303) 321-3720
Tomasetli DMD, Boyd
6850E Hamptlen Ave # 202
Denver 80224
(303) 758-6850
' Waggoner DMD, Clyde
3955 E Exposition Ave # 520
Denver 80209
(303) 777-1603
Denver - Endodontist/Root
Canals
Averbach DDS, Robert
155 Cook St # 301
Denver 80206
(303)321-7930
Benson DOS, Scott
910161h St # 710
Denver 80202
(303) 914-9727
Carr Jr DDS, Joseph
155 Cook St # 301
Denver 80206
(303) 321-7930
Chavez DDS, Robert
155 Cook St # 301
Denver 80206
(303) 321-7930
Fager DDS MS, Frank
3545 S Tamarac Or # 220
Denver 80237
(303)770-8141
Page 10 -means DPO Dentist at the time of publication 0124103
QUESTIONNAIRE
Group Dental Administrative Services Only (Cont.)
18. Do you provide a toll -free number for employees to call with questions on claims, plan
provisions or requests for dentist referrals?
Delta's toll free number is 1-800-610-0201. Employees can visit our website at
www.deltadentalco.com. Besides general information about Delta Dental Plan of
Colorado, this site includes pages for the Providers, Subscribers, Employers and
Brokers.
The Subscriber section includes a Provider Locator, which allows customers to
search for a dentist in his or her area, and a FAQ section, in which customers can
get answers to frequently asked questions or email in their own questions. The
Delta dentists are updated twice a month.
19. Do you provide a care line that employees can call with questions about proper levels of
care?
Deltas' customer relations representatives receive calls from 8:00 a.m. to 4:30 p.m.
MT, Monday through Friday at 303-741-9305 and 1-800-610-0201. They can assist
enrollees with any inquiries regarding dental services, eligibility, status of claim,
explanation of claim payment, etc.
20. Will you perform pre-treatment estimates? If yes, what is your average turnaround time?
Yes, some of the procedures that should be pre -authorized are Orthodontics, Oral
Surgery, and Periodontics. It is advised to obtain pre -authorization for treatment
plans in excess of $400.00. Although benefits are not denied due to a pre-
determination not being done, benefits may be impacted if it is not possible to
determine treatment options which would have been available prior to treatment
being completed. In that case, Delta would provide benefits based on the
procedures which in normal circumstances would provide the least expensive
acceptable result. A standard Attending Dentist Statement (ADS), or claim form is
prepared by the dentist and submitted to Delta. After Delta has processed the ADS,
verified the patient's eligibility and the group's benefits, a pre -determined ADS will
be returned to the dental office. Under most circumstances, pre -authorization
constitutes a guarantee of payment for exact services provided within 60 days of the
signed authorization date.
City of Fort Collins, RFP 2003 Q
Denver - Endodonllst/lImt
Canals
Hansell DDS, John
8585 N Huron St
Denver 80260
(303) 427-2769
Henske DDS MS, David
300 S Jackson St # 135
Denver 80209
(303)377-3548
Jando DDS, Eric
1660 S Albion # 7135
Denver 80222
(303) 757-5008
Jullak DDS, Jed
155 Cook St # 301
Denver 80206
(303) 321-7930
Levine DMD, Mark
10200 E Girard Ave # A-205
Denver 80231
(303)695.4838
Mendoza DDS, Mario
91016th St # 710
Denver 80202
(303)914-9727
Reader DDS, Chad
910 16th St # 710
Denver 80202
(303)914-9727
Rosenfeld DMD MS, Edward
3545 S Tamarac # 220
Denver 80237
(303)770-8141
Ryan DDS, James
1355 S Colorado Blvd #318
Denver 80222
(303) M-0753
Sachs DDS, Ellen
155 Cook St # 301
Denver 80206
(303)321-7930
Safer DDS, Donald
155 Cook St It 301
Denver B0206
(303)321-7930
Teitelbaum DDS, Robert
2560 N Sheridan Blvd # 3
Denver 80214
(303)458-0444
Trager DMD, Michael
155 Cook St # 301
Denver 80206
(303)321-7930
Denver - OrthodonUsl
Bellon DDS MS, Michael
7200 E Hampden Ave # 203
Denver 80224
(303)692-9610
Benson DDS MS, Gary
3200 Cherry Creek S Or # 420
Denver 80209
(303)722-1202
Carpenter DDS, Christopher
6850 E Hampden Ave # 203
Denver 80224
(303) 758-3414
Graham DDS, Mervin
7150 E Hampden Ave
Denver 80224
(303) 758-2366
Margolis DDS, Arthur
965 S Colorado Blvd # 102
Denver 80246
(303)744-1701
Michael DDS MS, Deborah
5055 E Kentucky Ave
Denver 80246
(303)757-0867
Miller DDS. Bill
2200 S Federal Blvd
Denver 80219
(303) 935-0815
Oersteds DDS MS, Larry
4200 E 9th Ave
Denver 80262
(303)316-4966
Denver - Orthc` ct
Perlov DDS MSD, Frank
240 St Paul St # 201
Denver 80206
(303) 320-0307
Reed DDS MS, Chaney
4301 E Amherst Ave # 1 DO
Denver 80222
(303) 758-5858
Rudman DDS MS, Robert
155 Cook St # 451
Denver 80206
(303) 331-0222
Sendroy DDS MSD, Peter
7150 E Hampden Ave # 202
Denver 80224
(303)757-3307
Shellhart DDS, W Craig
4200 E gth Ave
Denver 80262
(303)315-4966
Siersma DDS, G Fred
121 S Madison St # A
Denver 80209
(303)388-6489
Zinkann DDS MS, Karla
1601 S Federal Blvd
Denver 80219
(303)934-0232
Zinkann DDS MS, Karla
2121 S Downing St
Denver 80210
(303)733-8885
Denver- Pediatric Dentist
Adams DDS, Timothy
695 S Colorado Blvd # 250
Denver 80246
(303)733-7731
' Crump DDS, Thane
1056 E 19th Ave B 240
Denver 80218
(303) 861 -6788
' Dubin DDS, Louis
1501 S Gaylord St
Denver 80210
(303)722-1115
' Hayutin DDS, David
5055 E Kentucky Ave
Denver 80246
(303)757-8844
Hymer DDS, Barbara
1056 E 19th Ave B 240
Denver 80218
(303) 861-6788
Kluender DDS MS, Randy
4200 E gin Ave
Denver 80262
(303) 315-4966
Rubenstmnk DDS, John
6850 E Hampden Ave # 100
Denver 80224
(303) 7586057
Simons DDS, Nancy
4301 E Amherst Ave # 100
Denver 80222
(303) 758-5858
Smith DDS MS, Bradley
6850 E Hampden Ave # 1 DO
Denver 80224
(303)758-6057
Smith DDS MS, Scott
6850 E Hampden Ave # 100
Denver 80224
(303)758-6057
' Unrath DOS, Robert
4901 W 381h Ave
Denver 80212
(303)455-2273
Vean OMD, Allen
965 S Colorado Blvd # 105
Denver 80246
(303)722-2929
Wilson DOS, Anne
4200 E 9th Ave
Denver 80262
(303)3154966
' Wilson DMD, Stephen
1056 E 19th Ave B 240
Denver 80218
(303)861-6788
Denver -Pedotlongst
Bridgewater DDS, Martha
121 S Madison St # C
Denver 80209
(303) 320-3601
Buckstein DDS, Jan
1660 S Albion St # 718
Denver 80222
(303) 757-7759
Dale DDS, Eric
155 Cook St #211
Denver 80206
(303) 377-9102
Farthing DDS MSD, Gregory
7150 E Hampden Ave # 100
Denver 80224
(303)753-1717
Holmes DDS, David
4200 E 9M Ave
Denver 80262
(303)315.4966
Johnson DDS, Lonnie
4200 E 9th Ave
Denver 80262
(303)315-4966
Kantor DMD, Michael
1400 Glenarm PI # 200
Denver 80202
(303)534-2626
Knowles DDS, James
155 Cook St #211
Denver 80206
(303)377-9102
Kuhar DDS MS, Kenneth
3545 S Tamarac Or# 250
Denver 80237
(303)740-0080
Metcalfe DDS, Richard
1325 E 161h Ave
Denver 80218
(303)831-7811
Neugeboren DDS, Neil
10200 E Girard Ave # A409
Denver 80231
(303)695-0990
Pomeranz DDS, Alan
10200 E Girard Ave # A-2D9
Denver 80231
(303) 695-0990
Poulos DMD, Michael
700 Broadway #1135
Denver 80203
(303) 832-4867
Reissner DDS, Marc
10200 E Girard Ave # A-209
Denver 80231
(303)695-0990
Silberman DDS, David
700 Broadway #1135
Denver 80203
(303) 8324867
Somers DDS, Ann
700 Broadway #1135
Denver 80203
(303)832-4867
Stoller DMD, Norman
4301 E Amherst Ave # 100
Denver 80222
(303)758-5858
Weaver DDS, Adam
3545 S Tamarac Dr # 250
Denver 80237
(303) 740-0OBO
Wright Jr DDS, Raymond
7515 W Vale Ave # A
Denver 80227
(303) 988-3319
Denver - Prosthodontlst
Astrolh DDS, Jeffrey
4200 E glh Ave
Denver 80262
(303) 315-4966
Dresen DDS, William
8585 N Huron St # 4
Denver 80260
(303)428-0200
Gallegos DDS MSD, Louisa
90 Madison St 0208
Denver 80206
(303)316-4034
Denvj sthodondst
Hauschildt DDS, Theodore
1721 E 19th Ave # 270
Denver 80218
(303) 8614311
Lang DDS, Lisa
4200 E 9th Ave
Denver 80262
(303)3154966
Ray DMD MS, Daniel
1325 E 16th Ave
Denver 80218
(303)861-8072
Tavel DMD, Arnold
155 Cook St #231
Denver 80206
(303) 320-6272
Denver- Pathologist
Mcdmell DDS MS, John
4200 E 91h Ave
Denver 80262
(303) 315-4966
Dillon - General
Miller DDS, Murray Miles
119 Main St
Dillon 80435
(970) 468-2471
Morgan DDS, Vernon
119 Main St
Dillon 80435
(970)468-5297
Peterson DDS, Jerry
119 Main St
Dillon 80435
(970)468-2471
Durango - General
Valley Wide Health Services
3801 N Main Ave
Durango 81301
(970)385-5930
Caldwell DDS, Ronald
2301 W 2nd Ave # A
Durango 81301
(970)247-4743
Christopherson DDS, Brian
2323 W 2nd Ave # E
Durango 81301
(970) 247-26Tr
Eich DMD, James
3235 A N Main Ave
Durango 81301
(970) 259-3112
Fisher DDS, William
2323 W 2nd Ave # C
Durango 81301
(970) 259-2264
Grams DDS MS, Thomas
801 Florida Rd # 2
Durango 81301
(970) 259-0113
Haynes DDS, Kent
143 County Rd 260
Durango 81301
(970)247-9549
Hemicke DDS, Courtney
801 Florida Rd # 2
Durango 81301
(970) 259-0113
Hering DDS, John
2323 West 2nd Ave # B
Durango 81301
(970) 247-DO74
Jakubanis DDS, Terrence
22T7 W 2nd Ave
Durango 81301
(970)247-8228
Johnson DDS, Carl
1304 Main Ave
Durango 81301
(970) 247-0331
Klingener DMD, Elyse
3235a N Main Ave
Durango 81301
(970) 2593112
Lacey DMD, William
2323 W 2nd Ave # C
Durango 81301
(970)382-7780
Durango - General
Lunn DDS, George
1165 S Camino Del Rio 0 300
Durango 81303
(970) 382-8111
Mann DDS, J Gregory
/sue
2877 Main
Durango 81301
Durango
(970)259-1646164fi
Nelson DDS, Jeff
125 County Rd 250
Durango 81301
(970) 247-0682
Person DDS, Gail
1800 E 3rd Ave # 110
Durango 81301
(970)247-5565
Pettus DDS, John
800 S Camino Del Rio
Durango 81301
(970)259-2264
Ugai DDS, Mark
835 East Second Ave # 270
Durango 81301
(970) 247-4848
Volger DDS, Robert
2530 Colorado Ave Ste 1 A
Durango 81301
(970)247-0174
Durango - Oral
SurgerylExhactlons
Johnson DDS, Michael
3206 North Main #3
Durango 81301
(970)3a5-5432
Mulkey DDS MS, James
375 E Park Ave # 301
Durango 81301
(970) 247-0240
Durango - Orthodontist
Fletcher DDS MS, Michael
2323 A W 2nd Ave
Durango 81301
(970) 247-SB74
!i11
Johnson DDS MS, Vaughn
801 Florida Rd # 1
Durango 81301
(970) 247-3330
Pozo-AJon30 DOS, Manuel
1570 E 2nd Ave
Durango 81301
(970)247-3291
Durango - Prosthodontlst
Brown DDS, Gregory
801 Florida Rd # 2
Durango 81301
(970) 259-0113
Eagle - General
Adair DMD, Gregory
948 Chambers Ave
Eagle 81631
(970) 3286848
Gradolph DDS, Thomas
948 Chambers Ave
Eagle 81631
(970) 328-6848
Shainholtz DDS, Todd
112 W 6th St
Eagle 81631
(970) 3286347
Eaton - General
Kennedy DDS, James
360 Oak St #110
Eaton 00615
(970)4543341
Turner DDS, Celia
228 7th St
Eaton 80615
(970) 454-2326
Elizabeth - General
Krieger DDS, George
187 Hwy 86
Elizabeth 80107
(303) 6464678
Page 31 'means OPO Dentist at the time of publication OV24103
Elizabeth - General
Shibilski DDS, Kelly Ann
796 E Kiowe Ave # H-12
Elizabeth 80107
(303)646-3940
Unkel DDS, Stephen
F96 E Kiowa Ave # H-12
Elizabeth 80107
(303)646-3940
Englewood - General
Andow DDS, Kenneth
9025 E Mineral Cir # 101
Englewood 80112
1303) 799-1525
' Baker DDS, James
3601 5 Clarkson St # 220
Englewood 80110
(303) 781-3106
Bermel DMD, Thomas
9025 E Mineral Cir #101
Englewood 80112
(303) 799-8557
Berner DDS, Jeannette
2780 S Broadway
Englewood 80110
(303) 783-0100
Buist DDS, John
125 Inverness Dr E # 360
Englewood 80112
(720)875-1130
Christ DMD, Kevin
9025 E Mineral Cir # 200
Englewood 80112
(303) 792-9100
Christiansen DDS, Ban
9025 E Mineral Cir # 250
Englewood 80110
(303)790-9323
Cowen DDS, Neil
3535 S Lafayette # 108
Englewood 80110
(303) 761-8688
Crawford DDS, Jerry
7400 E Arapahoe Rd # 300
Englewood 80112
,303) 796-7400
Delapp DDS, H Candace
7500 E Arapahoe Rd # 202
Englewood 80112
(303) 694-9740
Delapp DDS, James
7500 E Arapahoe Rd # 202
Englewood 80112
(303)694-9740
Diode DDS, Michael
3555 S Clarkson St # 200
Englewood 80110
(303) 762-9575
Elliott DDS, Brian
7180 E Orchard Rd # 302
Englewood 80111
(720)488-6600
Evans DDS, Kevin
6900 E Belleview Ave # 203
Englewood 80111
(303)796-8668
Gates DDS, Pamela
3501 S Corona
Englewood 80110
(303) 781-6911
Goldfogel DDS, Michael
8200 E Belleview Ave # E 440
Englewood 80111
(303) 770-0801
Handelman DDS, Richard
7180 E Orchard Rd # 302
Englewood 80111
(720)488-6600
' Hanson DDS, Keith
3501 S Corona #5
Englewood 80110
(303) 761-3692
'iayes DDS, Paul Mark
3601 S Clarkson # 410
Englewood 80110
(303) 781-2811
Hoang DOS, Hang
8100 S Quebec # A 14
Englewood 80112
(720)489-9800
Englewood - General
Hopfensperger DDS, Stephen
7200 E Dry Creek Rd # A-102
Englewood 80112
(303) 771-5076
Jaques DDS, Ronald
5031 S Federal Blvd # 4
Englewood 80110
(303)795-3517
Kissinger DDS, Mary
8100 S Quebec St # B204
Englewood 80112
(303)779-2797
Kettke DDS, Steven
3601 S Clarkson St # 315
Englewood 80110
(303)762-8046
' Kuljis DDS, Lawrence
8200 E Belleview Ave # 465
Englewood 80111
(303)771-7326
Lee DDS, Charles
7180 E Orchard Rd # 304
Englewood 80111
(303) 741-9949
Love DDS, Michael
2780 S Broadway
Englewood 80110
(303) 783,0100
Miller DMD, Bryan
6979 S Holly Cir #230
Englewood 80112
(303) 779-1661
Mulvany DMD, Damien
3627 S Pennsylvania St
Englewood 80110
(303)781-0624
Myers Jr DDS, Sere
14100E Arapahoe Rd # 310
Englewood 80112
(303)699-5804
Neiman DDS, Ivan
8200 E Belleview Ave # 455
Englewood 80111
(303) 770-2900
Nessel DDS. Larry
2780 S Broadway
Englewood 80110
(303)783-0100
Nicolette DMD, John
3510 S Marion St
Englewood 80110
(303) 789-3455
Nicolosi DOS, Patricia
6900 E Belleview Ave # 203
Englewood 80111
(720)488-1388
Novelen DDS, Mark
3627 S Pennsylvania St
Englewood 80110
(303) 781-0624
Oneill DDS, Kevin
6990 S Holly Cir
Englewood 80112
(303)224-9400
Parker -smart DDS, Janis
7180 E Orchard Rd #304
Englewood 80111
(303)741-9949
Pohl DDS, Raymond
9592 E Maplewood Cir
Englewood 00111
(303) 796-0171
Prendergast DDS, Patrick
6979 S Holly Cir # 185
Englewood 80112
(303)771-0225
Rippe DDS, Christian
7180 E Orchard Rd Ste 301
Englewood 80111
1303) 779-9876
Rodrick DDS, David
6979 S Holly Cir # 235
Englewood 80112
(303) 793-0793
Schope DDS, Andrew
6990 S Holly Cir
Englewood 80112
(303)224-9400
Englewood - General
Schwan DDS, Steven
8200 E Belleview Ave # 410 E
Englewood 80111
(303) 770-0214
Sherman DDS, Lewis
5039 S Federal Blvd #8
Englewood 80110
(303)798-4377
Sievers DDS, Jahn
7901 E Belleview, Ave #260
Englewood 80111
(303)771-7907
Sims DDS, Alan
7180 E Orchard Rd # 309
Englewood 80111
(303) 290-8833
Spence DDS, Peter
3601 S Clarkson St # 315
Englewood 80110
(303) 762-6046
Spiegel DDS, Jeffery
2780 S Broadway
Englewood 80110
(303) 783-0100
Tilliss DDS, Larry
7200 E Dry Creek Rd # 201 A
Englewood 80112
(303)770-1267
Wagenaar DOS, Paul
7400 E Arapahoe Rd # 203
Englewood 80112
(303)770-5040
Weinstein DDS, Steven
7180 E Orchard Rd # 306
Englewood 80111
(303) 773-8012
Weisbard DDS, Lee
7901 E Belleview Ave # 280
Englewood 80111
(303)773-3373
West DDS, Walter
3597 S Pearl St # 101
Englewood 80110
(303)781-6722
Weyman DDS, Paul
3601 S Clarkson # 310
Englewood 80110
(303) 762-8048
Willis Sr DDS, Lawrence
3012 S Broadway
Englewood 80110
(303)789-1655
Wo#son DDS, Gary
14000 E Arapahoe Rd # C310
Englewood 80112
(303)632-3622
Yancey DDS, Marianne
8200 E Belleview Ave # 425 E
Englewood 80111
(303) 290-0962
Zimmer DDS, Donald
601 E Hampden Ave # 300
Englewood 80110
(303)788-6462
Englewood - Oral
SurgerylExtractions
Aragon DDS, Steven
125 Inverness Or E # 100
Englewood 80112
(303) 773-8228
Berman DDS MS, David
8200 E Belleview, Ave # 515e
Englewood 80111
(303)694-1700
Berman DDS, Mark
8200 E Belleview Ave # 515e
Englewood 80111
(303) 694-1700
Lessig DDS, James
9094 E Mineral # 260
Englewood 80112
(303)768-8570
Sexton DDS MS, James
125 Inverness Dr E # 100
Englewood 80112
(303)773-8228
Englewood I
SurgerylExtr$tgons
Sleh DDS, Dennis
7180 E Orchard Rd # 300
Englewood 80111
(303) 740-9772
Stone DDS, Thomas
3701 S Clarkson St #300
Englewood 80110
(303)806-8600
' Wennogle DDS, Charles
9025 E Mineral Cir # 103
Englewood 80112
(303) 649-1919
Yamamoto DDS, Steven
601 E Hampden # 250
Englewood 80110
(303) 788-6364
Englewood - EndociontistlRoot
Canals
Averbach DDS, Robert
8200 E Belleview, Ave # E450
Englewood 80111
(303)850-7474
Calhoun DDS, Gordon
6979 S Holly Cir # 260
Englewood 80112
(303) 721-7214
Carr Jr DDS, Joseph
8200 E Belleview Ave # E450
Englewood 80111
(303) 850-7474
' Chalian DDS MS, G Gam
9025 E Mineral Cir # 102
Englewood 80112
(303) 696-1919
Hoezman DMD, David
9025 E Mineral Cir # 102
Englewood 80112
(303) 696-1919
Jultak DDS, Jed
8200 E Belleview Ave # E450
Englewood 80111
(303)850-7474
' Parsons DDS, Joseph
9025 E Mineral Cir # 102
Englewood 80112
(303)696-1919
' Sachs DDS, Ellen
8200 E Belleview Ave # E450
Englewood 80111
(303) 850-7474
' Stein DDS, Adana
9025 E Mineral Cir # 102
Englewood 80112
(303) 696-1919
Tucker DDS, Janet
3601 S Clarkson # 230
Englewood 80110
(303) 789-2354
Englewood - Orthodontist
Barrett DDS, Edward
6901 S Yosemite #102
Englewood B0112
(720) 529-5777
Cassidy DMD, Mark
6979 S Holly Cir # 280
Englewood 80112
(303)779-1977
Duran DDS MS, Jack
3601 S Clarkson # 430
Englewood 80110
(303) 789-9257
' Gold DDS, David
9025 E Mineral Cir # 100
Englewood 80112
(303)792-0345
Intani DDS, Martz
8200 E Belleview # 420
Englewood 80111
(303) 773-6969
Englewood - Pediatric Dentist
Asher DDS MS, Randall
9025 E Mineral Cir # 100
Englewood 80112
(303) 792-9084
Englewood - Pediatric Dentist
Grant DDS, Nancy
6901 S Yosemite # 103
Englewood 80112
(303) 793-0899
Houston DDS MS, Kerrie
125 Inverness Or E # 300
Englewood 80112
(303)779-5306
Wartime DMD, Palma
8200 E Belleview Ave # 420
Englewood 80111
(303) 740-7088
Englewood - Pedodontist
Jankowski DDS, Mark
3601 S Clarkson # 330
Englewood 80110
(303)762-0621
Englewood - Prosthodon ist
Bedard DMD, Jean-francoi
3601 S Clarkson St # 400
Englewood 80110
(303) 789-2020
Erie - General
Macri DDS, Ann Made
77 Erie Village Sq # 200
Erie 80516
(303)828-5430
Macn DDS, Christopher
77 Erie Village Sq # 200
Erie 80516
(303) 828-5430
Estes Park- General
Alexander DDS, Robed
131 Stanley Ave # 201
Estes Park 80517
(970) 586-5657
Durward DDS, James
251 W Elkhorn Ave
Estes Park 80517
(970)586-2132
Ole Jr DDS, Eugene
1861 Marys lake Rd
Estes Park 80517
(970) 586-8180
Pike DDS, William
600 S St Vrain # 3-a
Estes Park 80517
(970)586-9434
Reek DDS, Daniel
343 S St Vrain
Estes Park 80517
(970) 586-9330
Evergreen - General
Bunch DDS, Robed
1202 Hwy 74 #208
Evergreen 80439
(303)670-0168
Deal DDS, Thomas
1202 Bergen Pkwy # 207
Evergreen 80439
(303) 674-6152
Fox DDS, Troy
3720 Evergreen Pkwy
Evergreen 80437
(303)674-3591
Kachidunan DDS, George
28000 Meadow Or # 107
Evergreen 80437
(303)674-5725
Larson DDS, Michael
30940 Stagecoach Blvd # E250
Evergreen 80439
(303) 674-6777
Pond DDS, Thomas
27972 Meadow Dr # 300
Evergreen 80439
(303)670-1539
Powell DDS, C Richard
28577 Buffalo Park Rd
Evergreen 80439
(303)674-7741
Sharp DDS, Donald
28000 Meadow Dr # 210
Evergreen 80439
(303)674-5566
Page 12 'means DPO Dentist at the time of publication OU24103
Evergreen - General
Sproul DDS, Jeffrey
28000 Meadow Or # 210
Evergreen 80439
(303)674-5566
Wheeler DDS, Richard
3540 Evergreen Pkwy
Evergreen 80439
(303)674-6264
Evergreen - Oral
Surgery/Extractions
Jensen DDS MS, Ole
28000 Meadow Or # 150
Evergreen 80439
(303)674-3452
Evergreen - Orthodontist
Papir DMD, Dori
30752 Soulhview Or # 200
Evergreen 80439
(303) 679-6111
Regan DMD, Paul
30960 Stagecoach Blvd # W100
Evergreen 80437
(303)674-1122
Wilkerson DDS, Damon
32156 Castle Court # 211
Evergreen 80439
(303) 670-5878
Evergreen - Pediatric Dentist
Strange DDS MSD, Malcolm
30960 Stagecoach Blvd # W 100
Evergreen 80439
(303) 670-7070
Fairplay - General
Gordon DDS, Charles
500 Front St
Fairplay 80440
(719) 836-2664
Federal Heights - General
" Bromell DDS, Susan
9462 N Federal Blvd
Federal Heights 80260
(303)427-2722
Cadotte DDS, Ana
9462 N Federal Blvd
Federal Heights 80260
(303)427-2722
Gohl li DDS, Fredric
9462 N Federal Blvd
Federal Heights 80260
(303) 427-2722
Kessler DOS, Mark
1557 W 84th Ave
Federal Heights 80260
(303)426-0330
Kneale DDS, Evan
9462 N Federal Blvd
Federal Heights 80260
(303) 427-2722
Kushner DDS, Rick
9462 N Federal Blvd
Federal Heights 80260
(303)427-2722
Park DDS, Alexander
1851 W 84th Ave
Federal Heights 80260
(303)429-6411
Smith DDS, Gerald
9462 N Federal Blvd
Federal Heights 80260
(303) 427-2722
Wong DDS, Alan
1851 W S4th Ave
Federal Heights 80260
(303)429-6411
Yasoni DDS, Marc
9462 N Federal Blvd
Federal Heights 80260
(303)427-2722
Florence - General
Mcfadyen DDS, John
100 S Pikes Peak Ave
Florence 81226
(719) 784-3935
Fort Collins-
Allen DDS, Kenneth
1241 Riverside Ave # 100
Fort Collins 80524
(970)221-1658
Allen DDS, Thomas
373 W Drake Rd # 10
Fort Collins 80526
(970) 223-0424
Anderson DDS, Timothy
523 Remington St
Fort Collins 80524
(970)482-6841
Astle DDS, John
218 S Overland Trail
FortCollins 80521
(970)482-9608
Baker DDS, Ronald
1040 E Elizabeth # 201
Fort Collins 80524
(970)484-7310
Basnar DDS, Cary
702 W Drake Rd Bldg F # B
Fort Collins 80526
(970) 4194711
Bennett DDS, Robed
1012 Center Ave # 102
Fort Collins 80526
(970) 224-3800
Brewer DDS, Thomas
1023 Robertson St
Fort Collins 80524
(970)484-6880
Burnham DDS, Arlie
2021 Battlecreek Or # C
Fort Collins 80522
(970) 229-0099
Cameron DDS, Stephen
310 E Prospect Rd
Fort Collins 80525
(970) 482-5141
Campbell DDS. King
934 S Lemay Ave
FortCollins 80524
(970)498-8300
Carson DDS, Thomas
1103 S Shields
Fort Collins 80521
(970)484-3213
Clark DDS, Bruce
2550 Stover Bldg E Suite 102
Fort Collins 80525
(970)498-8607
Clark DDS, Warren
1302 S Shields # A14
Fort Collins 80521
(970) 221-3933
Cowell DDS, John
2550 S Stover St Bldg F
Fort Collins 80525
(970)407-8080
Great DDS, Stephen
2001 S Shields St Bldg C
Fort Collins 80526
(970)482-2442
Dilley DDS, Steven
730 Whalers Way # 100
Fort Collins 80525
(970) 226-2920
Engelhardt DDS, Geoff
1136 E Stuart # 4101
Fort Collins 80525
(970) 4844890
Evans DDS, Gary
1040 E Elizabeth # D
Fort Collins 80524
(970)221-1926
Fischer DDS, J Antony
1217 E Elizabeth # 4
Fort Collins 80524
(970)482-6333
Foster DDS, Cory
373 W Drake Rd # 6
Fort Collins 80526
(970) 223-5258
Gilkinson DDS, Cameron
1040 E Elizabeth # 201
Fort Collins 80524
(970)484-7310
Fort Collins - General
- Green DDS, Leon
2550 S Stover St Bldg F
Fort Collins 80525
(970)407-8080
Hanck DDS, John
1136 E Stuart # 4101
Fort Collins 80525
(970) 4844890
Harrison DDS, Robed
383 W Drake Rd # 101
Fort Collins 80526
(970)223-5393
Harvey DDS, Thomas
718 S College Ave
Fort Collins 80525
(970)224-4093
Haschke DDS, Douglas
934 S Lemay Ave
Fort Collins 80524
(970)498-8300
Holmes DDS, Daniel
1136 E Stuart # 4105
Fort Collins 80525
(970)221-2499
Jacobs DDS, Naomi
1217 E Elizabeth St # 2
Fort Collins 80524
(970) 4844850
Johnston DDS, Ronald
2001 S Shields Bldg E # 200
Fart Collins 80526
(970)493-5120
Johnston DDS, Samantha
2001 S Shields Bldg E # 200
Fort Collins 80526
(970)493-5120
Jones DDS, Scott
333 W Drake Rd #120
Fart Collins 80525
(970) 2236100
Kaines DDS. Joel
2001 S Shields Bldg C
Fort Collins 80526
(970)482-8883
Kane DDS, Mary
1017 Luke St
Fort Collins 80524
(970)482-3166
Kaplan DOS, Zachary
373 W Drake Rd # 2
Fort Collins 80526
(970)223-1166
Keller DDS, James
1343 E Prospect Rd # D2
Fort Collins 80525
(970)484-3959
Knecht DDS, Nathan
373 W Drake Rd # 2
Fort Collins 80526
(970)223-1166
Koehler DMD, Steven
333 W Drake Rd # 120
Fort Collins 80526
(970) 2236101
Kramer DDS, Steven
1424 E Horsetooth Rd # 4
Fort Collins 80525
(970)223-2886
Lewis DDS, J Craig
1027 Robertson St
Fort Collins 80525
(970)4934313
Ley DOS, Brian
1136 E Stuart Bldg # 3120
Fort Collins 80525
(970) 206-0045
Lindsey DDS, Shiloh
1017 Luke St
Fort Collins 80524
(970) 482-3166
Loetz DDS, Duane
1437 Riverside Ave
Fort Collins 80524
(970)482-9955
Mangle DDS, James
1033 Robertson St
Fort Collins 80524
(970)4824242
Fort d�)- General
Marshall DDS, Daniel
2129 W Elizabeth
Fort Collins 80521
(970)493-9116
Missirlian DDS, H Arthur
3950 John F Kennedy Pkwy # 8
Fort Collins 80525
(970)267>0993
Motlrowski DDS, Brian
2021 Battlecreek Dr # C
Fort Collins 80522
(970)229-0099
Mucci DDS, Michael
333 W Drake Rd # 120
Fort Collins 80526
(970)223-6100
Northen DDS, Roger
1001 Centre Ave
Fort Collins 80526
(970)407-1001
Pettine DDS, Eric
333 W Drake Rd # 120
Fort Collins 80526
(970) 223-6100
Pixley DDS, Thomas
2170 W Drake Rd # 61
Fort Collins 80526
(970) 221-5115
Pool DDS, William
523 Remington St
Fort Collins 80524
(970)484-1188
Posey DDS, Russ
1331 E Prospect Rd # B-2
Fort Collins 80525
(970)224-5599
Raab DDS, Richard
1136 E Stuart # 3140
Fort Collins 80525
(970)482-1520
Rhodes DDS, Daniel
730 Whalers Way # 100
Fort Collins 80525
(970)226-2920
Robison DDS, Edmund
1008 Driftwood Or # A
Fort Collins 80525
(970)226-5433
Sanders DDS, Cary
1050 Robertson St
FortCollins 80524
(970)482-1477
Schaefer DDS, Stephen
2001 S Shields Bldg C
Fort Collins 80526
(970)482-8883
Siegmund DDS, John
730 Whalers Way # 100
Fort Collins 80525
(970) 226-2920
Simpson DDS, Joseph
718 S College Ave
Fort Collins 80524
(970)484-5297
Stratton DDS, Amy
1331 E Prospect Rd # B-2
Fort Collins 80525
(970)224-5599
Sullivan DDS, Raymond
2601 S Lemay # 32
Fort Collins 80525
(970) 223-8555
Swanbom DDS,Jon
1103 S Shields
Fort Collins 80521
(970)484-3280
Tabor DMD, Cad
1355 Riverside Ave # D
Fort Collins 80524
(970) 493-0999
Tomlinson DMD, Joseph
730 Whalers Way It 100
FortCollins 80525
(970) 226-2920
Tripam DDS, Alois
934 S Lemay Ave
Fort Collins 80524
(970)498-8300
Fort Collins - General
Tucker DDS, Steven
1103 Oak Park Dr # 105
Fort Collins 80525
(970) 223-2882
Washburn DDS, Lynn
1217E Elizabeth Bldg-2
Fort Collins 805244
(970) 4844850
Wells DDS, Gordon
2001 S Shields St # C
Fort Collins 80526
(970)493-9299
Wuerker DDS, Richard
2550 S Stover St Bldg F
Fort Collins 80525
(970)407-8080
Youngquist DDS, Adam
1103 South Shields
Fort Collins 80521
(970)484-3280
Zander-holmes DDS, Nicole
1136 E Stuart # 4105
Fort Collins 80525
(970)221-2499
Zimmer DDS, Colleen
1343 E Prospect # 1
Fort Collins 80525
(970)221-4500
Zimmer DDS, Richard
1343 E Prospect # 1
Fort Collins 80525
(970) 2214500
Fort Collins - Orel
Surgery/Extractions
Biggs DDS, Don
1032 Luke St
Fort Collins 80524
(970)482-1156
Felton DDS, Rickey
1008 B Centre Ave
Fort Collins 80526
(970)2214633
Hanawalt1029 Rob DDS, Ronald /�
1029 Robertson o 444("`"v..rr`41J
Fort Collins 80525
(970)493-4434
Fort Collins - EndodontistfRoot
Canals
Bergo DDS, Shane
730 Whalers Way # 300
Fort Collins 80525
(970)229-1404
Girardi DDS, Anthony
1331 E Prospect Bldg 81
Fort Collins 80525
(970) 4824916
Jones DDS, David
1331 E Prospect Bldg 81
Fart Collins 80525
(970) 4824916
Jones DDS MS, Kelly
1331 E Prospect Bldg B1
Fort Collins 80525
(970)482-4916
Kochevar DMD, Mark
1513 Riverside Ave
Fort Collins 80524
(970)221-5090
Levalley DDS, Bradley
730 Whalers Way # 300
Fort Collins 80525
(970)229-1404
Fort Collins - Orthodontist
Smoked DDS MS, Dennis
2001 S Shields St Bldg A
Fort Collins 80526
(970) 4844102
Ebert DDS MDS, Donna
1028 Centre # D
Fort Collins 80526
(970) 4906065
Iversen DDS, William
1103 S Shields
Fort Collins 80521
(970) 484-3214
Page 13 "means DPO Dentist at the time of publication 01)24/03
Fort Collins - Orthodontist
Lamb DDS, Robert
730 Whalers Way
Fort Collins 80525
(970) 226-5505
Mclean DDS, John
1000 Driftwood Or
Fort Collins 80525
(970) 226-6443
Way DDS MS. David
1424 E Horsetoolh Rd #1
Fort Collins 80525
(970) 223-8080
Fort Collins - Pediatric Dentist
Davis DDS, William
1025 Garfield St
Fort Collins 80524
(970)493-22M
Kramer DDS MS, Mark
1424 E Hometooth Rd If 4
Fort Collins 80525
(970) 223-2868
Pauly DDS, A Stephen
1513 Riverside Ave
Fort Collins 80524
(970) 4844255
Fort Collins - Periodontist
Braun DDS, James
1136 E Stuart St Bldg 4 # 103
Fort Collins B0525
(970) 221-24"
Lindeberg DDS MS, Richard
1120 E Elizabeth
Fort Collins 80524
(970)221-5050
Paris DDS MSD, Leslie
4033 Boardwalk Dr If 100
Fort Collins 80525
(970) 2074061
Thomas Jr DDS MS, Lloyd
1136 E Stuart St Bldg 4 # 103
Fort Collins 80525
(970)221-2444
Fort Lupton - General
Moore DDS, Steven
230 N Park Ave
Fart Lupton 80621
(303) 857-2258
Sinkule DDS, Steven
303 Park Ave
Fort Lupton 80621
(303)857-2718
Stangle DDS. Irene
229 Denver Ave
Fort Lupton 80621
(303)8574377
Fort Morgan - General
Lehrer DDS, L Earl
107 W 91h Ave
Fort Morgan 80701
(970) 867-2502
Marron DDS, Bruce
321 E Platte Ave
Fort Morgan 80701
(970) 867-9700
Schaefer DDS, Jerrold
314 W Bijou Ave
Fort Morgan 80701
(970)867-2288
Schoemaker DDS, Jeans
105 W 9lh Ave
Fort Morgan 80701
(970)867-7245
Schoemaker DDS, Neil
105 W 9lh Ave
Fort Morgan 80701
(970)867-7245
Theisen DDS, J Kelly
521 E Railroad Ave
Fort Morgan B0701
(970)867-2256
fibbetis DDS, Richard
931 Lincoln St
Fort Morgan 80701
(970) 867-7224
r�
Fort Morgan - Orthod,d
Wilhelm DDS, Robert
109 W 9th Ave
Fort Morgan 80701
(970)867-9464
Fountain - General
Bloss DDS, Patricia
200 Plaza Blvd
Fountain 80817
(719) 3924201
' Bmegger DDS, Robert
6980 Mesa Ridge Pkwy
Fountain 80817
(719) 392-4231
Galyardt DDS, Wesley
200 Plaza Blvd
Fountain 80817
(719) 392-4201
' Hill DDS, Doxiades
6908 Mesa Ridge Pkwy
Fountain 80817
(719) 392-1506
` Hill DDS, Jonathan
6908 Mesa Ridge Pkwy
Fountain 80817
(719) 392-1506
Johnson DDS, Jeff
200 Plaza Blvd
Fountain 80817
(719) 3924201
Noble DDS, Glenn
320 S Santa Fe Ave
Fountain 80817
(719)382-5500
Paterson DDS. Norman
320 S Sante Fe
Fountain 80817
(719) 3825449
` Pfister DMD, Candace
6980 Mesa Ridge Pkwy
Fountain 80817
(719) 3924231
` Ranta DDS, George
69BO Mesa Ridge Pkwy
Fountain 80817
(719) 392-4231
` Ranter DDS, Jeffrey
6980 Mesa Ridge Pkwy
Fountain 80817
(719) 392-4231
Franktown - General
Lacouture DDS, Cary
7601 Bumingtree Or
Franktown 80116
(303) 688-2515
Frederick - General
Rmgdahl DDS, Mark
336 5th St
Frederick 80530
(303) 833-3230
Frisco - General
Luchtefeld DMD, Jason
965 Ten Mile Or # AS
Frisco 60443
(970) 668-1010
Frisco - Endodontist/Root
Canals
` Breeden DDS, Randall
18 School Rd
Frisco 80443
(970)668-0330
Georgetown - General
` Losacco DDS, Thomas
801 Sixth St
Georgetown 804"
(303) 569-3141
Glenwood Springs - General
Bone DDS, John
2001 Blake Ave # 2d
Glenwood Springs 81601
(970) 945-6275
Casanova DDS, Joseph
1517 Blake Ave #201
Glenwood Springs 81601
(970)9456576
Glenwood Springs - General
Ford Jr DOS, J Pat
1517 Blake Ave #201
Glenwood Springs 81601
(970)945-6576
Murray DDS, Robert
1512 Grand Ave If 202
Glenwood Springs 81601
(970) 945-5112
Selterberg DDS, James
401 23rd St # 202
Glenwood Springs 81601
(970)945-8753
Glenwood Springs - Oral
Surgery/Extractions
Haltom DDS, George
406 S Hyland Park Or If B
Glenwood Springs 81601
(970) 945-96"
Perino DDS, Kenneth
406 S Hyland Park Or If B
Glenwood Springs 81601
(970)945-9644
Glenwood Springs - Pediatric
Dentist
Henry DDS MS, Robert
401 23rd St # 100
Glenwood Springs 81601
(970) 928-9500
Golden - General
Beacom DDS, David
1218 Arapahoe St
Golden 80401
(303)277-9600
' Brenner DDS, Laura
2305 Jackson St
Golden 80401
(303) 278-2800
' Burchfield DDS, John
2007 Jackson St
Golden 80401
(303)279-3992
' Burchfield DDS, John
2007 Jackson St
Golden 80401
(303) 279-3992
Goad DMD, Richard
1317 Washington Ave
Golden 80401
(303) 2794224
' Kawakami DDS, Sam
14062 Denver W Pkwy # 52-120
Golden 80401
(303)279-5050
Keeler DDS, Beverly
25918 Genesee Trail Rd # 210
Golden 80401
(303) 526-9155
Krug DOS, Ray
14062 Denver W Pkwy # 52 145
Golden 80401
(303)277-9024
Long DDS, Howard
11127 Circle Or
Golden 80403
(303)642-3650
Lundy DDS, Brooke
25918 Genesee Trail Rd # 210
Golden 80401
(303) 526-9155
Matsui DDS, Thomas
1526 Cole Blvd Bldg 3 If 120
Golden 80401
(303)234-0505
Miller DDS, Michael
727 Simms
Golden 80401
(303)232-3636
' Morrison DDS, Eric
17531 S Golden Rd
Golden 80401
(303)278-6953
' Poczatek DDS, Sharon
17531 S Golden Rd
Golden 80401
(303)278-6953
Golden -G0
Powell DDS, David
900 131h St
Golden 80401
(303) 279-2309
` Roberts DOS, Dale
17211 S Golden Rtl # 100
Golden 80401
(303)279-7444
' Sabo DMD, Joseph
607 14th St
Golden 80401
(303) 2795420
Strachan DMD, Bozena
24928 Genesee Trail Rd # 150
Golden 80401
(303) 526-1956
Young DOS, Richard
2007 Jackson St
Golden 80401
(303) 279-5741
Zinn DDS, Richard
12970 W 20th Ave
Golden 80401
(303) 234-9925
Golden - Orthodontist
Courted DOS, Charles
623 14th St
Golden 80401
(303) 279-3355
Zinkann DDS MS, Karla
14062 Den W Pkwy Bldg 52 # 120
Golden 80401
(303)279-5050
Grand Junction - General
Andreoletti DDS, Gary
790 Wellington Ave # 101
Grand Junction 81501
(970)245-9570
Aust DDS, Donald
790 Wellington Ave #206
Grand Junction 81501
(970)243-9292
Benak DDS, Susan
403 Kennedy Ave 93
Grand Junction 81501
(970) 243-3299
Berguin ODS, Brandon
514 28 Rd
Grand Junction 81501
(970)241-3483
Blehm DDS, Darrel
1212 Bookcliff Ave # 4
Grand Junction 81501
(970)245-0785
Corbett DDS, Byron
132 Walnut Ave
Grand Junction 81501
(970) 242-0288
Corbett DDS, J Michael
1120 Wellington Ave # 102
Grand Junction 81501
(970)245-1631
Craig DDS, Clarence
636 Walnut Ave
Grand Junction 81501
(970) 242-8481
Droskin DDS, Craig
900 North Ave
Grand Junction 81501
(970)242-2433
Feghali DDS, Carl
1120 Wellington Ave # 203
Grand Junction 81501
(970)245-9546
Fine DDS, Terry
2532 Patterson Rd If 1
Grand Junction 81505
(970) 2414800
Fletcher DDS, Brian
790 Wellington Ave # 206
Grand Junction 81501
(970) 2604603
Fuller DDS, Gilbert
3198 Elm Ave
Grand Junction 81504
(970)434-0707
Grand Junction - General
Gadeken DDS, Michael
2232 N 7th St # 14
Grand Junction 81501
(970) 2454483
Gaglione DDS, Lee
510 Patterson Rd
Grand Junction 81506
(970)242-6753
Gall DDS, Andrew
132 Walnut Ave
Grand Junction B1501
(970) 245-1758
Gillis DDS, Julie
1190 Bmokcliff Ave If 201
Grand Junction 81501
(970) 242-3635
Gilmore Jr DDS, Richard
510 Patterson Rd
Grand Junction 81506
(970)242-6753
Goggans DMD, James
2692 Hwy 50 # G
Grand Junction 81503
(970) 257-1103
Haddow DDS, Kit
120E Orchard Ave
Grand Junction 81501
(970) 245-2990
Harman DDS, Robert
2795 Skyline Ct
Grand Junction B1506
(970) 242-3545
Harsher DDS, Mark
2352 N 7th St If 4
Grand Junction 81501
(970) 242-9207
Harvey ODS, Shawn
514 28 Rd
Grand Junction 815DI
(970) 241-3483
Hurd DDS, Richard
2352 N 7th St
Grand Junction 81501
(970)243-5393
Johnson DDS, Glenn
2352 N 7th St If 4
Grand Junction 81501
(970)242-9207
Johnson DDS, Stephen
2249 Broadway
Grand Junction 81503
(970) 241-0110
Jones DDS, Dale
102 Lorey Or
Grand Junction 81505
(970) 2424945
' Lange DDS, Nadine
2795 Skyline Ct
Grand Junction 81506
(970) 242-3545
Madison DDS, Mark
2525 N 8th St # 109
Grand Junction 81501
(970)256-9500
Martin DDS, Mike
744 Horizon Ct # 240
Grand Junction 81506
(970)245-3633
Moore DDS, James
1301 N 7th St # A
Grand Junction 81501
(970) 242-9404
Moran DMD, Thomas
1306 E Sherwood Or
Grand Junction 81501
(970) 243-8230
Moreland DDS, Scott
1036 Grand Ave
Grand Junction 81501
(970) 243-8580
Moses DDS, Wilford
132 Walnut Ave
Grand Junction 81501
(970) 242-0288
Narania DOS, Anthony
2532 Patterson Rd # 1
Grand Junction 81505
(970) 2414800
Page 14 'means DPO Dentist at the time of publication 01/24/03
Grand Junction - General
Grand Junctid "ontlst
Greeley -General
Greenwood VIg - Orthodontist
Nofftinger DDS, David
1120 Wellington Ave # 102
Grand Junction 81501
(970) 243-2682
Peovey DMD, John
132 Walnut Ave # E
Grand Junction 81501
(970) 243-2025
Ricks DDS, Bruce
918 N 7th St#1
Grand Junction 81501
(970)245-1988
Sandner DDS, J Randolph
132 Walnut Ave # B
Grand Junction 81501
(970)242-6881
Stein DDS, Laurie
500 Patterson Rd If 2
Grand Junction 81506
(970)241-1171
Summers DDS, David
102 Lowy Or
Grand Junction 81505
(970)242-2717
Tedvick DOS, Thomas
2352 N 7th St If 4
Grand Junction 81501
(970) 242-9207
Tarr DDS, James
2531 W Pinyon Ave
Grand Junction 81505
(970) 242-5367
Taylor DDS, Ronald
132 Walnut Ave # 4
Grand Junction 81501
(970)242-6852
Toth DMD, Eric
1120 Wellington Ave #203
Grand Junction 81601
(970)245-9546
Wixom DDS, Alan
2490 Patterson Rd If 2
Grand Junction 81505
(970)242-9202
Young DDS, Bruce
2525 N 81h Sl # 101
Grand Junction 81501
(970)255-8024
Grand Junction - Oral
SurgerylExtractions
Kelly DMD, Stephen
2530 N 8th St # 103
Grand Junction 81501
(970) 245-2222
Nock DDS, David
425 Patterson Rd # 501
Grand Junction 81506
(970) 242-4433
Vincent DDS, Ronald
306 Glenwood Ave
Grand Junction 81501
(970) 242-6623
Grand Junction -
EndodontistlRoot Canals
Fante DDS, Stephen
2530 N 8th St # 106
Grand Junction 81501
(970)243-7392
Nonhup DDS, Paul
2525 N Blh St # 102
Grand Junction 81501.
(970)242-9088
Grand Junction - Orthodontist
Hymas DDS MS, T Allan
2454 Highway 6 8 50 # 210
Grand Junction 81505
(970) 245-8810
Grand Junction - Pediatric
Dentist
Bull DDS, John
2119 N 711, St
Grand Junction 81501
(970) 243-2855
Dean DOS, Glen
2525 N Bth St If 105
Grand Junction 81501
(970)241-1313
Alpha DDS MSD, K Eric
790 Wellington # 205
Grand Junction 81501
(970)243-9640
Drezek DDS. John
2532 Patterson Rd # 7
Grand Junction 81505
(970) 245-4478
Weenig DDS, Duane
790 Wellington #205
Grand Junction 81501
(970)243-9640
Greeley -General
Sunrise Community Health Ctr
100 N 11th Ave
Greeley 80631
(970)304-2376
Sunrise Community Health Ctr
1028 5th Ave
Greeley 80631
(970) 353-9403
Bagley DMD, Steven
913 27th Ave
Greeley B0634
1970) 3535664
Banks DDS, Robert
1640 25th Ave # B
Greeley 80634
(970)356-2120
Benner DDS, Sidney
3400 W 16th St # 8 E
Greeley 80634
(970) 351-0400
Bland DDS, Andrew
3400 W 16th St # 8 E
Greeley 80634
(970) 3565277
Bobier DDS, Gene
1910 56th Ave
Greeley 80634
(970) 339-9770
Boyes DMD, Richard
3400 W 16th St # Ww
Greeley 80634
(970) 352-4242
Casseday DDS, Bryan
1770 25th Ave It 102
Greeley 80634
(970)351-6200
Coleman DDS, Gail
2632 11 th Ave
Greeley 00631
(970) 353-5262
Day DDS, Kent
1028 5th Ave
Greeley 80631
(970)353-9403
Dick DDS, Clyde
1630 17th Ave
Greeley 80631
(970)353-1157
Forney DDS, W Mark
3400 W 16th St Bldg 1 # D
Greeley 80634
(970)351-0500
Gomez DDS, Jose
1122 9th St # 103
Greeley 80631
(970) 353-2340
Hatch DDS, Randy
1600 23rd Ave # 200
Greeley 80634
(970) 3534329
Heikes DMD, Lkryd
3400 W 16th St Bldg 1 n # Dd
Greeley 80634
(970)356-3743
Holmes DDS, J
918 131h St
Greeley 80631
(970)353-1197
Jamison li DDS, Nicholas
4669 W 20th St Rd # A
Greeley 80634
(970) 50&1122
Johnson DDS, Charles
1600 23rd Ave # 200
Greeley 80634
(970) 353-4329
Kinkade DDS, Donald
2525 16th St If A
Greeley a0634
(970) 352-2343
Kinkade Jr DDS, J
2525 16th St # A
Greeley 80634
(970)352-2343
Kirk DDS, Roderic
3400 W 16th St Bldg 8-e
Greeley 80634
(970) 351-6500
Kmn DMD, Robert
3535 W 12th St # B
Greeley 80634
(970) 351-6095
Kurtz DDS, Dwaine
1640 25th Ave # C
Greeley 80634
(970)352-5448
Ligon DDS, Richard
2000 16th St # 9
Greeley 80631
(970)353-6249
Meador DDS, Shivaun
1028 5th Ave
Greeley 80631
(97D)353-9403
Milos-valstad DMD, Pamela
902 141h St
Greeley 80631
(970)392-0152
Murphy DDS, David
1028 5th Ave
Greeley 80631
(970) 353-9403
Powell DDS, Jerald
3400 W 16th St # 8 E
Greeley 80634
(970)351-6506
Shaddock DDS, James
3705 W 12th St
Greeley 80634
(970) 356-2605
Smith DDS, Mark
3400 W 161h St # 7 F
Greeley 80634
(970)356-7474
Smith DDS, Summer
1910 56th Ave
Greeley 80634
(970)339-9770
Sydney DDS, Gilbert
3705 W 12th St
Greeley B0634
(970) 356-3717
Theme DMD, Donald
3705 W 12th St
Greeley 80634
(970)351-7505
Tischhauser DDS, John
3400 W 16th St # C
Greeley 80634
(970) 346-6183
Uyemura DDS, Douglas
1648 17th Ave
Greeley 80631
(970)353-8217
Uyemura DMD, Mark
1648 17th Ave
Greeley 80631
(970)352-7600
Waterman DDS, Richard
2632 11th Ave
Greeley 80631
(970) 353-5262
Greeley -Oral
SurgerylExtractims
Mellin DDS, Richard
3400 W 16th St # 1 A
Greeley 80634
(970)353-5826
Nicholas DDS, Kenton
1900 16th St
Greeley 80631
(970)353-1551
Grael('..�IndodontlsflRoot
Canals
Fundemurk DDS MS, David
3400 W 16th St Bldg 7 # H
Greeley 80634
(970) 356-8650
Lowry DDS, Scott
4669 W 20th St Rd
Greeley 80634
(970)330-2161
Greeley- Orthodontist
Barth DDS MS, Gary
1640 25th Ave # A
Greeley 80634
(970)353-4249
Edgren DDS MS, Bradford
3400 W 16th St If 4 V
Greeley 80634
(970)356-5900
Edgren DDS MS, Burdett
3400 W 16th St It 4 V
Greeley 80634
(970)356-5900
Gentile DMD MS, John
2855 35th Ave # A
Greeley 80634
(970) 330-5363
Kloberdanz DDS, Gary
2021 Clubhouse Or# 110
Greeley 80634
(970) 330-2500
Richter DDS MS, David
1600 23m Ave # 200
Greeley 80634
(970) 353-0329
Greeley - Pediatric Dentist
Morin DMD MSC, Chaves
2003 46th Ave
Greeley 80634
(970)33D-4600
Greeley -Pedrxbntlat
Eckles DDS MS, Terry
3400 W 16th St Bldg 5 If x
Greeley 80634
(970) 351-6166
Greenwood Vlg - General
Scheme DDS, Paul
6950 E Belleview Ave # 101
Gmenwood VIg 80111
(303) 741-2717
Boudreaux DDS, Gary
8480 E Orchard Rd If 4300
Greenwood VIg 80111
(303)T71-1009
Bmdie DDS, Mark
7000 E Belleview Ave # 205
Greenwood Vlg 80111
(303) 773-0960
D Hondl DDS, Enc Gerard
7000 E Belleview Ave If 205
Greenwood VIg 80111
(303)773-0960
Deal DDS, James
7730 E Belleview # At 03
Greenwood VIg 80111
(303)322-2724
Dwyer DDS, Daniel
5670 Greenwood Piz Blvd If 404
Greenwood VIg 80111
(303) 220-7662
Fischer DDS, Charles
8490 E Crescent Pkwy If 370
Greenwood VIg 80111
(303)740-9353
Jackson DDS, Stephen
8200 E Belleview If 445 E
Greenwood VIg 80111
(303) 771-8090
Laudon DDS, Suzanne
8200 E Belleview Ave # 460 E
Greenwood VIg 80111
(303)694-0587
Haskins DDS MS, Jeffrey
5972 S Holly St
Greenwood VIg 80111
(303)850-9253
Greenwood Vlg - Periodontist
Reich DDS MS, Gregory
8200 E Belleview Ave # 450 E
Greenwood Vlg 80111
(303) 779.6924
Tilliss DDS MS, Steven
8200 E Belleview Ave # 450 E
Greenwood VIg 80111
(303)T79-6924
Gunnison - General
Deforest DDS, Kenneth
204 N 12th St
Gunnison 81230
(970) 641-3406
Schlegel DDS, Paul
321 N Main
Gunnison 81230
(970) 641-2552
Slernsher DDS, David
611 N Main St
Gunnison 81230
(970) 641-6366
Gypsum - General
Oakson DDS, J Stephen
620 Red Table Or # D
Gypsum 81637
(970)524-1105
Hayden - General
Moquamie DDS, Rowan
150 W Jackson
Hayden 81639
(970)276-3123
Highlands Ranch - General
Beilby DDS, George
9249 S Broadway # 100
Highlands Ranch 80129
(303)693-3332
Bellamy DDS, Marcus
3626 Highlnds Ranch Pkwy # 107 ++VV
Highlands Ranch 80126
(303) 471-0841
Bollenbaugh DDS, Keith
2201 Wildcat Reserve Pkwy C6
Highlands Ranch 80129
(303)220-1122
Countrymen DDS, Joe
206 W County Line Rd # 360
Highlands Ranch 80129
(303)791-8530
Dymerski DDS, Daniel
66 W Springer Or# 304
Highlands Ranch 80129
(303)791-9141
Krainik DOS, Gregory
9461 S University Blvd
Highlands Ranch 80126
(303)470-1377
MarOnlch DMD, Robert
200 W County Line Rd # 250
Highlands Ranch 80129
(303)791-0160
Mcommell DDS, Chris
200 W County Line Rd If 240
Highlands Ranch 80129
(303) 791-6900
Miller DDS, Melissa
9557 S University Blvd # 101
Highlands Ranch 80126
(303)47D-8484
Morris DDS, Rosana
66 W Springer Dr # 207
Highlands Ranch 80129
(303)471-5500
Peters DDS, Kenneth
200 W County Line Rd If 270
Highlands Ranch 80129
(303) 791-2570
Rowlelte DDS, Michael
3626 Highlnds Ranch Pkwy # 107
Highlands Ranch 80126
(303)471-0841
Page 15 'means DPO Dentist at the time of publication 0124)03
Highlands Ranch - General
Rysner DDS, Ede
537 W Highlands Ranch Pky 102
Highlands Ranch 80129
(303)346-1118
Scavuzzo DDS, Frank
'120 E County Line Rd # 203
Highlands Ranch 80126
(303) 741-2727
Sewell DMD, David
9567 S University Blvd # C1
Highlands Ranch 80126
(303)683-2300
Theobald DDS, Charles
200 W County Line Rd If 210
Highlands Ranch 80126
(303) 791-0413
Turnquist DDS, Kerry
537 W Highlands Ranch Pky 102
Highlands Ranch 80129
(303)346-1118
Vadey DOS, Michael
8925 S Ridgeline Blvd # 110
Highlands Ranch 80129
(303) 470-0500
Zabel DDS, Lynette
9385 S Colorado Blvd # 102
Highlands Ranch 80126
(303)470-0017
Highlands Ranch - Oral
Surgery/Extractions,
Curry DDS. James
200 W County Line Rd # 230
Highlands Ranch 80126
(303) 791-0422
Latta DDS, James
200 W County Line Rd # 230
Highlands Ranch 80126
(303) 791-0422
Stein DDS, Stephen
8671 S Quebec St # 230
Highlands Ranch 80130
(303) 791-3232
Highlands Ranch -
EndodontistlRoot Canals
Patel DMD, Sanjay
537 W Highlands Ranch Pkwy 101
Highlands Ranch 80129
(303)346-3963
Hiahlands Ranch - Orthodontist
Garza DDS, Jennifer
200 W County Line Rd # 340
Highlands Ranch 80126
(303)791-2021
Hamersky DDS, Paul
9567 S University Blvd # C1 A
Highlands Ranch 80126
(720)344-2662
Havener Jr DDS, Darrell
200 W County Line Rd # 340
Highlands Ranch 80126
(303) 791-2021
Lindsey DDS, Gregg
200 W County Line Rd # 260
Highlands Ranch 80129
(303)791-0414
Redd DDS MS, Thomas
9385 S Colorado Blvd # 101
Highlands Ranch 80126
(303) 791-6646
Simpson DDS MS, Robert
200 W County Line Rd # 260
Highlands Ranch 80129
(303) 791-0414
Highlands Ranch - Pediatric
Dentist
Boren DDS, Robed
200 W County Line Rd If 330
Highlands Ranch 80129
(303) 791-4400
=ox DDS, Lisa
200 W County Line Rd # 330
Highlands Ranch 80129
(303) 791-4400
Norwood DDS MSD, James
200 W County Line Rd # 330
Highlands Ranch 80129
(303) 7914400
Highlands Ranch - Pt ntist
Chapman DDS, Thomas
9090 S Ridgeline Blvd # 225
Highlands Ranch 80129
(303)683-1144
Hotchkiss - General
Collar DDS, Richard
164 E Bridge St
Hotchkiss 81419
(970) 872-2299
Drbohlav DDS, Matthew
164 E Bridge St
Hotchkiss 81419
(970) 872-2299
Idaho Springs - General
Douvas DDS, George
102 Spruce Lane
Idaho Springs 80452
(303) 567-0840
Guyten DDS, Brad
1625 Miner St
Idaho Springs 80452
(303) 567-4412
Kooken DDS, Karen
1800 Colorado Blvd
Idaho Springs 80452
(303)567-2597
Ignacio - General
Health Clinic, Ignacio
123 Weeminuche
Ignacio 81137
(970) 5634581
Johnstown - General
Martin DDS, Steven
5 N Parish
Johnstown 80534
(970) 587-4423
La Jam - General
Valley Wide Health Services
421 Walnut St
La Jara 81140
(719) 274-8948
Jackson DDS, Darrell
421 Walnut St
La Jere 81140
(719)274-8948
La Junta - General
Lacy DDS, David
412 Santa Fe St
La Junta 81050
(719)384-2859
Lacy DDS, Rosa
13 E 4th St
La Junta 81050
(719)384-9442
La Salle - General
Bender DDS, William
202 2nd St
LaSalle 80645
(970) 284-7930
Lafayette - General
Belford DMD, Mark
204 E Baseline Rd
Lafayette 80026
(303) 6654000
Dhaliwal DDS, Kristy
511 Crossing Or # 200
Lafayette 80026
(303)664-1001
Eurich DDS, Steven
1120 W S Boulder Rd # 202
Lafayette 80026
(303) 666-4653
Keene DMD, Gregory
1140 W South Boulder Rd # 201
Lafayette 80026
(303)665-5578
Newsome DDS, Linda
489 N Hwy 287 # 200
Lafayette 80026
(303)664-9355
Sneaks DOS, Cynthia
1120 W S Boulder Rd # 202
Lafayette 80026
(303) 6664653
Lafayette - General
Stuart DMD, Charles
1373 Forest Park Cir # 103
Lafayette 80026
(303) 666-7773
West DDS, Gordon
1140 W South Boulder Rd 9201
Lafayette 80026
(303)665-5578
Lafayette - Orthodontist
Craig DDS MS, Robert
1120 W S Boulder Rd # 201
Lafayette 80026
(303)926-9224
Lafayette - Pediatric Dentist
Christensen DDS, Edward
1120 W South Boulder Rd # 204
Lafayette 80026
(303)604-9500
Lakewood - General
Andrus DDS, Paul
2009 Wadsworth Blvd # 102
Lakewood 80215
(303) 233-0212
Anundsen DDS, M Steven
2323 S Wadsworth Blvd If 1778
Lakewood 80227
(303) 980-4800
Arendt DMD, Paul
7373 W Jefferson Ave # 304
Lakewood 80235
(303)986-0090
Baldwin DDS, Bruce
13701 W Jewell Ave # 101
Lakewood 80228
(303)989-3192
Ball DDS, M Gene
10881 W Asbury Ave # 210
Lakewood 80227
(303)989-0452
` Barton DDS, Colin
6800 W Alameda Ave
Lakewood 80226
(303)727-9100
Bauer DDS, Gerald
3333 S Wadsworth Blvd # 309
Lakewood 80227
(303)988-6767
Saudi DDS, Steven
7575 W 20lh Ave
Lakewood 80214
(303)238-2800
Bausch DDS, Wayne
8015 W Alameda Ave # 250
Lakewood 80226
(303)232-1830
` Beckman DDS, R Todd
9990 W 26th Ave # 100
Lakewood 80215
(303)232-4500
` Blumenschein DDS, Gary
608 Garrison St Unit Q
Lakewood 80215
(303)232-1750
` Caldwell DDS, Michelle
3110 S W adsworth # 302
Lakewood 80227
(303) 988-7800
Callahan DDS, Richard
12790 W Alameda Pkwy If B
Lakewood 80228
(303)984-2630
Chavez DDS, David
8015 W Alameda # 140
Lakewood 80226
(303)984-0307
` Clouatre DDS, Jean
9955 W 20th Ave
Lakewood 80215
(303) 233-1241
Collins DDS, David
1555 S Wadsworth Blvd If 1
Lakewood 80232
(303) 986-9522
Coschignano DDS, Patrick
1360 S Wadsworth Blvd #100
Lakewood 80232
(303)986-9517
Lakewood- 1131
` Crockett DDS, Olen
1345 Wadsworth Blvd
Lakewood 80215
(303)238-1209
Decino DDS, Patricia
950 Wadsworth Blvd # 207
Lakewood 80215
(303) 237-3640
Dial DDS, Richard
363 S Harlan SI # 110
Lakewood 80226
(303)935-6559
` Ditabaugh DMD, Gary
9868 W Girton Or
Lakewood 80227
(303)989-0577
Duvall DDS, Daniel
3333 S Wadsworth # 316
Lakewood 80227
(303) 986-0043
Edlund DMD, David
7425 W Hampden Ave
Lakewood 80227
(303)988-7410
Ferr is DDS, Catherine
3405 S yarrow # B
Lakewood 80227
(303) 987-2121
Findling DDS, John
9975 W 20th Ave
Lakewood 80215
(303) 233-5455
Flood DDS, Patrick
6800 W Alameda Ave
Lakewood 80226
(303) 727-9100
Fulton DDS, Laurel
1659 Wadsworth Blvd
Lakewood 80214
(303)233-1323
Furgason DDS, Brian
10881 W AsburyAve # 100
Lakewood 80227
(303) 988-6938
Gan DDS, Kim Siang
12600 W Coffax Ave If B160
Lakewood 80215
(303)238-6880
Gold DDS, Frank
1360 S Wadsworth Blvd # 200
Lakewood 80232
(303) 988-2738
Grabiak DDS, Guy
3190 S Wadsworth Blvd # 300
Lakewood 80227
(303) 98MI10
Granger DDS, Mark
2525 S Wadsworth # 23
Lakewood 80227
(303) 985-0909
Greenhalgh DDS, Scott
3190 S Wadsworth Blvd # 300
Lakewood 80227
(303)988-6110
Haag DDS, Christine
7575 W 2oth Ave
Lakewood 80215
(303)238-2800
Hall DDS, Randall
255 Union Blvd # 495
Lakewood 80228
(303)989-1423
Hansen DDS, Dan
3333 S Wadsworth It D 305
Lakewood 80227
(303) 985-1615
Harvey DDS, Fred
10090 W 26th Ave
Lakewood 80215
(303) 237-9547
Herremans DDS, Tamara
7586 W Jewell Ave Ste 303
Lakewood 80232
(303) 984-1400
Hill DDS, Daniel
2290 Kipling St
Lakewood 80215
(303) 233-2906
Lakewootl-General
Humbargar DDS, David
3190 S Wadsworth Blvd # 300
Lakewood 80227
(303) 988.6110
Hurst DDS, Jeffery
2315 Kipling
Lakewood 80215
(303)238-5812
Johnsen DDS, Curtis
2349 Wadsworth Blvd
Lakewood 80214
(303)232-5555
Johnson DDS, Bruce
9868 W Girton Or
Lakewood B0227
(303) 989-0577
Johnson Jr DMD, Roy
6565 W Jewell Ave If 1 A
Lakewood 80232
(303) 935-3465
` Kern DDS, James
10815 W Jewell Ave # L
Lakewood 80232
(303)988-6860
Kivland DDS, Robert
2290 Kipling St
Lakewood 80215
(303)233-2906
Klein DDS, Mark
6800 W Alameda Ave
Lakewood 80226
(303)727-9100
Kloehn DDS, Richard
2290 Kipling St
Lakewood 80215
(303)232-3298
Lauder DDS, K Michael
3333 S Wadsworth Blvd # D325
Lakewood 80227
(303) 969-8551
Limpede DDS, Bogdan
1815 S Welch Cir #5
Lakewood 80228
(303)922-6083
Long DDS, Lance
7700 W 14th Ave
Lakewood 80215
(303) 237-4831
` Marshall DDS, Kevin
9990 W 261h Ave # 100
Lakewood 80215
(303)232-4500
Mcadhur DDS, Bruce
6565 W Jewell Ave # 9
Lakewood 80232
(303)935-9448
Modill Jr DDS, Michael
1555 S Wadsworth Blvd # 1
Lakewood 80232
(303)986-9522
Mcginty DDS, Eileen
3333 S Wadsworth Blvd # D 303
Lakewood 80227
(303)988-4949
Mcneely DDS, William
1880 S Pierce St # 16 B
Lakewood 80232
(303) 922-1103
Melaragno DDS, Henry
7373 W Jefferson Ave #204
Lakewood 80235
(303)986-6626
` Milausnic DDS, Michael
333 S Allison Pkwy # 202
Lakewood 80226
(303)936-5644
Miller DDS, Charles
2290 Kipling St
Lakewood 80215
(303)233-1354
Murphy DDS, Robert
950 Wadsworth Blvd # 207
Lakewood 80215
(303)237-3640
` Noland DDS, Andrew
84 Garrison St # A
Lakewood 80226
(303)233-1112
Page 16 'means DPO Dentist at the time of publication 012403
Lakewood - General
Nyvold DDS, Thomas
3190 S Wadsworth Blvd # 300
Lakewood 80227
(303)988-6110
Obeime DDS, Jacqueline
2323 S Wadsworth Blvd # 1778
Lakewood 80227
(303)985-0415
Odowd DMD, Cynthia
255 Union Blvd # 490
Lakewood 80228
(303)989-5237
Ontiveros DDS, Michael
2475 Wadsworth Blvd
Lakewood 80215
(303)233-1335
Palumbo DDS, Glenn
2599 Wadsworth Blvd # 1
Lakewood 80214
(303) 458-7061
Paswaters Pc DDS, Stephanie
12093 W Alameda Pkwy # A
Lakewood 80228
(303) 716-7321
Petrov DDS, Rays
13035 W Alameda Pkwy
Lakewood 80228
(303)987-0544
Phelan DDS, Cynthia
9990 W 26th Ave # 100
Lakewood 80215
(303) 2324500
Phillips DOS, James
3333 S Wadsworth Blvd # D325
Lakewood 80227
(303) 989-8551
Pious DDS, Michael
7575 W 20th Ave
Lakewood B0214
(303)234-1112
Pontarelli DDS, William
15 Wadsworth
Lakewood 80226
(303)936-5998
Pon DDS, Thomas
12600 W Colfax Ave # B 160
Lakewood 80215
(303)237-0307
Pride DDS, James
7373 W Jefferson Ave # 204
Lakewood 80235
(303)986-6626
Purcell DDS, Lawrence
7625 W Hampden Ave It 15
Lakewood 80227
(303) 988-2150
Cut DDS, Peter
10881 W Asbury Ave # 200
Lakewood 80227
(303)914-1182
Quigley DDS, John
2500 youngfield St
Lakewood 80215
(303)237-7004
Quigley DDS, John
7800 W Jewell Ave # D
Lakewood 80232
(303)988-2920
Rold DDS, Trent
7700 W 14th Ave
Lakewood 80215
(303) 2374831
` Schroeder DDS, Timothy
6565 W Jewell Ave # 3
Lakewood 80232
(303) 937-6345
Secrist DDS, Brian
3110 S Wadsworth Blvd # 204
Lakewood 80227
(303) 989-9010
Shaver DMD, Richard
10240 W 26th Ave
Lakewood 80215
(303)232-4928
SJordal DDS, Steven
9393 W Alameda Ave
Lakewood 80226
(303)237-2739
Lakewood-
- Slaysky DDS, Aaron
1614 Carr St
Lakewood 80215
(303)233-1704
Smith DDS, Richard
12600 W Colfax Ave # B100
Lakewood 80215
(303)237-1553
` Steen DDS, Dale
6800 W Alameda Ave
Lakewood 80226
(303) 727-9100
Stewart DDS, H Scott
2525 S Wadsworth Blvd # 11
Lakewood 80227
(303)988-0338
Swanson DDS, David
8015 W Alameda Ave # 170
Lakewood 80226
(303)232-2929
` Talavera DDS, Sylvia
10090 W 261h Ave
Lakewood 80215
(303)232-6205
` Thompson DDS, Larry
1360 S Wadsworth Blvd # 300
Lakewood 80232
(303)986-9505
Uchida DDS, Bruce
9965 W 201h Ave
Lakewood 80215
(303)234A349
Unser DDS. Michael
7575 W 201h Ave
Lakewood 80214
(303)238-2800
` Vairin DDS, Christopher
7425 W Hampden Ave
Lakewood 80227
(303)9894444
Vanek DDS, Ben
13440 W Alameda Pkwy
Lakewood 80228
(303) 988-0711
Vanek DDS, Melvin
13440 W Alameda Pkwy
Lakewood 80228
(303) 988-0711
Vanek Jr DDS, Ben
13440 W Alameda Pkwy
Lakewood 80228
(303)988-0711
Wadsworth DDS, Kenneth
11290 W Alameda Ave # 205
Lakewood 80226
(303) 985-9850
Walden DDS, Robert
12790 W Alameda Pkwy # B
Lakewood 80228
(3(13)984-2630
` Wasinger DOS, Jack
10090 W 26Ih Ave
Lakewood 80215
(303) 232-6205
Whalen DDS, Dann
8015 W Alameda Ave # 170
Lakewood 80226
(303)232-2929
Wise DDS, Randall
7373 W Jefferson Ave # 305
Lakewood 80235
(303) 985-1263
Wray DMD, William
205 S Garrison St # 4
Lakewood 80226
(303)232-2873
Lakewood - Oral
Surgery/Extractions
` Burtschi DDS, Thomas
10005 W 17th PI #3
Lakewood 80215
(303) 232-0500
Decino DDS, Donald
3405 S yarrow St # A
Lakewood 80227
(303)996-8500
Lakewood - Oral
Surgery/Extractions
Ingalls DDS, Gregory
6565 W Jewell Ave If 5
Lakewood 80232
(303) 727-8595
Lesnick DDS, Julie
6565 W Jewell Ave If 5
Lakewood 80232
(303)727-8595
Oday DDS, Richard
6565 W Jewell Ave # 5
Lakewood 80232
(303)727-8595
Snider DDS, Larry
2290 Kipling St
Lakewood 80215
(303)232-5637
Trammell DDS, Gerald
9990 W 26th Ave
Lakewood 80215
(303)232-4422
Lakewood - EndodontisVRoot
Canals
Graves DDS, Lowell
3190 S Wadsworth Blvd # 300
Lakewood 80227
(303) 988-6110
Kardelis DDS MS, Tony
7373 W Jefferson Ave # 404
Lakewood 80235
(303) 986-2765
Kleier DDS, Donald
2290 Kipling
Lakewood 80215
(303)232A327
Miller DMD, James
2290 Kipling
Lakewood 80215
(303)232-1327
Lakewood - Orthodontist
Asercion DDS, Joseph
7125 W Jefferson Ave #380
Lakewood 80235
(303)989-5607
Bobak DMD MS, Voylek
1840 S Wadsworth Blvd
Lakewood 80232
(303) 988-0844
Callender DDS, David
2460 youngfield
Lakewood 80215
(303)233-2929
Carnes DMD, Cathy
7125 W Jefferson # 380
Lakewood 80235
(303)989-5607
Carter DDS MS, Stephen
3333 S Wadsworth Blvd # D310
Lakewood 80227
(303)988-3101
Duryea DDS, Michael
11290 W Alameda Ave It 102
Lakewood 80226
(303)987-0500
Konegni DDS, John
255 Union Blvd # 430
Lakewood 80228
(303) 988-2780
` Mason Jr DDS, James
12018 W Jewell Ave Unit B
Lakewood 80228
(303)980-6411
Mulholland DDS, Richard
10111 W 26th Ave
Lakewood 80215
(303)232-2525
Lakewood - Pediatric Dentist
Sexton DDS MS, John
2323 S Wadsworth Blvd #104
Lakewood 80227
(303)954-9700
Lake( } Periodontist
Brown DDS MS, Cherie
7373 W Jefferson Ave # 404
Lakewood 80235
(303)986-2212
Miller DDS MS, Gaylen
7373 W Jefferson Ave # 404
Lakewood 80235
(303)986-2212
Thompson DDS, Dennis
3190 S Wadsworth Blvd # 300
Lakewood 80227
(303) 988-6110
Titus DDS, Timothy
7114 W Jefferson Ave # 208
Lakewood 80235
(303) 988-0488
Vanderven DMD, Franc
3333 S Wadsworth Blvd # D 211
Lakewood 80227
(303) 969-9150
Will DDS, Joseph
2290 Kipling St
Lakewood 80215
(303)232-3443
Will DDS, Peter
2290 Kipling St
Lakewood 80216
(303)232-3443
Williams DMD, Dee
2599 Wadsworth Blvd
Lakewood 80215
(303) 233-0475
Lamar- General
High Plains Community Hlth Ctr
200 Kendall Dr # 1
Lamar 81052
(719) 336-8445
Branes DDS, Gerald
109 W Lee # 5
Lamar 81052
(719)336-7323
Sprout DDS, Gilbert
110 S 5th St
Lamar 81052
(719)336-9023
Leadville - General
Brookshire DDS, Jack
919 Hamiann Ave
Leadville 80461
(719)486-2232
Limon - General
Hines Jr DDS, John
170 E Ave
Limon 80828
(719) 775-8758
Littleton - General
Ahern DDS, John
2275 E Arapahoe Rd #136
Littleton 80122
(303)797-6453
Amundson DMD, Peter
7900 S University Blvd # 100
Littleton 80122
(303) 773-9400
Barker DDS, Stephen
7889 S Lincoln Ct # 202
Littleton 80122
(303)798-4967
Barton DDS, Stephen
5622 S Delaware St
Littleton 80120
(303) 794-1707
Becker DDS, Amy
2 W Dry Creek Cir # 125
Littleton 80120
(303)794-6800
Bevan DDS, David
7889 S Lincoln CI # 100
Littleton 80122
(303)798-1454
Blanchard DDS, Jason
8089 S Lincoln St # 102
Littleton 80122
(303)794-9271
Littleton - General
Boeyink DDS, Timothy
7920 S University Blvd # 200
Littleton 80122
(720)489-7333
Burkhart DDS, Scott
7761 Shaffer Parkway # 230
Littleton 80127
(303) 973-31115
Burns DDS, William
5125 S Kipling St # 315
Littleton 80127
(303)979-2546
Bustamanle DDS, A Dianne
7500 S University Blvd # 111
Littleton 80122
(303)770-1100
Cadlle DMD, C Daren
6901 S Pierce St # 335
Littleton 80128
(303) 973-1900
Carlson DDS, Vance
7325 S Pierce St # 200
Littleton 80128
(303) 932-6018
Casson DDS, Anne
5401 S Prince St # 101
Littleton 80120
(303) 797-3867
Caulfield DDS, Jon
8340 Sangre De Cristo Rd # 206
Littleton 80127
(303)972-2224
Cavanaugh DMD, Mark
2 W Dry Creek Cir # 125
Littleton 80120
(303) 794-6800
Cavanaugh DMD, Valerie
2 W Dry Creek Cir # 125
Littleton 80120
(303) 794-6800
Chernoff DDS, Kenneth
5151 S Federal Blvd G2
Littleton 80123
(303)795-1107
Colt DDS, James
9200 W Cross Dr # 407
Littleton 80123
(303) 933-4117
Creer DDS, David
6179 S Balsam Way # 220
Littleton 80123
(303) 932-2872
Creer DDS, Lonn
6179 S Balsam Way # 220
Littleton 80123
(303)932-2872
Danna DDS, Charles
7761 Shaffer Pkwy # 250
Littleton 80127
(303) 933-2522
Devlin DDS, Julie
7720 S Broadway # 300
Littleton 80122
(303)795-1213
Echols DDS, Steven
10184 W Balleview Ave # 220
Littleton 80127
(303)932-1077
Elson DDS, Christopher
11614 W Balleview, Ave # L
Littleton 80127
(303) 972-2700
Etc DDS, Robert
7500 S University Blvd # 111
Littleton 80122
(303)770-1100
Farley DDS, Lynn
6930 S University Blvd # 204
Littleton 80122
(303)794-1415
Febeley DOS, Lisa
7562 S University Blvd # J
Littleton 80122
(303) 779.4334
Fond DDS, Thomas
5959 S University Blvd
Littleton 80121
(303) 795-7674
N
0l
Page 17 'means DPO Dentist at the time of publication 0104103
Littleton - General
Friedl DDS, Michele
5959 S University Blvd
Littleton 80121
(303)795-7674
Toning DDS, Thomas
r102 W Ken Caryl Ave # 200
Littleton 80128
(303) 978-9572
Geck DDS MS, David
10288 W Chatfield Ave If 103
Littleton 80127
(303) 973-9663
Gitlin DDS, Larry
11757 W Ken Caryl Ave # J
Littleton 80127
(303) 979-9488
Glass DDS, Walter
7325 S Pierce St If 201
Littleton 80128
(303) 9794981
Goral DDS, Alan
10789 W Bradford Rd # 100
Littleton 80127
(303) 933-3263
Green DDS, Richard
8010 S Holly St # 250
Littleton 80122
(303) 770-3333
Greene DDS, Craig
8441 W Bowles Ave # 220
Littleton 80123
(303)979-2544
Grout DDS, Jeffrey
8 W Dry Creek Cir # 101
Littleton 80120
(303) 730-1222
Grout DDS, Ronald
8 W Dry Creek Cir # 101
Littleton 80120
(303)730-1222
Gryzick DDS, David
6691 W Ken Caryl Ave
Littleton 80128
(303) 9794994
Halls DDS, Mark
5590 S Windermere
Littleton B0120
(303) 794-3003
Hasselback DDS, Christopher
129 W County Line Rd
Littleton 80126
(303) 738-9499
Hendry DDS, Robed
9200 W Cross Or # 407
Littleton 80123
(303) 9334117
Hill DDS, Elizabeth
6638 W Ottawa Ave # 200
Littleton 80128
(303)973-1112
Hoang-zuan DDS, Khiem Duy
129 W County Line Rd
Littleton 80126
(303) 738-9499
Hobbs DDS, Donald
6691 W Ken Caryl Ave
Littleton 80128
(303) 979-4994
Hoeft DDS, Paul
6690 S Broadway
Littleton 80121
(303) 794-6339
Hubble DDS, Gregory
9200 W Cross Or # 315
Littleton 80123
(303)979-1600
Johnson DMD, Bruce
8 W Dry Creek Cir # 200
Littleton 80120
(303) 797-9099
Johnson DDS, Charles
5401 S Prince St # 101
itlleton 80120
r303) 797-3867
Johnson DDS, Scott
7325 S Pierce St # 104
Littleton 80128
(303)979-0229
Littleton - General 1
` Jolstad DDS, Mark
129 W County Line Rd
Littleton 80126
(303)738-9499
Kinder DDS. Bruce
9083 W Peakview Or
Littleton 80123
(303)979-0654
King DDS, James
6650 S Vine St # 260
Littleton 80121
(303) 795-0066
Kissinger DDS, Scott
7889 S Lincoln Ct # 202
Littleton 80122
(303) 7984967
Klumb DDS, Thomas
8420 W Coal Mine Ave
Littleton 80123
(303)904-2273
Lampert DDS, Jodi
8120 S Holly St#116
Littleton 80122
(303) 779-8948
Liberman DMD, Atlam
7720 S Broadway If 430
Littleton 80122
(303)795-1443
Lim DDS, Shaun
8500 W Bowles Ave # 305
Littleton 80123
(303)972-2988
Lind DMD, Stace
8290 S Holly St If A
Littleton 80122
(303)770-9901
Lindsay DDS, Scott
8290 S Holly St # A
Littleton 80122
(303)770-9901
Loper DMD, Darlyne
5728 S Gallup St
Littleton 80120
(303) 794-3969
Love DDS, Michael
129 W County Line Rd
Littleton 80126
(303)738-9499
Lunders DDS, Jennifer
8170 S University Blvd 240
Littleton 80122
(303) 770-1106
Madden DDS, Robert
9200 W Cross Or # 300
Littleton 80123
(303)973-5859
Matoy DDS, Robert
5419 S Curtice St
Littleton 80120
(303)798-4515
Maloy DDS, Shawn
5419 S Curtice St
Littleton 80120
(303) 798A515
Masterson DOS, Timothy
8120 S Holly St # 208
Littleton 80122
(303) 770-2254
Meyer DDS, M William
6691 W Ken Caryl Ave
Littleton 80128
(303) 979-4994
Miller DDS, Andrew
6885 S Marshall St
Littleton 80128
(303)979-2900
Moreland DDS, Jodie
5590 S Windermere St
Littleton 80120
(303) 7984571
Motzkus DDS, Paul
10789 Bradford Rd
Littleton 80127
(303)979-6075
Mullins DDS, Rob
7940 S University Blvd #200
Littleton 80122
(720)482-0793
Littleton - General
Noyes DDS, Michael
6650 S Vine St If 220
Littleton 80121
(303) 797-0832
Offerdahl DMD, John
8246 West Bowles Ave If S
Littleton 80123
(303)932-0200
' Oldershaw DDS, William
8420 W Coal Mine Ave
Littleton 80123
(303)904-2273
Olson DOS, Richlund
6930 S University Blvd If 204
Littleton 80122
(303) 741-4600
Pavel DDS, Margamla
8370 W Coal Mine Ave # 103
Littleton 80128
(303) 978-1522
Perlov DDS, Alvin
6930 S University Blvd #200
Littleton 80122
(303)770-1915
Porter DDS, James
7900 S University Blvd If 210
Littleton 80122
(303) 224-0400
Preston DDS, James
5950 S Platte Canyon Rd
Littleton 80123
(303)797-2286
Pucheril DDS, Aneem
7660 S Pierce St
Littleton 80128
(303) 972-7227
Richardson DDS, Brian
8089 S Lincoln St# 102
Littleton 80122
(303) 794-9271
Roepe DDS, Steven
8246 West Bowles Ave # S
Littleton 80123
(303)932-0200
Sanchez DDS, Phillip
7889 S Lincoln Ct # 202
Littleton 80122
(303) 7984967
Scheich DDS, Stephanie
5151 S Federal Blvd G2
Littleton 80123
(303) 795-1107
Schindler DDS, Joy
2305 E Arapahoe Rd # 250
Littleton 80122
(303) 798-2305
Secora DDS, Greg
6736 W Coal Mine Ave
Littleton 80123
(303) 973-9000
Seuell DDS, John
26 W Dry Creek Cir If 430
Littleton 80120
(303)794-6959
Smialek DDS, Barry
6650 S Vine St # L20
Littleton 80121
(303) 794-1204
Tedford DDS, Terry
7562 S University Blvd # J
Littleton 80122
(303)770-8278
Thompson DOS, Scot
7735 W Long Or # 9
Littleton 80123
(303) 933-8880
Tidwell DOS, Scott
2001 E Easter Ave If 203
Littleton 80122
(303) 794-5357
" Tomasetti DMD, David
7889 S Lincoln Ct# 100
Littleton 80122
(303)798-2822
Trani DDS, Tram
9860 W Belleview Ave
Littleton 80123
(303)933-9969
Littleton - C 1 A
Uchida DDS, Thomas
5035 S Kipling Pkwy If B2
Littleton 80127
(303) 933-3111
Vetowich DOS, Michael
129 W County Line Rd
Littleton 80126
(303)738-9499
Volp Jr DDS, John
8 W Dry Creek Cir # 204
Littleton 80120
(303) 730-0720
Weekes DDS, Brad
8420 W Coal Mine Ave
Littleton 80123
(303) 904-2273
Wheeler DDS, David
6169 S Balsam Way # 330
Littleton 80123
(303)933-8230
Wilsted DDS, Neal
7920 S University Blvd # 200
Littleton 80122
(720)489-0797
Wimpee DDS, Philip
6885 S Marshall St
Littleton 80128
(303) 979-2900
Wood-harman DDS, Beckie
5959 S University Blvd
Littleton 80121
(303)795-7674
Wostrel DDS, Terry
7720 S Broadway # 410
Littleton 80122
(303) 797-6129
Young DDS, J Blake
7720 S Broadway # 430
Littleton 80122
(303) 795-1443
Littleton - Oral
SurgerylEztractlons
Carroll DDS, John
7900 S University Blvd If 200
Littleton 80122
(303)224-0500
Esposito DMD, Daniel
6169 S Balsam Way # 280
Littleton 80123
(303) 933-8282
Garehime DDS, William
8120 S Holly #210
Littleton 80122
(303) 741-4441
Iverson DDS, Bruce
9200 W Cross Dr # 603
Littleton 80123
(303)932-7458
Littleton - Endodontist/Root
Canals
Burquest DDS, James
8120 S Holly St#214
Littleton 80122
(303) 796-7676
Carnes DMD, Perri
8120 S Holly St # 214
Littleton 80122
(303) 796-7676
Deal DDS, Brock
8120 S Holly St#214
Littleton 80122
(303)796-7676
Degerness DDS MS, Randolph
8340 S Sangre Decristo Rd #202
Littleton 80127
(303) 948-4884
Hubble DMD MS, Timothy
8120 S Holly St If 214
Littleton 80122
(303) 796-7676
Macameg DDS, Omar
2 W Dry Creek Cir If 170
Littleton 80120
(303) 795-9699
Littleton - Orthodontist
Alban DDS MSD, David
7889 S Lincoln Ct #102
Littleton 80122
(303) 798-0928
Callender DOS MS, Galen
6169 S Balsam Way# 380
Littleton 80123
(303)973-7771
" Gardner DDS, Robert
9878 W 8elleview
Littleton 80123
(303)978-1316
Hoggan DDS, Brent
6650 S Vine #200
Littleton 80121
1303)730-2083
Chided DDS, Scott
10288 W Chatfield Ave # 101
Littleton 80127
(303)979-0211
Resnick DDS MSD, Jeffrey
9200 W Cross Dr # 426
Littleton 80123
(303)973-8833
Rock. DDS MS, Paul
7901 Southpark Plaza # 204
Littleton 80120
(303)773-3388
Roth DDS, Justin
5151 S Federal Blvd G2
Littleton 80123
(303) 795-1107
Urbaniak DOS MS, James
6931 S Pierce St # 101
Littleton 80128
(303)978-1104
Werking DDS, Donald
9878 W 8elleview
Littleton 80123
(303)978-1316
Zinkann DDS MS, Karla
8 W Dry Creek Cir # 102
Littleton 80120
(303) 798-8293
Littleton - Pediatric Dentist
Hurd DDS, Autumn
7889 S Lincoln Ct # 203
Littleton 80122
(303) 7984400
Landgren DDS, John
6931 S Pierce St # 101
Littleton 80128
(303)978-1104
Moyer DDS MS, Barbara
10184 W Belleview # 110
Littleton 80127
(303) 9734424
Moyer DDS, Ire
10184 W Belleview # 110
Littleton 80127
(303) 973-0424
Slimmel DDS MS, Lisa
8194 S Holly St
Littleton 80122
(303) 771-8300
Littleton - Periodontist
Bernard DDS. Gary
8120 S Holly St # 204
Littleton 80122
(303) 771-6969
Glick DDS MS, Paul
6650 S Vine St #120
Littleton 80121
(303)795-5700
Shimoda DDS, Mark
7761 Shaffer Pkwy # 240
Littleton 80127
(303)979-1705
Lone Tree - General
Almeida DDS, Adam
8683 E Lincoln Ave # 200
Lone Tree 80124
(303) 790-2273
Almeida DDS, Donald
8683 E Lincoln Ave # 200
Lone Tree 80124
(303) 790-2273
Page 18 *means DPO Dentist at the time of publication 0124/03
Lone Tres - General
' Case DDS, William
9227 Lincoln Ave # 100
Lone Tree 80124
(303)925-0603
Desimone DMD, D Michael
7430 Park Meadows Dr # 100
Lone Tree 80124
(303)790-2323
Oleary DDS, Joseph
7430 Park Meadows Or # 100
Lone Tree 80124
(303)790-2323
Osborn DDS, Angela
9218 Kimmer Or # 106
Lone Tree 80124
(303)799-9993
Lone Tree - Oral
Surgery/Extractions
Robinson DDS MD, Randolph
7430 E Park Meadows Or # 300
Lone Tree 80124
(303) 706-1100
Longmont - General
Abbey DDS, Paul
1507 W Mountain View Ave
Longmont 80501
(303)678-0997
Ahem DDS, Robert
1055 17th Ave # 202
Longmont 00501
(303)7-76-3018
' Brown DDS, Stephen
641 Ken Pratt Blvd
Longmont 80501
(303)651-2700
Buck DDS, James
1055 17th Ave # 104
Longmont 80501
(303)776-1335
Castle DDS, Wayne
1361 Francis St # 202
Longmont 80501
(303) 772-8020
Caussy DDS, William
1361 Francis St it 201
Longmont 80501
(303) 776-0117
Coats DDS, Brian
1840 Mountain View Ave
Longmont 80501
(303)776-4090
Coats DDS, Frederick
1501 Mountain View Ave
Longmont 80501
(303) 776-3150
Dicks DDS, Gary
739 Emery St
Longmont 80501
(303)772-2354
' Drake DDS, Thomas
1246 N Main St
Longmont 80501
(303)678-7800
' Erikson DDS, Donald
1503 Mountain View Ave
Longmont 80501
(303) 776-7804
' Farmer DDS, Amy
920 S Hover St
Longmont 80501
(303)485-8888
' Hamblin DOS, Robert
1250 South Hover Rd # F
Longmont 80501
(303)678-1125
' Harmon DDS, Frank
1246 N Main St
Longmont 80501
(303)678-7800
Hoemer DDS, Terry
2211 Mountain View
Longmont 80501
(303) 776-2214
Jensen DDS, Douglas
1332 Linden St # 2
Longmont 80501
(303)772-2392
Longmont - G(�,
Johnson DDS, Corey
2929 17th Ave
Longmont 80503
(303)772-7622
Johnson DDS, Ronald
2929 171h Ave
Longmont 80503
(303)772-7622
Kammer DDS, Thomas
640 Tarry St
Longmont 80501
(303) 776-0633
Kelliher DDS, Joseph
2929 W 17th Ave
Longmont 8D503
(303) 772-6333
Kellogg DDS, Michael
1616 Mountain View Ave
Longmont 80501
(303) 772-3313
Knechtel DMD, Kurt
1317 Vivian St
Longmont 80501
(303)776-4229
Kusek DDS, Alan
1055 17th Ave # 201
Longmont 80501
(303)772-0317
Ladd DDS, Stanley
2211 Mountain View Ave
Longmont 80501
(303)772-5882
' Lindenmuth DMD, Robert
2051 Terry St
Longmont 80501
(303)678-7232
' Magnuson DDS, Ronald
1250 South Hover Rd # F
Longmont 80501
(303)678-1125
Maurer DDS, James
2350 17th Ave If 204
Longmont 80503
(303)772-7000
Mocary DDS, Robert
600 S Airport Rd Bldg A 200
Longmont 80503
(303) 776-3320
Mertz DDS, Guy
1950 Terry St
Longmont 80501
(303)678-1111
Mertz DDS, Peter
1950 Terry St
Longmont 80501
(303)678-1111
Mills DDS, Jay
1055 17th Ave # 203
Longmont 80501
(303)776-2020
` Obrien DDS, Robed
1446 Hover St
Longmont 80501
(303)694-9700
` Ranucci DMD, Andrew
515 Main St # B
Longmont 80501
(303)6B4-9422
Roby DDS, Todd
1055 17th Ave # 203
Longmont 80501
(303)776-2020
` Rogge DDS, Cliff
920 S Hover St
Longmont 80501
(303) 485-8888
Souza DDS, Juan
900 S Main St # 201
Longmont 80501
(303) 776-9701
Scheidles DDS, Jennifer
921 9th Ave
Longmont 80501
(303) 651-2035
Sessions DDS, Bruce
541 Main St
Longmont 80501
(303) 776-3030
Longmont - General
Visger DDS, Sean
1720 Duchess Or
Longmont 80501
(303)772-6960
' Whiftem DDS, Cathy
13876 Elmore Rd
Longmont 80504
(303) 678-7558
Longmont - Oral
Surgery/Extractions
Johnson DDS, Daniel
275 S Main #101 B
Longmont 80501
(303)485.0300
KalbBeisch DDS, Gregg
1361 Francis St # 101
Longmont 80501
(303)772-8585
Reynolds MD, Ralph
1361 Francis St # 101
Longmont 80501
(303)772-8585
Sclwettger DDS. Jerry
1055 17th Ave # 91
Longmont 80501
(303) 772,3101
Longmont - EndodontiaVRoot
Canals
' Carbone DDS MS, David
1055 17th Ave If 105
Longmont 80501
(303) 651-0202
Longmont - Orthodontist
Beckwith DDS, F Richard
1800 Mountain View
Longmont 80501
(303) 651-1315
Martin DDS, Lawrence
1361 Francis St #104
Longmont 80501
(303)772-5055
' Mcmanaman DDS, Richard
1600 Hover Rd # 01
Longmont 80501
(303) 772-7722
Venrick DDS MS, Melissa
1055 17th Ave a 103
Longmont 80501
(303)651-7771
Longmont - Perlodontlst
Hovick DDS, Craig
1055 171h Ave If 101
Longmont 80501
(303) 6785253
Singiser DDS, R Todd
1505 Mountain View Ave
Longmont 80501
(303)772-6550
Louisville -General
Belenski DDS, Alan
225 S Boulder Rd # 200
Louisville 80027
(303) 666-5080
' Bueltel DDS, Allen
339 Mccaslin Blvd Unit B
Louisville 80027
(303)673-0500
Carter DDS, Brian
1760 Centennial Or
Louisville 80027
(303)665-7505
From DDS, A Wayne
400 S Mcceslin Blvd # 207
Louisville 80027
(3031 W64900
Greany DDS, Thomas
275 Century Cir If 200
Louisville 80027
(303) 6664499
Hanson DDS, Russell
1371 Hecla Or # D2
Louisville 80027
(303)604-2609
Lour nerel
Hatch DDS, Royce
1760 Centennial Dr
Louisville 80027
(303)665-7505
Jaded DMD, Charles
1371 Heels Or If C2
Louisville 80027
(303) 604-2689
Lambert DDS, Ronald
1760 Centennial Or
Louisville 80027
(303)665-7505
Lorenz DDS, Robert
1760 Centennial Or
Louisville 80027
(303) 665-7505
Mccerty DDS, Cheryl
333 S Boulder Rd # 3
Louisville 80027
(303) 666-7267
Neill DDS, Steve
535 S Boulder Rd
Louisville 80027
(303) 666-8820
Scarpella DDS, Pasco
1068 S 881h St Unit A
Louisville 80027
(303)665-8024
Ters DDS, Martin
400 S Mccaslin Blvd # 107
Louisville 80027
(303)666-0600
` Weber DDS, John
339 Mccaslin Blvd Unit B
Louisville B0027
(303)673-0500
Wertz DDS, David
801 Main St # 220
Louisville 80027
(303)926-8225
Zedengo DDS, Wayne
1017 S Boulder Rd # B
Louisville 80027
(303) 666-7110
' Zimmel DDS, Neil
339 Mccaslin Blvd Unit B
Louisville 80027
(303)673-0500
Louisville - Oral
SurgeryfExtrections
Bluestein DDS, Eve
864 South Boulder Rd
Louisville 80027
(303)938-1161
Reisman DDS, Alan
1075 S Boulder Rd # 230
Louisville B0027
(303) 665-2377
Louisville - Orthodontist
MIN DDS MS, David
1760 Centennial Dr If B
Louisville 80027
(303)665-7333
Matcher DDS MS, Thomas
335 S Boulder Rd #1
Louisville 80027
(303)666-9717
Weinbach DDS MS, Jonathan
1075 S Boulder Rd # 235
Louisville 80027
(303)604-0300
Louisville- Pediatric Dentist
Bane DDS, Rodney
225 S Boulder Rd # 202
Louisville 80027
(303) 661-9454
Loveland - General
' Sunrise Community Health Ctr
450 N Cleveland Ave
Loveland 80537
(970)461-8942
Andersen DMD, Dennis
1907 N Boise Aveif 4
Loveland 80538
1970)667S124
Loveland - General
Ballard DDS, Stephen
2700 Madison Sit Or
Loveland 80538
(970)669-1236
Bruner DDS, Lawrence
2502 Abarr Dr
Loveland 80538
(970)669-1444
Carter DMD, David
2114 N Lincoln Ave # 201
Loveland 00538
(970) 669-0306
Curtis DDS, John
3013 N Taft Ave # 1
Loveland 80538
(970)669-8662
Dildine DDS, John
2664 Abair Or
Loveland 80538
(970) 667-2248
Edwards DDS, Mary
1242 N Cleveland Ave
Loveland 80537
(970)667-6101
Feichtinger DDS. Dale
27DO Madison Sq Dr
Loveland 80538
(970)669-1236
' Feinberg DDS, Joel
3400 W Eisenhower Blvd
Loveland 80537
(970)669-2853
Franckum DDS, James
2903 Aspen Or # G
Loveland 80538
(970) 667-6040
Goding DDS, Norman
1966 W 151h St # 1
Loveland 80537
(970)669-5700
Harden DDS, Ronald
1440 W 29th St #600
Loveland 80538
(970)6674977
Harrison DDS, Richard
2008 Blue Mass Cl
Loveland 80538
(970)669-3880
Jarve DDS, Margery
3013 North Taft Ave
Loveland 80538
(970) 667-6943
' Jimison DDS, Lori
1440 W 29th St # 400
Loveland 80538
(970) 622-0922
Krause DDS, Rhonda
1242 N Cleveland Ave
Loveland 80537
(970) 667-6101
Lacy Jr DDS. Edward
2550 Abort Or
Loveland B0538
(970)667-2372
Meaner DDS, Steven
2700 Madison Square Or
Loveland 80538
(970) 669-1236
Mioduski Jr DDS, Ted
1414 W 28th St
Loveland 80538
(970) 663-1000
Nordstrom DDS, David
1907 N Boise Ave # 5
Loveland 80538
(970)667-1236
Oligmueller DDS, James
2114 N Lincoln Ave If 201
Loveland 80538
(970)669-0306
Pearson DDS, Randall
2889 N Monroe Ave
Loveland 80538
(970) 6634730
Pitt DDS, David
1524 W Eisenhower Blvd
Loveland 80537
(970)669-3967
N
Page 19 'means DPO Dentist at the time of publication 0124103
Loveland - General
Prolti DDS, Nicole
1414 W 281h St
Loveland 80538
(970) 663-1000
alhre DDS, Richard
r04 W 15th St Ste 5
,oveland 80538
(303) 663-3542
Schreiber DDS, William
1413 N Cleveland Ave
Loveland 80538
(970)667-8782
Stacey DDS, Robert
1930 Blue Mesa Ct
Loveland 80538
(970) 667-2040
Wright DMD, David
2004 W 15th St # 3
Loveland 80538
(970)663-2133
Loveland - Oral
Surgery/Extractions
Branca DDS, Richard
1974 Blue Mesa Crt
Loveland 80538
(970)669-4802
Zulian DDS, Michael
2800 Madison Sq Dr # 2
Loveland 80538
(970) 6696850
Loveland - Orthodontist
Mclean DOS, John
1931 Boise Ave #2
Loveland 80538
(970) 663-4871
Loveland - Pediatric Demist
Gerken DDS, Louis
2800 Madison Sq Dr # 1
Loveland 80538
(970)669-7711
Loveland - Periodontist
vyersdod DDS, Ralph
40 E Eisenhower Blvd
Loveland 80537
(970)669-7300
Lyons - General
Banter DDS, Richard
3D4 Main St
Lyons 80540
(303)823-6006
Miller Jr DDS, Mahlon
305 Main St
Lyons 80504
(303)823-0180
Monte Vista - General
Combes DDS, Craig
10 Rupert Ave
Monte Vista 81144
(719)852-2589
Santi DDS, Richard
10 Rupert St
Monte Vista 811"
(719)852-2552
Montrose - General
Dmkulich DDS, Daniel
747 South 51h St
Montrose 81401
(970) 249-9811
Garcia DDS, Nomima
1425 Hawk Pkwy # 7
Montrose 81401
(970) 2494249
Hansen DDS, Douglas
1100 E Main St # D
Montrose 81401
(970)249-3330
Kroack DDS, Kalman
25 South Lot Ave
bntrose 81401
70) 2494096
Mcgowan DMD, Michael
1127 E Main St
Montrose 81401
(970) 2494301
Montrose - General
Means DDS, James
101 S Mesa Ave
Montrose 81401
(970)2494457
Sanchez DDS, Donald
747 S 5th St
Montrose 81401
(970) 249-9811
Stucky DDS, Joe
154 Colorado Ave # 201
Montrose 81401
(970) 249-1898
Montrose - Oral
Surgery/Extractions
Cayo DDS, Craig
204 S Uncompahgre St
Montrose 81401
(970)2404485
Montrose - Orthodontist
Delio DDS, Anthony
200 S Uncompahgre
Montrose 81401
(970)249-8828
Monument -General
Boniface DDS, Michael
236 N Washington St If iw
Monument 80132
(719)488-2721
Gerathy Jr DMD MS, A
125 Second St
Monument 80132
(719)481-4949
Jones DDS, David
18925 Base Camp Rd
Monument 80132
(719)488-2375
Walsh DDS, Stephen
1840 Woodmoor Or If 106
Monument 80132
(719)481-2120
Monument - Orthodontist
Timmins DDS MS, Gerard
325 Second St
Monument 80132
(719)488-2806
Monument - Pediatric Dentist
Farrar DDS, Norman
1840 WODdmeor Or If 106
Monument 80132
(719)481-2120
Morrison - General
Dean DDS, Cheryl
19423 N Turkey Creek Rd # F
Morrison 80465
(303) 6974038
Lahr DDS, Kenneth
19423 N Turkey Creek Rd # F
Morrison 80465
(303) 6974038
Nkvot - General
' Moriarity DDS, Thomas
6857 Paiute Ave
Niwot 80503
(303)652-3444
' Oneil DMD, Brian
6857 Paiute Ave
Niwot 80503
(303) 652-3444
Northglenn - General
' Best DDS, Cory
10780 N Washington
Northglenn 80233
(303) 4526630
Carroll DDS, Bernard
10780 N Washington
Northglenn 80233
(303)452-6630
trick DDS, Bruce
10780 N Washington
Northglenn 80233
(303)452-6630
Jensen ODS, Neal
11411 N Pead St
Northglenn 80233
(303) 4524556
Northglenn-General
Kellogg DDS MSD, Howard
124 E 1201h Ave
Northglenn 80223
(303)457-9328
Martin DDS, Roy
10780 N Washington
Northglenn 80233
(303)452-6630
Man DDS, Charles
11152 Huron St It 104
Northglenn 80234
(303)452-1563
Mcclure DDS, Patrick
11310 Huron St # 210
Northglenn 80234
(303)428A 155
Moss DDS, Stewart
421 W 1041h Ave # 201
Northglenn 80234
(303)427-6462
Murphy DDS, Kathleen
11411 N Pearl St
Northglenn 80233
(303) 4524556
Rieker DDS, Bryan
11150 Huron St If 211
Nodhglenn 80234
(303) 452-9200
Than DDS, Luan
11160 Huron # 102
Northglenn 80234
(303) 451-5111
Wearner DDS, Brian
10465 Melody Or It 207
Northglenn 80234
(303)452-8813
Weamer DDS, Glenn
10465 Melody Dr # 207
Northglenn 80234
(303)452-8813
Northglenn - Oral
Surgery/Extractions
` Welch DMD, Scott
421 W 104th Ave # 201
Northglenn 80234
(303) 4276462
Northglenn - Orthodontist
Crawford DDS, Stanley
11411 N Pearl St
Northglenn 80233
(303)452-4656
Northglenn - Periodontist
Scheidt DDS, Michael
11160N Huron#101
Northglenn 80234
(303)457-9617
' Wheeler DMO, Mark
11160 N Huron # 101
Northglenn 80234
1303) 457-9617
Nucla - General
Nelson DDS, John
495 Main
Nucla 81424
(970) 864-7368
Pagosa Springs - General
Rutherford DDS, J Glenn
103 Pagosa St
Pagosa Springs 81147
(970) 264-2366
Thompson DMD, Harold
228 Village Or
Pagosa Springs 81147
(970)731-2126
Thomell Jr DDS, William
75 S Pagosa Blvd # 300
Pagosa Springs 81147
(970) 7316600
Palisade - General
Day DMD, Brian
125 W 3rd St
Palisade 81526
(970)464-5123
Poodle - Gant
Ridgway DDS, Alan
223 Minnesota Ave
Paonia 81428
(970) 5273757
Parker - General
Adams DDS, Larry
11005 S Packer Rd
Parker 80134
(303)805-3588
Albin-daAs DDS, Teresa
10371 Parkglenn Dr # 175
Parker 80138
(720)851-1676
Allen DDS, Rodney
10219 Parkglenn Way # 100
Parker 80138
(720)851-6784
Burgner ODS, Dennis
17821 Cottonwood Or
Parker 80134
(720) 870-9500
Coffee DDS, Paula
11031 S Pikes Peak Or # 103
Parker 80138
(303) 8414580
Digiorgio DDS, Robert
17821 Cottonwood Or
Parker 80134
(303)699-6100
Dicey DDS, Kenneth
10521 S Parker Rd # E
Parker 80134
(303) 841-5313
Evanson DDS, Angela
18801 E Main St # 130
Parker 80134
(303) 840-3379
Geving DDS, Anna Made
10219 Parkglenn Wy # 200
Parker 80138
(303)840-2920
Gillespie DDS, Terri
12539 N Hwy 83 # B
Parker 80134
(303)841-7045
Hale DDS, Michael
19750 E Parker Sq Or # 105
Parker 80134
(303)841-3322
Hannan DDS, Greg
19700 E Parker Sq Or # A
Parker 80134
(303)041-21"
Howard DDS, Samh
11031 S Pikes Peak Or # 103
Parker 80138
(303)8414580
Jorgensen DDS, Thomas
11031 S Pikes Peak Dr If 103
Parker 80138
(303) 8414580
Killingsworth DDS, Yvette
19700 E Parker Square Or It 1
Parker 80134
(303) 841-2070
Martin DDS, Robed
19700 E Parker Sq Or # A
Parker 80134
(303) 841-2144
Martin DDS, Timothy
19700 E Parker Sq Or # A
Parker 80134
(303)841-2144
Nadk DDS, Steven
11031 S Pikes Peak Dr # 103
Parker 80138
(303) 8414580
Oneill DDS, Larry
11031 S Pikes Peak Dr # 103
Parker 80138
(303)841-7466
Petersen DDS, Michael
10219 Parkglenn Wy # 200
Parker 80138
(303)840-2920
Riley DDS, Stephen
11005 S Parker Rd
Parker 80134
(303) 805-3588
Parker- General
Scott DDS, Daniel
11005 S Parker Rd
Parker 00134
(303) 805-3588
Tatarko DDS, Olga
10371 Parkglenn Way # 250
Parker 80138
(303)840-19DO
Theroux DDS, Christine
18801 E Main St If 130
Parker 80134
(303) 840-3379
Whitney DDS, Hal
18721 E Ponderosa Or# C
Parker 80134
(303) 8054655
Parker- Oral SurgerylExtractions
Hunter MD, R Beryl
10219 Parkglenn Way # 201
Parker 80138
(303)840-7400
Parker - EndodontlsVRoot
Canals
Chalian DDS MS, G Garo
19700 E Parker Sq Or # 3
Parker 80134
(303)805-4141
' Holtzman DMD, David
19700 E Parker Sq Or # 3
Parker 80134
(303) 8054141
' Parsons DDS, Joseph
19700 E Parker Sq Dr # 3
Parker 80134
(303) 8054141
Stein DDS, Arlene
19700 E Parker Sq Or # 3
Parker 80134
(303) 8054141
Parker- Orthodontist
Collins DDS, Jeffrey
19700 E Parker Sq Or # C
Parker 80134
(303) 841-5500
Hasstedt DDS, Charles
19700 E Parker Sq Or # 4
Parker 80134
(303)841-0284
Hoggan DDS, Brant
10219 Parkglenn Way If 101
Parker 80138
(303) 84D6505
Trompeter DDS, James
19700 E Parker Sq Or it 8
Parker 80134
(303)841-2262
Wiggins DMD, Cassy
17021 Lincoln Ave # A
Parker 80134
(303)805-7111
Parker- Pediatric Dentist
Kutter-kaelin DMD, Kathryn
19700 E Parker Sq Dr # 2
Parker 80134
(303) 8056266
Penrose - General
Vanacker DDS, Alexander
712 S Broadway
Penrose 81240
(719) 372-3041
Pueblo - General
Andrus DDS, Robert Faus
1022 Liberty Lane
Pueblo 81001
(719) 5455778
Arbuckle DDS, Richard
1848 Vinewood Lane
Pueblo 81005
(719) 566-1858
Autobee DDS, Thomas
108 E Pitkin Ave
Pueblo 81004
(719) 543-8940
Page 20 'means DPO Dentist at the time of publication 0124103
GROUP DENTAL PROPOSAL
for
City of Fort Collins
Proposal Number P902
Provided by: DELTA DENTAL PLAN
4582 South Ulster St., S-800
Denver, Colorado 80237
(303) 741-9300 or
(800) 233-0860
Date: August 25, 2003
QUESTIONNAIRE
Group Dental Administrative Services Only (Cont.)
21. Will you provide COBRA services?
Delta can administer COBRA two different ways. COBRA enrollees can be included in
the billing sent to the group and they can be separately listed so the group can easily
check off premium payments received. The group in this case is responsible for
collecting the premium and making payment to Delta. Delta does offer Cobra
administration for a fee of $5.00/person enrolled under COBRA for full notification
including the initial letter and all follow-up notifications or $4.00/per person for billing
services after the person has elected to continue on COBRA.
22. Please certify that you are in compliance with HIPAA privacy regulations, and include a copy
of your privacy statement or policy.
Delta is compliant with the 834 format. See Exhibit 8 for a copy of our privacy
statement.
23. Please refer to the checklist on page 10 for additional items to submit (e.g., audited financial
statements, etc.).
Agreed.
City of Fort Collins, RFP 2003 5
Pueblo - General
Beck DDS, George
1700 N Salem Ave
Pueblo 81001
(719)545-9936
Beck DDS, Jim
1700 N Salem Ave If B
Pueblo 81001
(719)543-9797
` Bergles DDS, James
1560 Bonforte Blvd
Pueblo 81001
(719) 544-5340
` Berry DDS, Eric
1800 W Fortino Blvd # 1
Pueblo 81008
(719) 545-0400
Boren DDS, Michael
3559 Baltimore Ave
Pueblo 81008
(719) 543-8109
Bourdon DDS, Timothy
902 W 29th St
Pueblo 81008
(719)542-1212
`Chambers DMD, Alvin
405 W 15th Ste # 12
Pueblo 81003
(719)545-5213
Childress DDS, Kenneth
1407 W 29th St
Pueblo 81008
(719)543-3100
Concialdi DDS, Ron
2037 Jerry Murphy Rd # 202
Pueblo 81001
(719)545-3070
Corley DDS, William
540 E Abriendo Ave # D
Pueblo 81O04
(719)545-8422
Cortese DDS, Anthony
1848 Vinewood Lane
Pueblo 81005
(719) 566-1858
Cover DDS, James
2020 S Pueblo Blvd
Pueblo 81005
(719) 566-0206
Creager Jr DDS, Donald
2328 N Grand Ave
Puebla 81003
(719)545-3664
` Daurio DDS, Ronald
1820 Vinewood Ln
Pueblo 81005
(719)564-1102
Davis DMD MAGD, Robert
902 W 29th St
Pueblo 81008
(719)542-5300
Driscoll DDS, Dennis
3926 Sandalwood Lane
Pueblo 81005
(719)561-936D
Duran DDS, Tomas
830 W Abriendo Ave
Pueblo 81004
(719) 545-3838
` Fitzgerald DDS, Josefina
3210 Wedgewood Or
Pueblo 81005
(719)561-8115
Garbiso DDS, Gilbert
3210 Wedgewood Or # A
Pueblo 81005
(719) 561-2237
Giannetto DDS, Steven
4104 D Outlook Blvd Ste 138
Pueblo 81008
(719) 543-2271
Graves DDS, Gary
2099 W U S Hwy 50 # 120
Pueblo 81008
(719)542-3595
Healy DDS, Robert
226 W Abriendo Ave
Pueblo 81004
(719)642-8643
Page 21
�
Pueblo - Ge )-
Heun DDS. Robert
902 W 29th St
Pueblo 81008
(719)542-1212
Hurd DDS, Mark
3901 Outlook Blvd # C
Pueblo 81008
(719) 544-7020
Hurtado DDS, Michael
107 Carlile Ave
Pueblo 81004
(719)546-4649
Jagger DDS, William
510 Colorado Ave
Pueblo 81004
(719)543-1132
Johnson DDS, Jamie
1001 S Pueblo Blvd
Pueblo 81005
(719) 564-0990
Jones DDS, Clayton
2208 Thatcher Ave
Pueblo 81004
(719)543-6066
Moreschinl DDS, Richard
1000 W 6th St
Pueblo 01003
(719)542-7420
Moreschinl DDS, Ronald
1000 W 6th St
Pueblo 81003
(719) 542-7420
` Oreskovich DDS, Tony
1902 W Northern Ave
Pueblo 81004
(719) 542-8182
` Oreskovich DOS, Tony
1902 W Northern Ave
Pueblo 81004
(719)542-8182
Ortegon DMD, Ginn
401 W 12th St
Pueblo 81003
(719) 583-0555
Padula ODS, Adolph
1560 Sonforte Blvd
Pueblo 81001
(719) 544-5340
Parco DDS, Todd
1560 Bonforte Blvd
Pueblo 81001
(719)544-5340
Peck DDS, Merin
1315 S Pueblo Blvd
Pueblo 81005
(719)564-3900
` Poulson DDS, Greg
830 W Abriendo
Pueblo 81004
(719) 545-6421
Ragulsky DDS, Ronald
3939 Sandalwood Lane
Pueblo 81005
(719) 564-7737
Ready DDS, Thomas
643 S Pueblo Blvd
Pueblo 81005
(719)561-8170
` Roberts DDS, Tony
1225 N Grand Ave # 104
Pueblo 81003
(719)542-6014
Robinson DDS, David
1560 Bonforte Blvd
Pueblo B1001
(719) 544-5340
Saunders DMD, Robert
707 S Main St
Pueblo 81004
(719) 544-6787
Schultz DDS, R
430 Colorado Ave
Pueblo 81004
(719) 542-0036
Schulz DDS, Kyle
3911 Outlook Blvd
Pueblo 81008
(719)544-6788
Pueblo - General
Stricca DDS, Duilio
753 W Abriendo Ave
Pueblo 81004
(719) 543-2604
Swanson DOS, James
1001 S Pueblo Blvd
Pueblo 81005
(719) 564-D990
Takaki DDS, Alan
41 Montebello # 214
Pueblo 81001
(719)545-246B
Takaki DOS, Duane
41 Montebello # 214
Pueblo 81001
(719)545-2468
Vidmar DDS, Dennis
329 Colorado Ave
Pueblo 81004
(719)543-6878
Villalon DMD, Elmer
1225 N Main St #207
Pueblo 81003
(719)542-7844
Wohlwend DDS, Charles
902 W 29th St
Pueblo 81008
(719) 542-5300
Wohlwend DDS, Joseph
902 W 29th St
Pueblo 81008
(719) 542-5300
Pueblo - Oral
Surgery/Extractions
Day DDS, Gregory
1925 E Orman Ave # 132 A
Pueblo 81004
(719) 561-2440
Payne DDS, Wayne
1619 N Greenwood Ave # 102
Pueblo 81003
(719) 5424546
Zufall DDS, Joseph
1930 E Oman Ave
Pueblo 81004
(719)564-2842
Pueblo - EndodontistfRoot
Canals
Gimlin DDS, Dennis
1641 Horseshoe Or
Pueblo 81001
(719)542-8855
Westphal DDS MS, Reginald
2037 Jerry Murphy Rd
Pueblo 81001
(719)545-3072
Pueblo - Orthodontist
Arango DDS MS, Jose
24 Club Manor Or # 203
Pueblo 81008
(719)643-3475
Colb DDS, Michael
3901 Outlook Blvd
Pueblo 81008
(719) 543-0000
Geller DDS, Jeffrey
501 Quincy
Pueblo 81004
(719)545-7600
Ordahl DDS, John
41 Montebello # 214
Pueblo 81001
(719) 545-2468
Scott DDS, Nile
1641 Horseshoe Or
Pueblo 01001
(719) 545-2722
StnngertDDS MS, Howard
3965 Sandalwood Lane
Pueblo 61005
(719)564-3333
�1
Puel, JedlaWc Dentist
�v
Derose DDS, Edward
1022 Liberty Lane
Pueblo 81001
(719) 545-5778
Derose DDS, Michael
1022 Liberty Lane
Pueblo 81001
(719) 645-5778
Neubaum DDS MSD, Edward
2023 Vinewood Ln
Pueblo 81005
(719)564-0436
Purcell DDS, Michael
1800 Fortino Blvd # 2
Pueblo 81008
(719)543-7123
Pueblo - Periodontist
Bamhurst DMD, Kenneth
1401 Anita St
Pueblo 81001
(719)543-8808
Lyford DDS, Robert
39D3 Outlook Blvd
Pueblo 81008
(719)545-6485
Pueblo West - General
Beard DMD, Byron
50 E Harms Peak Ave # A
Pueblo West 81007
(719) 547-3737
Rangely-General
Myers DDS, Kenneth
509 S White Ave
Rangely 81648
(970)675-2389
Ridgway - EndociontlstfRoot
Canals
Vangheluwe DDS, Judy
156 Liddell Or
Ridgway 81432
(970)626-3774
Rifle - General
Davis DDS, Jack
543 West Ave
Rifle 81650
(970) 625-1391
- Dembitsky DDS, Stephen
160 E 261h St#1
Rifle 81650
(970)625-2345
Rocky Ford - General
`Valley Wide Health Services
903 S 121h St
Rocky Ford 81067
(719)254-7623
Frankmore DDS, Thomas
410 N Main St
Rocky Ford 81067
(719) 254-7582
Salida - General
Filter DDS, Jenny
113 E Sackett St
Salida 81201
(719) 539-6142
Lowther DDS, Andrew
105 F Street
Salida 81201
(719) 539-2587
Sites DDS, Brent
105 F Street
Salida 81201
(719)539-2587
Wilken DDS, Keith
105 F Street
Salida 81201
(719) 539.2587
San Luis - General
Silverthorns - General
Hill DDS, Todd
222 Summit PI
Silvedhome 80498
(970)468-8866
South Fork - General /^\
Dodgion DDS, Ead �ll
0130 Ponderosa Or
South Fork 81154
(719)873-5846
Springfield - General
Branes DDS, Gerald
900 Church St
Springfield 81073
(719) 5234603
Steamboat Spgs - General
Banks DDS, David
116 Sin St
Steamboat Spgs 80477
(970)879-5439
Dennis DDS, Eugene
440 S Lincoln Ave # B 10
Steamboat Spgs 80487
(970) 879-5630
Diehl DDS, Steven
1495 Pine Grove Rd If A 101
Steamboat Spgs 80487
(970) 879-5150
Eivins DOS, Scott
940 Central Park Drive If 210
Steamboat Spgs 80487
(970) 8714611
Ganz DDS, Neil
440 S Lincoln Ave If B 10
Steamboat Spgs 80487
(970)879-5630
Schrock DMD, Theodore
505 Anglers Or # 201
Steamboat Spgs 80487
(970)879-0817
Steamboat Spgs - Orthodontist
Welmef DDS MS,Allan
100 Park Ave If 104
Steamboat Spgs 80487
(970)8794290
Steamboat Spgs -
Prosthodondsl
Dresen DDS, William
505 Anglers Or # 201
Steamboat Spgs 80487
(970)879-0817
Sterling - General
Janda DDS, Matthew
801 Ins Or
Sterling 80751
(970) 522-4050
Faison DDS, Thomas
625 Holly Or
Sterling 80751
(970) 522-5454
Scriven DDS, Clark
629 Holly Or
Sterling 80751
(970)522-8518
Weber DDS, Gary
1402 S 3rd Ave
Sterling 80751
(970) 522-6280
Strasburg - General
Lee DDS, Robert
55981 E Colfax
Strasburg 00136
(303) 6224660
Superior- General
Atha DDS, Jason
1613 Coalton Rd
Superior 00027
(720)304-3267
`Valley Wide Health Services
` Dandy Jr DDS, Richard
North Hwy 159
1697 E Coalton Rd # B t J
San Luis 81152
Superior 80027 .�
(719) 672-3352
(303)494-9400
Nieml DDS, Thomas
1613 Coalton Rd
Superior 80027
(720)304-3267
'means DPO Dentist at the
time of publication 0124/03
Superior - General
Spencer DDS, Jaclynn
1613 Coalton Rd
Superior 80027
(720) 304-3267
1n Wagenen DDS, Jason
A 3 Coalton Rd
Superior 80027
(720)304-3267
Telluride - General
Conrad DDS, Gary
500 W Pacific
Telluride 81435
(970) 7284336
Thornton - General
Acevedo DDS, Alexander
3957 A East 120th Ave
Thornton 80233
(303) 452-3982
Babych DDS, Christopher
550 E Thornton Pkwy # 240 A
Thornton 80229
(303) 280-8878
Call DMD MS, Richard
3984 E 1201h Ave
Thornton 80233
(303)457-1513
Chien DDS, Shin
500 E 84th Ave E-3
Thornton 80229
(303)288-0888
' Choi DDS, In Chat
2200 E 1041h Ave # 112
Thornton 80233
(303)452-4142
Costa DDS, Benjamin
8989 Huron # 105
Thornton 80260
(303)428-8560
Dunn DDS, Christopher
10001 N Washington
Thornton 80229
(303) 452-2053
•eley DMD, John
J295 N Washington St
Thornton 80229
(303)451-1111
Given DDS, Carl
3901 E 112th Ave # G
Thornton 80233
(303)451-1674
Hamilton DMD, Jeffery
550 E Thornton Pkwy, # 240 A
Thornton 80229
(303) 280-8878
Hoffman DDS, Geffory
10001 N Washington
Thornton 80229
(303)452-2053
Humphrey DDS, Stephen
10001 N Washington
Thornton 80229
(303)452-2053
James DDS, Sue
9351 Grant St # 340
Thornton 80229
(303) 254-4484
Kelly DDS, Brian
3984 E 120th Ave
Thornton 80233
(303)457-1513
Olivier DDS, Jonathan
3984 E 120th Ave
Thornton 80233
(303)457-1513
Puchalski DDS, John
10001 N Washington
Thornton 80229
(303)452-2053
Ramsey DDS, David
9981 N Washington #11
Thornton 80229
03)457-3046
Richemon DMD, Leslie
550 E Thornton Pkwy # 240 A
Thornton 80229
(303)280-8878
Thornton - General
Smith DDS, Lance
12297 Pennsylvania St # 1
Thornton 80241
(303) 920-4199
Smith DDS, Mark
3984 E 120th Ave
Thornton 80233
(303)457-1513
' Stamm DDS, Heather
2200 E 104th Ave # 112
Thornton B0233
(303)452-4142
' Timlin DDS, Scott Andrew
2200 E 104th Ave # 112
Thornton 80233
(303)4524142
Unger DOS, Jennifer
3957 A East 120th Ave
Thornton 80233
(303)452-3982
Woessner DDS, Rudolph
12297 Pennsylvania St # 1
Thornton 80241
(303) 9204199
Thornton - Oral
Surgery/Extractions
' Knappe DDS, Thomas
2300 E 120th Ave # 118
Thornton 80233
(303) 451-6767
Thornton - Endodontist(Root
Canals
Barton DMD MS, Daniel
12297 Pennsylvania St # 2
Thornton 80241
(303) 9204196
Davis DDS, Matthew
12297 Pennsylvania St # 2
Thornton 80241
(303)920-4196
Thornton - Orthodontist
Hamersky DDS, Paul
12720 N Colorado Blvd # H
Thornton 80241
(303)422-6752
' Lake DDS, William
3861 E 120th Ave
Thornton 80233
(303) 427-2237
' Masan Jr DDS, James
901 E 120th Ave # E
Thornton B0233
(303)452-0077
Nelson DDS, Brian
12720 N Colorado Blvd # H
Thornton 80241
(303) 422-6752
Trinidad - General
Andreatta DDS, Paul
1723 E Main St
Trinidad 81082
(719)8464028
Berry DDS, Daniel
403 E 1 st St
Trinidad 81082
(719) 846-2259
Elsberry DDS, Gary
134 W Main # 34
Trinidad 81082
(719)546-3371
Holderness DDS, Harold
430 E tat St
Trinidad 81082
(719)846-2106
Welch DDS, Christopher
209 E Main St
Trinidad 81082
(719)846-0870
Vail - General
Corcoran DDS, Paul
953 S Frontage Rd W # 104
Vail 81657
(970)476-3991
Vail - Orthodontist
Distelhorsl DDS, Fred
4592 Streamside Cir
Vail 81657
(970)476-3463
Walsenburg-General
Schambach DMD, Bruce
104 E 6th St
Walsenburg 81089
(719)738-2544
Walsh - General
Morrow OMD, Robert
137 Kansas
Walsh 81090
(303)324-5251
Westminster - General
' Abeyta DDS, Edward
3489 W 72nd Ave #210
Westminster 80030
(303)428-6721
Belenski DDS, Gary
9191 Sheridan Blvd # 201
Westminster 80030
(303) 4264838
Bennett DDS, James
5130 W 80th Ave # 202
Westminster 80030
(303) 429-3549
' Bennett DDS, Scott
5130 W 80th Ave # 202
Westminster 80030
(303)429-3549
Bertagnolli DDS, Edward
7280 Irving St # 101
Westminster 80030
(303)429-6222
' Bertagnolli DDS, John
7280 Irving St If 101
Westminster 80030
(303)429-6222
' Borg DDS, Timothy
10359 N Federal Blvd # 110
Westminster 80260
(303)466-2300
Carpenter DDS, J Marc
8774 Yates Or # 340
Westminster 80031
(303) 427-4120
Chiovitti DDS, Nicholas
1005 W 120th Ave # 800
Westminster 80234
(303)452-2221
Demarey DDS, Robert
7901 Zenobia St
Westminster 80030
(303)429-4177
Demarco DDS, Richard
2701 W 84th Ave # 205
Westminster 80031
(303) 428-7555
Ferraro DDS, Dennis
1333 W 120th Ave # 307
Westminster 80234
(303) 288-3718
Gibbs DDS, Tamara
12030 Melody Or
Westminster 80234
(303)451-5599
Heil DDS, Brian
7919 Zenobia St
Westminster 80030
(303)429-3115
Heil DDS, Jacob
7919 Zenobia St
Westminster 80030
(303)429-3115
Jebril DDS, Hansa
8774 Yates Or # 340
Westminster 80031
(303) 4274009
Jeranko DDS, Stanley
9100 W 100th Ave # 5 B
Westminster 80021
(303)420-9720
Lack DDS, Ray
5130 W 80th Ave # A 200
Westminster 80030
(303)429A426
Westminster Intel
Lares-nelson DDS, Blanca
9100 W 100th Ave # 5 B
Westminster 80021
(303)420-9720
Lecavalier DDS, Ross
1333 W 1201h Ave # 307
Westminster 80234
(303)288-3718
' Lewis DDS, Jonathan
10359 N Federal Blvd # 110
Westminster 80260
1303)466-2300
' Long DDS, Daniel
12030 Melody Or
Westminster 80234
(303)920-4900
Masthay DMD, Robert
4955 W 72nd Ave # Lt
Westminster 80030
(303)429-1766
Mcmurtrey DDS, Lonnie
12910 Zuni St # 600
Westminster 80234
(720)872-2750
Merkel Jr DOS, Ernest
3380 W 72nd Ave
Westminster 80030
(303)4294405
Miller DMD, Mathew
8300 N Alcolt # 205
Westminster 80030
(303)426-4860
Mizoue DDS, Paul
1005 W 120th Ave If 800
Westminster 80234
(303) 452-2221
Moffitt DDS, Ben
5068 W 92nd Ave
Westminster 80031
(303)426-0023
' Pareja DDS, Claude
4070 W 72nd Ave
Westminster 80030
(303)429-7072
Pedotto DDS, Joseph
8300 N Alcott # 205
Westminster 80030
(303)4264860
Sadar-belenski DDS, Loretta
9191 Sheridan Blvd # 201
Westminster 80030
(303)426-4838
Seeks DDS, Adam
9100 W 100th Ave # 5 B
Westminster 80021
(303)420-9720
Sanders DDS, Nelson
7350 Lowell Blvd
Westminster 80430
(303)428-6571
Schaeffer DMD, Ted
12030 Melody Or
Westminster 80234
(3031451-5599
Skelton DDS, Martha
4850 W BOth Ave
Westminster 80030
(303)427-8690
Stang DDS, Jeffrey
9100 W 100th Ave # 5 B
Westminster 80021
(303)420-9720
Stiles DOS, Michael
7350 Lowell Blvd
Westminster 80030
(303)428-6571
Sullivan DDS, Daniel
1005 W 120th Ave # 800
Westminster 80234
(303)452-2221
West-bennett DDS, Kirsten
5130 W 80th Ave # 202
Westminster 80030
(303)429-3549
Willard DDS, Chris
12000 N Pews # 260
Westminster 80234
(303)457-2266
Westminster - General
Zelazek DDS, Paul
7350 Lowell Blvd
Westminster 80030
(303) 428-6571
Westminster - Oral
Surgery/Extractions
Bench DDS, Martin
9111 Benton St # 150
Westminster 80031
(303)429-2271
Pryor DMD, David
2701 W 94th Ave
Westminster 80031
(303)427-0400
Westminster -
EndodontisVRoot Canals
Leonardson DDS, T Doug
9111 Benton St
Westminster 80031
(303) 428-7773
Mcmurtrey DDS MS, Lamont
gill Benton St # 100
Westminster 80031
(303)422-6464
Westminster - Orthodontist
Chubb DDS, Thomas
5150 W 80th Ave
Westminster 80030
(303)428-3613
Harrell DMD, Ricky
1333 W 120th Ave # 303
Westminster 80234
(303)452-2277
Masan Jr DDS, James
2701 W 84th Ave
Westminster 80031
(303)428-8800
Unterseher DDS MS, Ronald
10359 N Federal Blvd # 200
Westminster 80260
(303)466-1955
Weddle Jr DMD MS, Larry
1001 W 1201h Ave # 110
Westminster 80234
(303)255-3339
Barr DMD, Elizabeth
5150 W 80th Ave
Westminster 80030
(303) 427-1952
Barr DDS, Neils
5150 W 80th Ave
Westminster 80030
(303)427-1952
Decker DDS, Jill
1333 W 120th Ave # 305
Westminster 80234
(303) 280-9036
Howe DDS, Keaton
1333 W 1201h Ave # 305
Westminster 80234
(303)280-9036
Kretsch DDS, Kimberly
1333 W 1201h Ave # 305
Westminster 80234
(303) 280-9036
Young DDS, Jeffrey
1333 W 120th Ave # 305
Westminster 80234
(303)280-9036
Wheat Ridge - General
Anema DMD, Mark
7900 W 44th Ave # 102
Wheat Ridge 80033
(303)433-7391
Antista DDS, Domenic
8850 W 38th Ave
Wheal Ridge 80033
(303) 431-5830
Barta DDS, F Dean
6985 W 38th Ave
Wheat Ridge 80033
(303)424-5411
Page 22 -means DPO Dentist at the time of publication 0124/03
Wheat Ridge -General
Bernbaum DDS, Alan
6654 W 38th Ave
Wheat Ridge 80033
(303)424-1517
Buck Jr DDS, Ronald
4350 N Wadsworth Blvd # 321
Wheal Ridge 80033
(303)420-5243
Burger DDS, Anna
7760 W 38th Ave Uiow Big # 200
Wheat Ridge 80033
(303)424-1005
Coopers DOS, Susan
3785 Kipling St
Wheat Ridge 80033
(303)421-1472
Cox DDS, Don
6494 W 44th Ave
Wheal Ridge 80033
(303) 423-2555
Dell DDS. Colman
8850 W 38th Ave # C
Wheat Ridge 80033
(303)421-3556
Depose DDS, Louis
3805 Marshall St # 300
Wheat Ridge 80033
(303)420-8478
Dumke DDS, Paul
7863 W 38th Ave
Wheat Ridge 80033
(303)424-3993
Ebner DDS, Norman
6605 W 38th Ave
Wheal Ridge 80033
(303) 424-6421
Freimuth DDS, Michael
8850 W 381h Ave
Wheat Ridge 80033
(303)431-5830
Freimuth DDS, Ronald
8850 W 38th Ave
Wheat Ridge 80033
(303)4315830
Gershlenacn DDS, Michael
7900 W 44th Ave # 104
Wheal Ridge 80033
(303) 425-4111
Graham DDS, D
0850 W 38th Ave
Wheat Ridge 80033
(303)431-5830
' Hairy DOS, Christopher
7900 W 44th Ave #106
Wheat Ridge 80033
(303)422-3813
Herrera DDS, Thomas
6175 W 38th Ave
Wheat Ridge 80033
(303) 940-9755
Johnston DDS, Robert
3785 Kipling St
Wheat Ridge 80033
(303)421-8753
Kcike DDS, Kimberly
7900 W 44th Ave If 105
Wheal Ridge 80033
(303)422-5817
Mahoney DDS, Ronald
6055 W O6Ih Ave
Wheat Ridge 80033
(303)422-2333
Omi DMD, Sheldon
7900 W 44th Ave # 101
Wheat Ridge 80033
(303)422-7978
' Poczatek DDS, Sharon
4045 Wadsworth #104
Wheat Ridge 80033
(303)421-5751
Robinson DDS, Harold
4485 Wadsworth Blvd # 305
Wheat Ridge 80033
(303)431-1221
Scherber DOS, Joseph
4045 Wadsworth Blvd # 103
Wheat Ridge 80033
(303)421-2702
Wheat Rldg9; end
` Sekiya DDS, Floyd
79DO W 44th Ave # 101
Wheal Ridge 80033
(303)422-7978
Sherlock DDS, Edward
8850 W 38th Ave # C
Wheal Ridge 80033
(303)420-1010
Shope -Tomlinson DMD, C Susie
7900 W 44th Ave # 105
Wheat Ridge 80033
(303)422-5817
Sullivan DDS, Cort
6785 W 38m Ave
Wheat Ridge 80033
(303)425-6123
Sullivan DDS, Margot
3655 Lutheran Pkwy # 402
Wheat Ridge B0033
(303)421-4820
Sweeney DDS, Patrick
4350 Wadsworth Blvd #410
Wheal Ridge 80033
(303) 424-9470
` Sweet DDS, Ronald
6055 W 46th Ave # B
Wheat Ridge 80033
(303)420-3445
Thomason DMD, Ethelyn
7760 W 38th Ave Ufcw Big # 200
Wheat Ridge 80033
(303) 424-1 005
Winber DDS, Ralph
7825 W 38th Ave Bldg 1
Wheat Ridge 80033
(303)423-3592
Wyatt DDS, John
4960 Ward Rd
Wheat Ridge 80033
(303)421-0600
Wheat Ridge - Oral
SurgerylExhwilonu
` Musette ODS, Anthony
7760 W 38th Ave # 102
Wheat Ridge 80033
(303)421-4010
Schafer DDS, Natalie
7760 W 38th Ave # 102
Wheat Ridge 80033
(303) 4214010
Wheat Ridge - Orthodontist
Chapman DMD, Kevin
0852 W 381h Ave
Wheal Ridge 80033
(303) 421-9814
Windsor - General
Boltz DDS, Roger
519 Main St
Windsor 80550
(970)686-7121
Bruhin DDS, Michael
1226 W Ash St # A
Windsor 80550
(970)686-7858
` Meta DDS, Duane
1194 NAsh SI#A
Windsor 80550
(970)686-7775
Reardon DDS, William
1218 W Ash St#D
Windsor 80650
(970) 686-1 186
Weakland DDS, Patrick
214 5th St
Windsor 80550
(970)6865544
Winter Park - ProsthodoMlst
Dresen DDS, William
Pine Tree Plaza #107
Winter Park 80482
(970)726-5556
Woodland Park - General
Anderson DMD, Charles
791 Kelley Rd
Woodland Park 80863
(719)687-9219
Balthazor DDS, Terry
491 Forest Edge Rd
Woodland Park 80863
(719)687-6366
Elliott DDS, Robert
750 E Hwy 24 # 100
Woodland Park 80863
(719)686-1800
Holland DDS, Eric
300 W Lake Ave
Woodland Park 80866
(719)687-2000
Thompson DDS, Charles
451 Rampart Range Rd
Woodland Park 80866
(719)687-3131
Thomson DMD, Patrick
207 N West St
Woodland Park 80866
(719)687-6225
Yardumian DMD, Robert
791 Kelley Rd
Woodland Park 80863
(719)687-9219
Wray -General
Neumann DDS, Daniel
416 Main St
Wray 80758
(970)332-4817
Yuma - General
Schaffner DDS, Nathan
900 S Ash
Yuma 80759
(970)848-5777
i�
0
Page 23 'means DPO Dentist at the time of publication 0124)03
No Text
0
Visit Delta's Website at:
www.deltadentalco.com
You can search for a dentist, download a claim form or
access other personal account information.
d DELTA pENTALO
Delta Dental Plan of Colorado
Stanford Place III
4582 South Ulster Street
Suite 800
Denver, CO 80237
(303) 741-9300
Customer Service:
(303) 741-9305 or (800) 610-0201
15,000 1/03
Performance Guarantees
DELTA DENTAL PLAN OF COLORADO
Delta Dental Plan of Colorado
Proposed Performance Guarantees
Sample
Penalty will be assessed against annual administrative fees or retention net commissions. If penalty is assessed,
payment will be made after annual results are released. No more than 5% of administrative fee/retention net
commissions will be assessed in any given year. Quarterly results reporting will be provided on the below
Performance Measures:
Descri #itrn.
-77777777,
Raiiltltft of •Periarmance
Annual f>enalt
Average Speed of
Performance guarantee = 45 seconds
1 %
Answer
Definition:
Average speed of answer is the average length of time a caller waits
on hold before a representative answers their call. IVR calls are
included. Computed on all calls not group specific.
Abandoned Call
Performance guarantee = 5% that hang up after 30 seconds
10/1
Rate
Definition:
Percent of callers that hangs up after 30 seconds. Computed on all
calls not group specific.
Claim Turnaround
Performance guarantee = 90% within 15 calendar days
1 %
Time
Definition:
Percent of claims processed within 15 calendar days. Turnaround
time commences on the date of initial receipt of a claim form with all
the necessary information and ends on the date of adjudication of the
claim. Group specific reports are available.
Inquiry Response
Performance guarantee = 95% within 10 calendar days
1 %
Time
Definition:
Percent of written inquiries resolved within 10 calendar days. Does
not include appeals and grievances. Computed on all inquiries, not
group s ecific.
Financial Payment
Performance guarantee = 99%
1 %
Accuracy
Definition:
Percent of claim dollars paid accurately. Financial accuracy is
defined as total dollars that should be paid minus the sum of the
absolute value of dollars overpaid and/or underpaid divided into the
total claims dollars than should be paid. Analysis is a random
sample from book of business.
Timely and accurate
The Alpha Claims Listing Reports and the Experience Reports are to
1%
reports
be distributed by the 30 day following end of the claims month.
Calculation: Late distributed reports will result in the penalty being
assessed and will a I in an month where this occurs.
5% of Annual
Total Maximum Annual Penalty
Admin/Retention
Not to Exceed:
net
Commissions
All penalties are stated as a percent of total retention net commissions.
08/25/03
Financial Exhibits
DELTA DENTAL PLAN OF COLORADO
a DWG DENTAL'
Iklu Rnul %an of Colorado
Delta Dental Plan of Colorado
ADMINISTRATIVE SERVICES
For Self -Funded Plans
1. Use of Delta claim forms.
2. Eligibility verification.
3. Employee inquiry services for claim information.
4. Professional review of claims by dentists.
5. Use of Delta checks.
6. Claim payment notices to employees including statement of employee's share of
the cost of services.
7. Toll free number.
8. Full monthly claims experience reports by type of service.
9. Use of Delta network of participating dentists.
10. Preparation and printing of employee booklets with ID cards.
11. Postage costs included.
*1 vear Rate Guarantee
Efile Paper
Monthly Administrative Fee per Employee: $3.41 $3.65
Plus Paid Claims
* See Exhibit 4 for both 1 Year and 2 Year Rates
d DELTA DENTAL"
LM,. D, ..i M� of CO -A.,
PROCEDURES FOR CLAIM PAYMENT REIMBURSEMENT
Each month the group will be responsible for payment of the Administrative Fee and for
payment of claims. Two forms of transfer are available. The group may choose one
method or the other for reimbursement of claims payments; the choice must be made
prior to the inception date of coverage.
Administrative Fee
At the first of each month, a statement for the administration will be mailed to you. The
statement will include the administrative fee of $3.41 for Efile eligibility/$3.65 for Paper
eligibility per eligible employee times the number of eligible employees for that month.
Wire transfer with Invoice to Group
A representative of Delta will fax the person at the group (who has been designated by
the group to authorize transfer of funds) indicating the dollar amount of claims paid.
Group will contact their bank requesting a wire transfer of funds, for the total dollar
amount of claims paid to the Delta claims payment account established at Delta's bank.
The wire instructions are:
Type of Account: Delta Dental Plan of CO Depository/Funding Account
Name of Financial Institution: Wells Fargo
Branch: Monaco
Transit/ABA No: #102000076
Account No: #2408016005
Delta will provide a supporting invoice and a report of claims paid to Group. The group
will also receive utilization reports indicating claim paid, number of claims and dollar
amounts. This information will be shown separately for employees, spouses and
children with a final page totaling all utilization. Wire transfers will be initiated three
times per month on or about the 10th, 20th and 30th day of the month. The group is
required to transfer payment within 48 business hours of receipt of the faxed invoice.
ACH Transfer
Upon receipt of a signed authorization (sample attached), Delta will initiate wire transfer
of funds from the Group's designated account. This will be done on or about the 10th,
20th, and 30th day of the month and a supporting invoice and report of claims will be
supplied to the Group for each transfer.
Fax this form and voided check to (303) 221-4457, aun.: Accounts Receivable
a DWA DENTAL"
Delta Dental Plan of Colorado - ACH - Automatic Draft Authorization
Please print or type when completing this form.
Purpose of Authorization (please indicate one)
New Authorization
Changes to Existing Authorization (Note: Changes will be completed within 30 days of receipt date)
Name of Company:
Group Number:
Address:
City: State: Zip:
Phone No: Fax No:
Name of Depositor:
I (We) hereby authorize DELTA DENTAL PLAN OF COLORADO hereinafter called "COMPANY", to
initiate debit entries from our account indicated below and the BANK named below. I understand that
employer group eligibility can be placed on hold for a rejected draft. I also understand that this specified
account would be deducted no later than 48 hours after a claims or premium invoice is faxed to the group
contact.
Type of Account: Checking Savings
Name of Financial Institution: Branch:
Transit/ABA No: Account No:
This authority is to remain in full force and effect until COMPANY has received notification from us of
termination in such a time and in such a manner as to afford COMPANY and BANK a reasonable
opportunity to act on it.
Authorized on behalf of:
Printed Name:
Signature:
Date:
Fax this form and voided check to (303) 221-4457, aun.: Accounts Receivable
a DWA oMTAR=
NIm�nt,l%.no«olormlo
Delta Dental Plan of Colorado - Wire Transfer Payment Authorization
Please print or type when completing this form.
Purpose of Authorization (please indicate one)
New Authorization
Changes to Existing Authorization (Note: Changes will be completed within 30 days of receipt date)
Name of Company:
Group Number:
Address:
City: State: Zip:
Phone No: Fax No:
Name of Depositor:
DELTA DENTAL PLAN OF COLORADO, hereinafter called "COMPANY", authorizes the above listed
employer group to initiate wire transfer payments into the COMPANY account indicated below and the
BANK named below. I understand that employer group eligibility can be placed on hold for failure to
send timely claims or premium payments
Wire payments should be initiated to the following account:
Type of Account: Delta Dental Plan of CO Depository/Funding Account
Name of Financial Institution: Wells Fargo
Branch: Monaco
Transit/ABA No: #102000076
Account No: #2408016005
This authority is to remain in full force and effect until COMPANY has received notification from us of
termination in such a time and in such a manner as to afford COMPANY and BANK a reasonable
opportunity to act on it.
Authorized on behalf of:
Printed Name:
Signature:
Date:
Fax this form and voided check to (303) 221-4457, attn.: Accounts Receivable
Items Included with Proposal
Reports.......................................................................................I
Current Insurance Contract............................................................2
ImplementationTimeline................................................................3
MemberCommunication................................................................4
EOBSample................................................................................5
HIPAA.......................................................................................6
GeoAccess...................................................................................7
ProviderDirectories......................................................................8
Reports
DELTA DENTAL PLAN OF COLORADO
Executive Summary
2
Signature Page
3
Checklist of Items
4
Plan Designs
5
Questionnaire Responses
6
Performance Guarantees
7
Financial Exhibit
$
Items Included with
Proposal
AA%i "o IV ocnnv Mncvu WnCVIM`. cVcTcu
ALPHA CLAIMS LISTING REPORT
Delta Dental Plan of Colorado
ALPHA CLAIMS LISTING REPORT
1. Group Number and Group Name
2. Name of the person who received treatment
3. Claim number; first digit indicates year claim received; next three digits indicate
day received in Julian calendar (which numbers each day of the year beginning
with 1 for January 1 and ending with 365 for December 31); rest of numbers are
sequential numbering and have no significance.
4. Indicates the date of service for the claim.
5. Total amount submitted on the claim form. This amount can include duplicate
submissions, ineligible charges plus amounts chargeable to the patient, i.e.,
deductibles and or copayments.
6. This is the amount of the check. checks are issued three times per month on or
about the 10th, 20th and 30th of the month.
7. This is the amount chargeable to the patient, i.e., deductibles and/or
copayments.
8. This is the amount that is not chargeable to the patient, i.e., the portion of the
charged fee which exceeds the dentist's Maximum Plan Allowance for the
particular Delta program.
9. Employee's identification number; usually is social security number but can be
an assigned number if the employee objects to use of SSN for identification
purposes.
10. Name of Employee
11. Dentist's name
Delta Dental Plan of Colorado
DELTA DENTAL PLAN OF COLORADO
ALPHA CLAIMS LISTING
Month Year
Group 12341
Group Name
Date
Page 1
PATIENT
CLAIM'
DATE(S)'
TOTAL
DELTA'
PATIENT
NOT'
EMPLOYEE
EMPLOYEE
DENTIST'S
NAME
NO.
OF
'FEE
PAID
PAYS'
CHARGEABLE
SSN'
NAME"
SERVICE
LAST,FIRST
123456
MM/DD/YY
100.00
100.00
00.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
100.00
00.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
30.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MM/DDIYY
1DD.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MM/DD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MM/DD/Yl'
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MM/DDIYY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MM/DD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDD/YY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
Delta Dental Plan of Colorado
ALPHA CLAIMS LISTING
Month Year
Group 12341 SUBGROUP 000900
Group Name
Date
Page 2
PATIENT'
CLAIM'
DATEISI'
TOTAL
DELTA'
PATIENT
NOT'
EMPLOYEE
EMPLOYEE
DENTIST"
NAME
NO.
OF
'FEE
PAID
PAYS'
CHARGEABLE
SSN'
NAME 10
SERVICE
LAST,FIRST
123456
MMIDDIYY
100.00
100.00
00.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDDIYY
100.00
100.00
00.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDDIYY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDDIYY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDDIYY
100.00
50.00
50.00
30.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
LAST,FIRST
123456
MMIDDIYY
100.00
50.00
50.00
XXX-XX-3333
LAST,FIRST
FIRST LAST
2 PROCESSED CLAIMS
SUBGROUP FEES CHARGED
$600.00
DELTA PAID SUB -TOTAL
$300.00
TOTAL GROUP SUMMARY FOR GROUP 000000
139 PROCESSED CLAIMS TOTAL FEES CHARGED $2,400.00
DELTA PAID TOTAL $1,300.00
NOT CHARGEABLE $60.00
Delta Dental Plan of Colorado
EXPERIENCE REPORT
Delta Dental Plan of Colorado
EXPERIENCE REPORT
Time period for top half of report.
2. Group number and name.
3. This heading refers to utilization by subgroup.
4. Description of services: Numbers indicate the American Dental Association
(ADA) series of procedure codes.
5. Amount claimed (or submitted), allowed and paid, by category of service. Please
note the amount allowed column includes reductions for the following reasons:
a) Amount claimed exceeds the participating dentist's prefiled fee with Delta.
b) Amount claimed exceeds the allowable prevailing fee.
c) Services not covered by the plan.
d) Deductible subtracted from amount claimed.
6. Total number of dental procedures (not claims) by category of care.
7. Totals of amounts claimed, allowed and paid.
8. Total dollar amount of deductibles.
9. Total number of paid claims.
10. Amount saved as a result of Delta's secondary payment liability.
11. Fiscal/policy year-to-date information in same categories as numbers 5 through
10 above.
12. Total Group Report page: Summary of experience for the subgroups combined.
Delta Dental Plan or Colorado
Date
Page 1
DELTA DENTAL PLAN OF COLORADO
GROUP NUMBER' 'EXPERIENCE REPORT - MONTH/DAY/YEAR THROUGH MONTH/DAYIYEAR
GROUP NAME
TOTAL SUB -GROUP REPORT'
AMOUNT 5
AMOUNT'
AMOUNT'
NUMBER OF 6
CLAIMED
ALLOWED
PAID
PROCEDURES
101-999
DIAGNOSTIC
4,743.00
4,087.00
3,212.60
148
1000-1999
PREVENTIVE
3,714.00
3.096.00
2,476.80
78
2000-2399
RESTORATIVE
2.850.00
2,332.00
1,781.30
27
2400-2899
MAJOR RESTORATIVE
6,471.00
4,753.00
2,226.50
9
2900-2999
RESTORATIVE
1,474.00
1.169.00
345.30
9
3000-3999
ENDODONTICS
2,646.00
1,985.00
892.50
6
4000-4999
PERIODONTICS
3,229.00
2,256.00
893.50
19
5000-5999
REMOVABLE PROSTHODONTICS
95.00
95.00
22.50
1
6000-6999
FIXED PROSTHODONTICS
2,382.00
1.460.00
705.00
3
7000.7999
ORAL SURGERY
80.00
80.00
15.00
1
8000-8999
ORTHODONTICS
565.00
565.00
262.50
5
9000-9999
ADJUNCTIVE GENERAL SERVICES
323.20
238.00
98.60
8
'TOTALS:
28,572.20
22,116.00
12,952.10
314
'TOTAL AMOUNT OF DEDUCTIBLES:
1,148.00
10 COB SAVINGS:
88.80
TOTAL CLAIMS:
137
CONTRACT YEAR — MONTH/DAY/YEAR THROUGH MONTH/DAY/YEAR
AMOUNT
AMOUNT
AMOUNT
NUMBER OF
CLAIMED
ALLOWED
PAID
PROCEDURES
101-999
DIAGNOSTIC
53,535.20
46,057.20
36,128.06
1,660
1000.1999
PREVENTIVE
46.147.95
39,970.00
31,336.80
934
2000-2399
RESTORATIVE
53.960.00
45,256.00
33,852.75 -
512
2400-2899
MAJOR RESTORATIVE
79,913.00
61.757,00
28,967.80
- 127
2900.2999
RESTORATIVE
13,966.00
9,157.00
3,530.60
94
3000-3999
ENDODONTICS
26,686.00
22,701.00
9,919.50
62
4000.4999
PERIODONTICS
26,121.00
19,226.00
8,129.10
177
5000-5999
REMOVABLE PROSTHODONTICS
13.098.00
10,001.00
4,447.40
38
6000-6999
FIXED PROSTHODONTICS
30,635.50
25.277.50
8,437.95
61
7000-7999
ORAL SURGERY
15,366.00
12,848.00
5,306.10
135
8000-8999
ORTHODONTICS
14,384.50
13,459.50
6,373.25
71
9000-9999
ADJUNCTIVE GENERAL SERVICES
7,770.70
2,253.00
1,332.40
102
TOTALS:
381,583.85
307.962.20
177,761.71
3.973
TOTAL AMOUNT OF DEDUCTIBLES:
9,729.00
COB SAVINGS:
1,659.15
TOTAL CLAIMS:
1,664
Delta Dental Plan o/ Colorado
Group Name
Payments Received
Month/Day/Year — Month/DayNear
Premium/Admin. Claims
Fees Reimbursements
Month Group Total
Mo/Yr 1234 0.00 11,172.69 11,172.69
Mo/Yr 1234 1,693.54 0.00 1,693.54
Mo/Yr 1234 0.00 150.40 150.40
Total Payments Received: $1,693.54 $11,323.09 $13,016.63
The Payments Received Report is included in the monthly reports and is found as the
first page under the mailing label. This report identifies money received for a given
month. This report is on a billing subgroup level. The Premium column is for a fully
insured contract and the Administrative Fees and Claims Reimbursements column is
for a self -funded contract.
Delta Dental Plan or Colorado
GROUP INFORMATION
REPORT
DELTA DENTAL PLAN OF COLORADO
9/28/01
Delta Dental Plan of Colorado
Group Information
Group Number: 1234 Effective: 1/1/02
Group Name: Sample Group Terminate:
Anniversary: Jan
Month
Eligibles
Premium
Claims
Number of
Claims
Jan
2002
5,250
218,656.85
191,344.14
1527
Feb
2002
5,225
219,240.94
182,139.28
1406
Mar
2002
5,251
220,279.77
159,089.21
1247
Apr
2002
5,278
218,737.51
204,203.78
1534
May
2002
5,281
217,293.32
176,672.06
1293
Jun
2002
5,299
217,208.90
198,141.03
1469
Jul
2002
5,159
220,538.95
199,225.00
1512
Aug
2002
5,531
222,802.61
294,793.27
2157
Sep
2002
5,027
224,745.13
201,067.56
1458
Oct
2002
5,840
236,366.75
158,320.75
1232
Nov
2002
5,726
236,943.78
160,816.54
1262
Dec
2002
5,536
237,054.81
183,767.82
1398
Totals
64,403
2,689,869.32
2,309,580.44
17495
Group's Pure Loss Ratio is 85.86%
Average number of eligibles is 5,367
Group is averaging $132.01 per Claim
and 3.26 Claims per Eligible ANNUALLY
Executive Summary
DELTA DENTAL PLAN OF COLORADO
9/28/01
Delta Dental Plan of Colorado
Self -Funded Group Information
Group Number: 1234
Group Name: Sample Group
Month Eligibles
Admin Fee
Claims
Effective:
Anniversary:
Number of
Paid Claims
1/1/02
Jan
Number of
Processed Claims
Jan
2002
5,982
15,373.74
204,426.91
1978
2304
Feb
2002
6,038
15,517.66
218,781.57
2139
2457
Mar
2002
6,051
15,551.07
199,935.17
1866
2101
Apr
2002
6,074
15,610.18
233,410.23
2220
2563
May
2002
6,057
15,566.49
228,320.76
2060
2420
Jun
2002
6,090
15,651.30
260,608.84
2234
2518
Jul
2002
6,222
15,990.54
201,890.79
1912
2170
Aug
2002
6,190
15,908.30
258,807.25
2257
2521
Sep
2002
6,218
15,980.26
251,980.08
2124
2374
Oct
2002
6,216
15,975.12
236,159.91
2101
2348
Nov
2002
6,315
16,229.55
215,889.14
2046
2280
Dec
2002
6,284
16,149.88
252,938.72
2132
2379
Totals
73,737
189,504.09
2,763,149.37
25069
28435
Group's Current Administrative Fee is $2.57 per Eligible
Average number of eligibles is 6,145
Delta's Overall
ASC Average
Average Number of Annual Paid Claims 3.37 per Eligible
Average Number of Processed Claims 3.98 per Eligible
Group's
Average
4.08
4.63
COST CONTAINMENT REPORT
DELTA DENTAL PLAN OF COLORADO
DELTA DENTAL PLAN OF COLORADO
COST CONTAINMENT REPORT
GROUP NUMBER:
GROUP NAME:
TIME PERIOD:
NA
ALL DELTA GROUPS
01 /01 /2002-12/31 /2002
% OF
DOLLAR SUBMITTED
SAVINGS CHARGES
1. COB SAVINGS .................................
$
2,668,938.66
0.69%
2.
FILED FEES/UCR CONCEPT..........
$
15,770,142.77
4.10%
3.
DENIED FOR CONTRACT LIMIT....
$
8,584,697.10
2.23%
4.
ELIGIBILITY VERIFICATION............
$
25,249,658.62
6.56%
5.
NON -COVERED PROCEDURES....
$
17,055,906.99
4.43%
6.
DENTIST CONSULTANT REVIEW..
$
1,064,829.32
0.28%
7.
OPTIONAL SERVICES .....................
$
5,451,115.50
1.42%
8.
NON -BILLABLE PROCEDURES......
$
18,964,336.38
4.93%
9.
MAXIMUM/DEDUCTIBLE.................
$
24,424,007.69
6.34%
TOTAL CONTAINED ............................
$
119,233,633.03
30.97%
TOTAL SAVINGS DUE TO
THE DELTA DIFFERENCE .................. $ 41,250,423.97 10.71%
(ITEMS 2, 6, 7, AND 8)
TOTAL OF SUBMITTED CHARGES.... $ 385,033,588.15
TOTAL PAID CLAIMS ........................... $ 159,376,668.89
2/10103
COST CONTAINMENT REPORT
Explanation of Terms
1. COB SAVINGS - Dollars saved by Delta's special attention to properly applying
our Coordination of Benefits policies. COB savings are the difference between
what Delta would have paid without COB minus what was paid.
2. FILED FEES / UCR CONCEPT - Dollars saved from reduction in submitted fees
to reflect the dentist's fees as filed with Delta or the maximum Delta allowance;
the balance of which is not chargeable to the patient by the participating dentists.
3. DENIED FOR CONTRACT LIMIT - Savings resulting from procedures denied
due to specific contract limitations.
4. ELIGIBILITY VERIFICATION - Savings resulting from Delta's careful attention to
monitoring and maintaining subscriber and group eligibility records.
5. NON -COVERED PROCEDURES - Savings from procedures chargeable to the
patient but excluded or limited by the group contract. (Does not include amounts
over contract maximums, co -payments and deductibles.)
6. DENTIST CONSULTANT REVIEW - Savings from determinations on procedures
which, in the opinion of Delta's dental consultants, are not supported by
diagnostic records as being necessary.
7. OPTIONAL SERVICES - Savings from administrative determinations made by
Delta's dental consultants for the most cost-effective, dentally acceptable
alternative procedures.
8. NON -BILLABLE PROCEDURES - Procedures not chargeable to the patient or
the group contract by the participating dentists as determined by Delta's dental
consultants.
9. MAXIMUM/DEDUCTIBLE - Savings due to charges being credited to the
deductible and amounts in excess of the annual maximum benefit.
Delta Dental Plan of Colorado
INCURRED REPORT
DELTA DENTAL PLAN OF COLORADO
EXPLANATION OF THE INCURRED REPORT
The Date Incurred Report may also be called the Claims Lag
Report. The data reported here is the dollar amount paid in any given
month allocated to the month in which the services were provided.
This report can be supplied on a monthly basis by request. Self -
funded groups may especially find this information helpful in projecting
their claims liability.
Delta Dental Plan of Colorado
DELTA DENTAL PLAN OF COLORADO
DATE INCURRED REPORT --- November
DELTA GROUP NUMBER: 1234 SAMPLE
GROUP
PAYMENT DATE YEAR/MONTH
INCURRED AMOUNT
1995/11 1995/11
1,991.50
1995/10
2,279.30
1995/9
290.00
1995/8
90.00
1995/7
132.00
1995/6
1995/5
1995/4
1995/3
1995/2
1995/1
1994/12
1994/11
TOTAL 4,782.80 -
12/15/95
1995
PERCENT OF TOTAL
41.64
47.66
6.06
1.88
2.76
100.00
10
DELTA DENTAL
PLAN OF COLORADO
•
zopw
"Excellence
77
13
It's a job we take to heart. Delta Dental not onl) i; t I w states largest d -ntal benefits company —
serving more than i million Coloradoans —we're commiticd to providing the be:.t card possible for our
subscribers and their families through our relationships with tlieir employers and dentists located
throughout the state. Delta Dental contracts with a,goo Colorado licensed dentists y percent of the
mfists statewide.
As a non-profit organization, Delta Dental's primary responsibility is to provide �erviccs to our
subscribers and dentists. Delta Dental supports the needs of the community by providing benefits for
the underserved, improving oral health and creating an environment in which dentists are responsible
for the outcomes of care.
Giving Back to the Community
Delta Dentals r5o employees bring a sense of pride and service to work every day. Tlrcy also bring a
giving spirit that makes them an outstanding foundation for our company's non profit mission.
In 2003, Delta Dental received the Mile High United Way Spirit of Hope Award, for going "above and
beyond" in employees' support of the United Way campaign. We're proud of our employees and their
commitment to volunteerism.
These efforts and more distinguish Delta Dental Plan of Colorado
As Mark Twain said, "Always do right; this will gratify some people and astonish the rest."
Our goal at Delta Dental is to continue to strive to astonish -with our strong customer service, our
commitment to excellence in all we do and our perseverance in doing
good works to the benefit of our communities.
Kathryn A. Paul Will.am Lake, D.D.S.
President and CEO Clia: nnan of the Board
EXECUTIVE SUMMARY
Delta Dental's Qualifications
Delta Dental Plan of Colorado was established as a non-profit health service corporation in 1958 with the
direction and aid of the Colorado Dental Association. Today 90% of Colorado's practicing dentists are
participating members of Delta. The Service Corporation concept means that, unlike any other dental benefit
provider, Delta's participating dentists agree to support the corporation.
Delta's administrative procedures covering quality assurance and cost containment easily distinguishes Delta
from the world of ordinary carriers providing indemnity reimbursement. These procedures have been refined
through years of experience and have been successful in relationships with both privately and publicly funded
programs.
While Delta is in the risk management business, we are different from other insurance companies in subtle, but
important ways. Like some insurance companies, Delta administers group dental benefits. Unlike most
insurance companies, Delta Dental Plan is a non-profit service corporation formed specifically to provide dental
benefits - and only dental benefits.
Our computer systems are custom -designed to monitor dental claims. They check individual dental utilization,
contractual data, and eligibility of almost 1 million subscribers in Colorado. Almost 10 years ago (1993) our
claims processing was transformed from manual processing to a nearly totally automated process for routine
claims. Delta's claims processors' expertise is being used fully rather than it being used to perform routine
tasks.
Client service is provided through our toll free number to our Customer Relations department, which has a staff
who answer questions from patients, employers, and dentists regarding claims, benefits and other areas of
concern. Our Account Management staff from the Marketing department personally calls on Delta clients to
assure a smooth running dental plan. They provide answers to client's questions regarding any aspect of their
plan including billing, claims, supplies or anything the client wishes to discuss.
You can visit our website at www.deltadentalco.com. Our website is composed of 4 home pages for Patients,
Employers, Dentists, and Brokers. This site provides general information about Delta Dental Plan of Colorado.
Each home page contains a link to our e-Dental system, a link called "Performance" that takes you to our
performance statistics for the most recent three years, and a link called "Contact Us". The "Contact Us" link
contains Delta's local and toll -free phone numbers along with some important addresses and phone numbers a
subscriber may need. It also has a link to our most recent dentist newsletter "The Minor", and a "Why Delta
Dental" link that details the advantages of choosing Delta Dental as your plan of choice for dental. All home
pages also have a "Group Access" link via the "e-Dental" link in which users can log onto our e-Dental system
to view Group Benefits using their Delta Group Number.
Additionally, Delta has implemented a telephone Interactive Voice Response system with which subscribers can
obtain information regarding their eligibility and/or dental benefits including their current maximum used and
deductible paid.
As advanced as our products and services are, our real expertise lies with our people. From staff dental
consultants and dental auditors to management information system specialists, underwriters, and customer
service representatives who have worked in dental offices, you are sharing in decades of experience when
choosing a Delta Dental program.
DELTA DENTAL PLAN OF COLORADO
0
Delta Dental Plan of Colorado is not your typical insurance company.
It's a non-profit dental benefits organization dedicated to supporting dentists'
practices and improving the oral health of the communities it serves.
Delta Dental
Supports Colorado Communities
Delta Dental in 2002 has enhanced its support for community
programs. In 2002, Delta was awarded the contract for the
Child Health Plan Plus (CHP+) program, which provides dental
care for more than 41,000 low-income Colorado children.
Delta also has teamed up with the University of Colorado
Health Sciences Center School of Dentistry, through the
Delta Dental Foundation, to fund a study of CHP+ children.
The study will examine how the population has received care
in the past, the magnitude of the need and utilization patterns.
In addition, the study will identify children who have reached
their annual maximum, but still need additional dental work.^
Delta has contributed $200,000 to the Delta Dental (�
Foundation to fund the study and provide additional care
for these needy children.
Smile-A-Bration
It's a celebration of healthy smiles for uninsured kids. As part
of its non-profit mission, Delta Dental Plan of Colorado in
2002 created Smile-A-Bration, a day of free dental care for
needy children in Colorado.
The program, implemented in 2003, is a partnership with
Delta Dental and the Colorado Dental Association — the largest
effort of its kind in Colorado. More than zoo dentists statewide
will provide care for 3,000 uninsured children.
Delta Dental has earmarked $300,000 for the Smile-A-Bration
program. These funds will pay for a variety of dental
procedures — including dental exams, cleanings, fillings,
X-rays and other services.
If participating dentists donate their time to the program, the
money will be given to the Colorado Dental Association's
Charitable Fund. 40
-)elta Dental Foundation
Delta Dental created a foundation in 1997 to provide
economic support to non-profit organizations providing
dental services to disadvantaged populations. In 2oo2, Delta
contributed more than $200,000 through the foundation to
community programs.
f
Delta has made contributions to Kids in Need of Dentistry
(KIND), the Colorado Foundation for Dentistry for the
Handicapped, the Marillac Clinic in Grand Junction, the
Melvin Turner Trust in Colorado Springs, among others.
The foundation in 2003 will undertake a strategic planning
process to refine its mission and to consider new ways to
meet the needs of our communities.
Michael )ones, itz s„ grew up Owbom" Tints was rskevod s o
Delta Dental Listens to Its Customers
in ahousimgl�rcjeriirrSan wmtotheCl€R+ltmgrsemafier
Franeisco Ne has a plidure of leer t�tetnpsprariy lost-
Delta Dental Plan of Colorado in 2002 asked our customers
himself sit a boy' on the wall of us jcb."Tlo Tltms bn*has
how we were doing.
Ids +. wig In
Delta Dental surveyed dentists, subscribers and brokers — and
kz
Chi tows C[ie+lo';— *,K oftee age f awe S'ty.
asked them what they thought of our products and services.
' t�aahh
They gave us valuable input on what we're doing right and
Cant er.' He I t Ntiiekrlt gtcaMirtg "The sit of sire asps
f that we need to improve.
u{s Ina ;is wat'S haveP ", ; ' %filpattk
When asked to rate their satisfaction with Delta, using a
s 77;
scale of Very Satisfied or Not At All Satisfied, nine -out -of -ten
dentists (go%) surveyed said they were "Very' or "Somewhat
Satisfied." Four -out -of --ten (qr%) chose the highest rating of
77
"Very Satisfied."
'�' Ifsstr
Good customer service and fast claims payment were the most
"
frequently cited as what dentists liked most about Delta Dental,f
And when it came to the courtesy of Delta's customer service
representatives, seven -out -of --ten provided the highest rating
possible, "Very Satisfied," when describing the interactions
"
they've had.
P
Nine -out -often brokers (87%), who sell Delta Dental products,
.
reported being satisfied with Delta, with half (q 9%) giving
the highest rating of "excellent" overall. Additional areas in
which brokers gave Delta exceptional or strong ratings
included the following:
• The good -working relationship and ease of
dealing with Delta.
• Delta's large network of dentists.
Although we were pleased with these positive responses,
• The ease of administering Delta's plans. Employees also
we see opportunities to further listen to and respond to the
were able to easily understand the plans, brokers say.
concerns of our customers and dentists.
The high quality service provided by Delta's customer service
Our partnerships with customers are key to how we do
representatives.
business. We'll continue to strive to meet their needs.
Delta Dental Launches
New Products in 2002
Delta Dental Plan of Colorado is committed to providing
0
dental benefits to underserved markets. We developed two new
products in 2002 to give dental coverage to people who would
not have been able to obtain it by any other means.
DeltaPreferred Option Small Group Plan
The DeltaPreferred Option (DPO) Small Group Plan will
provide Delta Dental services for employer groups with 5-9
employees. These smaller employers have not been able to
receive Delta Dental benefits in the past.
The DPO Small Group Plan uses a discounted fee
arrangement for providers used in- and out -of -network.
Employers will be offered two options that cover diagnostic,
preventive, basic and major services at different rates. If a
subscriber uses a DPO dentist, the deductible for diagnostic
and preventive services is waived.
Voluntary Group Dental Plan
The Voluntary Group Dental Plan gives employers, who canno
afford or choose not to pay the full cost of a dental benefits
plan, the ability to offer a plan to their employees. The
employees, who would not have had dental benefits otherwise,
will pay part of or the entire premium for dental benefits.
The choices in plan designs were created to give employees
and families the services they require. Services are grouped in
five distinct categories: diagnostic and preventive, basic, major,
major restorative and prosthetic and orthodontic services.
products offered by
Dental Plan of Colorado:
DeltaPremier Plan
The DeltaPremier Plan is a managed fee -for -service plan in
which patients may choose any licensed dentist for treatment.
Delta makes a direct payment to DeltaPremier participating
dentists. The patient is only responsible for the payment of the
deductible and coinsurance portions of the charge.
' Delta Preferred Option (DPO)
Patients may choose any licensed dentist for treatment under
the DeltaPreferred Option Plan. If the patient chooses a
DeltaPreferred Option dentist, services are provided at a
reduced fee that has been accepted by the dentist. The reduced
fee means the patient's share, based on the fee, is less than it
would be under the DeltaPremier Plan. This reduced fee is only
if the patient goes to the DPO provider.
Exclusive Preferred Option (EPO)
Patients, whose employer chooses an EPO Plan, select a
dental office from a listing of panel dentists provided by
Delta Dental. This location becomes the primary center for the
dental needs of the enrollee. This product provides no benefit
for services received out of panel, but patients may go to any
dentist listed within the panel.
Administrative Service Contracts
Self -funded dental plans purchase administrative dental
services and the use of Delta Dental's provider network.
Jnder these agreements Delta Dental provides the dental
services that it normally would provide under the
DeltaPremier or DeltaPreferred Option plans. Self funding
employers pay administrative fees to Delta Dental for
processing claims, the use of network providers and for
additional administrative services.
e-Dental Offers Ease of Service
Delta Dental Plan of Colorado wants to make doing business
as easy as possible.
In aooa, our customers — dentists, brokers, benefit
administrators and subscribers — accessed e-Dental,
a web -based online system, more than 428,000 times.
The system allows customers to quickly and easily perform a
variety of claims- and eligibility -related tasks — all with the click
of a mouse.
e-Dental is easy to use. Customers can access the system aq
hours a day, seven days a week. And the system provides more
privacy, security and confidentiality than paper records. It's also
'ree of charge. Access to the Internet is all that is needed.
Financial Strength
Delta Dental meets its mission through sound business
practices that combine excellent customer service with carefi l
stewardship of resources. Delta Dental posted $186 million in
premium revenue for the fiscal year 2002, a net gain of $q
million and $32 million in capital reserves.
Serving Our Customers
Delta Dental continues to raise the standard when it comes to
customer service. In 2002, Delta Dental processed more than
1.4 million dental claims — approximately 27,00o every week
with an accuracy rate of 99 percent.
More than 68,00o customers use our e-Dental online service
to do business, allowing us to meet their needs with even
greater speed and efficiency.
Delta Dental's unique cost control measures and contractual
agreements help ensure quality care at moderate fees, saving
groups more than $rg million in 2002.
District Denver Public Schools University of Colorado
Abuse and Neglect through Dental Awareness) Dental Aid
o Bicycle Health Promotion Project
Excelsior Youth Centers
(4 Condensed Balance Sheet
Years ended December 31 (in thousands)
2002 2001
Assets
Cash and investments $ 35,197 $ 27,931
Accounts receivable 9,656 11,u6
Property and equipment, net and other assets 3,927 4,304
Total assets $ 48,78o $ 43,351
Liabilities
Loss and loss adjustment reserves $ 12,042 $ 12,100
Unearned premium 1,021 750
Accounts payable and accrued liabilities 3,489 1,977
Total liabilities $ 16,552 $ 14,827
Reserves
Reserves $ 32,228 $ 28,524
CTotal Liabilities and Reserves $ 48,780 $ 43,351
Condensed Statement of Operations
And Fund Reserves
Group revenues $ 186,151 $ 159,839
Investment income 1,540 1,485
Total revenues $187,691 $ 16l,324
Benefits for services to members
And operating expenses $183,692 $ 157,650
Net gain 3,999 3,674
Reserves at the beginning of the year 28,524 25,621
Change in unrealized appreciation (depreciation) (128) (728)
on investments
Unfunded pension gain (loss) (167) (43)
Reserves at the end of the year $ 32,228 $ 23,524
(Complete audited financial statements are available for inspection
at our corporate offices upon request.)
Standard and PwWs Rating
In 20o2, Delta Dental Plan of Colorado was rated by Standard & Poor's and
continues to maintain a financial security rating of Strong, A-.
7
Delta Dental Plan of
Colorado Executive Staff
Kathryn A. Paul
President and CEO
Linda M. Arneson
Vice President Operations
Frank P. Bellipanni, D.D.S.
Vice President
Professional Affairs
Dennis R. Phillips
Vice President Marketing
Russell J. Schreier
Vice President Finance
Barbara B. Springer
Vice President Administration
8
0
communities
ids in Need of Dentistry (KIND)
0
Neighbors in Health Fair
United Way
Kaiser Permanente
Human Services, Inc.
Wilderness on Wheels
!> DELTA DENTAL
0A., Plan „r�
N) Ilm 510,�',
Drum, CO-�cerr,I(,,A
v,�\ \� Ji I Ct'l i,. I!,[ l<<i.,n[ it
u
111
Current Insurance Contract
DELTA DENTAL PLAN OF COLORADO
COMPANY HISTORY
Delta's History and Organization
Colorado Dental Service was founded in 1958 to meet the growing interest in dental prepayment programs. The
name was changed in 1978 to Delta Dental Plan of Colorado; one of 48 states which belong to a nationwide
organization known as Delta Dental Plans Association. Delta is a nonprofit health care service corporation.
In 1987, Delta Dental Plan of Colorado added the DeltaCare capitation product to its portfolio and in 1991 the
Delta Preferred Option was introduced. In 2002, Delta introduced two principal Voluntary Plans — Gold and
Platinum.
On a national level, Delta Dental is a network of independent dental Plans that conduct business in all 50 states,
the District of Columbia, and Puerto Rico. These Plans are all members of the Delta Dental Plans Association
(DDPA); whose mission is to help improve the overall oral health of the nation by making dental care more
available and affordable to the public through the expansion of dental benefits programs. Delta Dental's unique
cost control measures and contractual agreements with dentists help to ensure quality care at moderate fees,
saving groups nationally over $3 billion in 2002. Delta Dental's panel of dentists for its fee -for -service product
is the country's most extensive. Delta contracts with almost three out of four dentists in over 135,000 locations
across the country.
Delta Dental Plan of Colorado's present annual group dental insurance volume is approximately
$180,249,000.00.
Organization and Vital Statistics
Delta is a non-profit health care service corporation licensed in the State of Colorado to promote the health and
welfare of the people of the State of Colorado; therefore, Delta does not have public or private ownership.
Legal name: Colorado Dental Service d.b.a. Delta Dental Plan of Colorado
4582 S. Ulster Street, Suite 800
Denver, CO 80237
Phone: 1-800-233-0860 or 1-800-610-0201
Fax:303-741-9338
Standard & Poors' rating = A- for years 2000, 2001, 2002
Delta Dental has alliances with Rocky Mountain HMO, Kaiser Permanente, CEBA, CANPO, and U.S. Life.
DELTA DENTAL PLAN OF COLORADO
AMENDMENT TO AGREEMENT
GROUP #1857
The CONTRACT dated January 1, 1999 as amended between CITY OF FORT COLLINS and DELTA
DENTAL PLAN OF COLORADO is hereby further amended effective January 1, 2002 as follows:
PART IV ELIGH31LITY
Section 1. ENROLLMENT OF DEPENDENTS
[. [-lily � � [ l� Altl�l l�i�l�l [ \�3�Z� 1 � � \� lti•l�l L•i1 <•� lti i1�i� l� lei [ \t•�1�1'l�i [! \i l�=�.A1�1 [ \�1�1�1 [ t• \mil l• � � Itii l l�i� I l•�1�1.1�1 [� l��
a) Newly acquired dependents who are enrolled in the medical plan provided by this employer
must be enrolled within thirty-one (31) days of acquisition. Newborn children must be
enrolled within thirty-one (31) days of birth.
b) Any eligible dependents that suffer involuntary loss of coverage through another sources
will be allowed to enroll with satisfactory proof of coverage loss. Such dependents must
be enrolled within thirty-one (31) days of the loss of coverage and must be enrolled in the
medical plan provided by this employer.
The Continued Coverage Option Rider attached hereto includes amended provisions of COBRA.
All other provisions of this Contract shall remain as previously stated.
DELTA DENTAL PLAN OF COLORADO
By�,�
Authorized Signature
DATED: JANUARY 1, 2002
CITY OF FORT COLLINS
On January 7, 2002 On
Title:
AMENDMENT TO AGREEMENT
GROUP #1857
The Agreement dated January 1,1997 as amended between CITY OF FORT COLLINS and DELTA DENTAL
PLAN OF COLORADO is hereby further amended effective January 1, 2003 as follows:
PART 1 PREFERRED OPTION ADMINISTRATIVE AGREEMENT
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT - On the tenth (10th), twentieth (20th), and
thirtieth (30th) day or the last business day closest to such date of each month, Delta will notify
the Group of the total claims paid for the specified period. The Group will make a prompt
transfer of funds to Delta to cover such disbursements as they become due and payable upon
receipt of said notification. In addition, the Group agrees to reimburse to Delta a monthly
Service Fee of $3.18 per eligible employee.
PART V BENEFITS, LIMITATIONS AND EXCLUSIONS
Section 1. DIAGNOSTIC PREVENTIVE AND ADJUNCTIVE BENEFITS
b) Limitations on Diagnostic, Preventive and Adjunctive Benefits:
1) Benefits for oral examinations and prophylaxis treatment (adult and child) shall not
be provided more than twice each in any twelve (12) month period except for
special need as determined by Delta. For payment purposes, an adult prophylaxis
is not a benefit for persons under age fourteen (14). Allowance separate from the
allowance for oral examination shall not be made for diagnosis, treatment planning
or consultation by the treating dentist, which for purposes of this Contract, are
considered components of a complete examination service.
All other provisions of this Agreement shall remain as previously stated.
DELTA DENTAL PLAN OF COLORADO
By
Authorized Signature
DATED: JANUARY 1, 2003
CITY OF FORT COLLINS
M
On December 16, 2002 On
Title:
AMENDMENT TO AGREEMENT
GROUP #1857
The Agreement dated January 1, 1999 as amended between CITY OF FORT COLLINS and DELTA
DENTAL PLAN OF COLORADO is hereby further amended effective January 1, 2002 as follows:
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT - On the tenth (10th), twentieth (20th),
and thirtieth (30th) day or the last business day closest to such date of each month, Delta
will notify the Group of the total claims paid for the specified period. The Group will make
a prompt transfer of funds to Delta to cover such disbursements as they become due and
payable upon receipt of said notification. In addition, the Group agrees to reimburse to
Delta a monthly Service Fee of $2.82 per eligible employee.
PART IV ELIGIBILITY
Section 1. ELIGIBLE PERSONS
All full-time permanent active employees working a minimum of twenty (20) hour per week
shall become eligible the first day of the month following thirty (30) days of employment.
Employees who have been absent from work due to strike, lay-off or leave of absence, and
who return to work, will become eligible on the first day of the month following the return
to work, provided the absence does not exceed six (6) months. If an absence exceeds six
(6) months, then such employees shall be considered newly hired employees in every
respect and must fulfill the eligibility requirements and application of deductibles, maximum
benefit payments and waiting periods. The following exception applies:
Delta Dental Plan of Colorado complies with all regulation related to the Uniformed
Services Employment and Reemployment Rights Act (USERRA) for employees called to
active duty in the uniformed services. Employees who return to active employment are
eligible to enroll as if there had been no leave of absence for uniformed service provided
they are still in an eligible class of employee as defined by the group. In addition, USERRA
allows for employees to elect continuation of coverage when coverage would otherwise
terminate due to an absence to serve in the uniformed services.
Services provided while an employee is not eligible, due to their leave of absence, shall
not be covered by this Contract, unless the employee or any dependent elects continued
coverage as provided in the Continued Coverage Option Rider attached hereto or
according to USERRA where applicable.
PART VI DEDUCTIBLE, MAXIMUM AMOUNT AND COORDINATION OF BENEFITS
Section 2. MAXIMUM BENEFIT PAYMENT
Delta will pay up to a maximum of One Thousand Five Hundred ($1,500.00) per calendar
year for each Covered Person.
PART VII. CONDITIONS UNDER WHICH BENEFITS SHALL BE PROVIDED
Section 1. PAYMENT OF CLAIMS
b) Appeal of a Claim Denied in Whole or in Part:
1) Internal Appeal:
i) With the exception of a claim appeal that qualifies for Independent
External Review, the Employer, or his designee(s) shall have authority for
determination of Benefits in any case involving disputed Benefits. The
Covered Person may appeal this determination within one hundred and
eighty (180) days by filing a written notice with the Dental Director of
Delta Dental. Any written communication should include documents or
records in support of the claim. Delta may submit the matter to Delta's
Executive Committee of the Board of Trustees for determination of
Benefits.
2) Appeal to request an Independent External Review (only available on
qualified claims):
i) In addition to the Internal Appeal procedures outlined above, Covered
Persons have certain rights under Colorado Division of Insurance
Regulation 4-2-21.. Covered Persons may request an Independent
External Review of a claim when the above Internal Appeal procedures
result in a final denial AND that final denial is based on one of the
following reasons:
• medical necessity;
• effectiveness;
• efficiency;
• experimental; or
• investigational.
ii) When a claim qualifies for External Review, Delta will mail the Covered Person
a notice that explains their rights to request an Independent External Review of
the denied claim. In addition to the notice, the Covered Person will receive the
required form for submitting this request.
ORTHODONTIC BENEFIT RIDER
3) The maximum amount payable by Delta for all Orthodontics rendered to each
Covered Person shall be One Thousand Five Hundred Dollars ($1,500.00) per
lifetime and the limitations on the maximum amount payable during the calendar
ear, if any, specified in the attached Contract shall not apply to Orthodontic.
All other provisions of this Agreement shall remain as previously stated.
DATED: JANUARY 1, 2002
DELTA DENTAL PLAN OF C.OLORADO CITY OF FORT COLLINS
By By !j V
Authorized Signature T' e: j�atfCYiO�'�>2ccr'c,
On December 5 2001 On
r f
AMENDMENT TO AGREEMENT
GROUP #1857
The AGREEMENT dated January 1, 1999 as amended between CITY OF FORT COLLINS and DELTA
DENTAL PLAN OF COLORADO is hereby further amended effective January 1, 2000 as follows:
PART I PREFERRED OPTION ADMINISTRATIVE AGREEMENT
Section 2. TERM -The term of the Agreement is from January 1, 2000 through December 31, 2000
and for successive one-year periods thereafter unless terminated as herein provided.
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT - On the tenth (10th), twentieth (20th),
and thirtieth (30th) day or the last business day closest to such date of each month, Delta
will notify the Group of the total claims paid for the specified period. The Group will make
a prompt transfer of funds to Delta to cover such disbursements as they become due and
payable upon receipt of said notification. In addition, the Group agrees to reimburse to
Delta a monthly Service Fee of $2.65 per eligible employee. The monthly Service Fee is
guaranteed from January 1, 2000 through December 31, 2001.
All other provisions of this Agreement shall remain as previously stated.
DATED: January 1, 2000
DELTA DENTAL PLAN OF COLORADO CITY OF FORT COLLINS
By �5 By
P resident T fie:
,ZAP, C15
On / 2 On 12-00
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A
1
PART
PREFERRED OPTION ADMINISTRATIVE AGREEMENT
DELTA DENTAL PLAN OF COLORADO
DELTA GROUP #1857
Section 1. PARTIES -The parties to this Agreement are CITY OF FORT COLLINS, herein called the
"Group," "Applicant," or "Employer" and Colorado Dental Service Inc., a not for profit
Colorado Corporation, d/b/a Delta Dental Plan of Colorado, herein called "Delta".
Section 2. TERM - The term of the Agreement is from January 1, 1999 to December 31, 1999 and for
successive one-year periods thereafter unless terminated as herein provided.
Section 3. SERVICE FEE AND CLAIMS REIMBURSEMENT - On the tenth (10th), twentieth (20th),
and thirtieth (30th) day or the last business day closest to such date of each month, Delta
will notify the Group of the total claims paid for the specified period. The Group will make
a prompt transfer of funds to Delta to cover such disbursements as they become due and
payable upon receipt of said notification. In addition, the Group agrees to reimburse to
Delta a monthly Service Fee of $2.55 per eligible employee.
Section 4. Changes - This Agreement may not be changed, altered or terminated except in
accordance with PART III, GENERAL TERMS AND CONDITIONS, of this Agreement.
Section S. BENEFITS - Delta will provide to the Enrolled Eligible Employees and their enrolled eligible
dependents the Benefits as described in PART V, BENEFITS, LIMITATIONS AND
EXCLUSIONS of this Agreement.
Section 6. AGREEMENT- PART I, ADMINISTRATIVE AGREEMENT; PART II, DEFINITIONS; PART
III, GENERAL TERMS AND CONDITIONS; PART IV, ELIGIBILITY; PART V, BENEFITS,
LIMITATIONS AND EXCLUSIONS; PART VI, DEDUCTIBLE, MAXIMUM AMOUNT AND
COORDINATION OF BENEFITS, PART VII, CONDITIONS UNDER WHICH BENEFITS
SHALL BE PROVIDED; and the attached appendices and riders constitute the entire
Contract of the parties. The Agreement is binding upon the parties and their respective
successors and assigns.
Section 7. SIGNATURES - When accepted by the President of Delta Dental Plan of Colorado and the
Authorized Officer of the Group, this Agreement becomes binding and effective as of
January 1, 1999.
Countersigned: Accepted:
DELTA DENTAL PLAN OF COLORADO ITY OF FORT COLLINS
BY BY �LJ'
resident Title: rfl42 0 F- 'C,40`'
ON 2 Z ON 5-11 1 6;i�
2
A roved AS To rm:
t-_
Assistant City At ne
PART II
For the purpose of this Agreement, the following definitions shall apply:
Section 1. APPLICANT means the Group or Employer for whose members or employees dental
benefits are being provided.
Section 2. ADMINISTRATIVE AGREEMENT means this agreement referenced in PART I, Section
6., between DELTA and the Applicant and the attached appendices and riders, if any. This
Agreement constitutes the entire agreement between the parties.
Section 3. PARTICIPATING AND NON -PARTICIPATING DENTIST
a) Participating Dentist means a dentist who is licensed to practice by the State of
Colorado, has executed a Participating Dentist Agreement with Delta, and agrees to
render dental care to Covered Persons in accordance with standard terms and
conditions applicable to Dentist participation in Delta prepaid dental care programs as
established by the Board of Trustees of Delta.
b) Non -Participating Dentists means a dentist licensed to practice by the State of Colorado
who has not executed a Participating Dentist Agreement with Delta.
Section 4. PREFERRED OPTION DENTIST means a dentist licensed to practice by the State of
Colorado who meets the criteria for the DELTA Preferred Option program and has made
a special agreement with Delta to participate in that program.
Section 5. COVERED SERVICES means the dental procedures as set forth in AppendixA - Covered
Services, attached hereto and made a part of this Agreement.
Section 6. BENEFITS means those dental services which are available under the terms of this
Agreement as specified in PART V, BENEFITS, LIMITATIONS AND EXCLUSIONS.
Section 7. Each of the words in the term USUAL. CUSTOMARY AND REASONABLE as used herein
shall have the following meanings:
a) USUAL: A "usual fee" for a private patient is a fee charged or offered and received by
an individual dentist or group of dentists; i.e., his/her or their own usual fee. However,
if a dentist or group of dentists charge a lower fee to patient(s) who are members of any
individual or group dental care program for the same or similar service or procedure,
the "usual fee" shall be deemed to be the lowest fee charged or offered and received.
3
The "usual fee" shall not be affected by fees accepted for patients covered by non-
commercial programs funded by public or charitable funds primarily intended to assist the
poor or disadvantaged or those occasional instances where professional courtesy
discounts are given or fees waived or discounted in case of financial hardship.
Fees which are established by a bona fide arm's length agreement between a participating
dentist and any third -party payor under a prepayment, insurance or health care service
corporation program shall not be considered to "regularly" or "usually" charge and
therefore, shall not affect a participating dentist's "usual fee." If so requested by Delta, it
shall be the responsibility of the participating dentist to document the existence of a "bona
fide arm's length agreement" between the dentist and such third -party payor, in order for
the dentist's fees charged to such payor to be considered to be not "regularly or usually
charged." This interpretation shall not be construed to alter the following well established
policies of Delta:
1. The fee considered to be the participating dentist's usual fee for a particular
dental procedure shall in no event be more than the lowest fee charged or
offered and received by the same dentist or group of dentists for prepayment or
indemnity insurance healthcare service corporation programs, except as
specified immediately above, or for uninsured patients.
2. Fees which are advertised shall be made available to Delta -eligible patients if
lower than the participating dentist's accepted filed fees.
3. Offers, arrangements, or agreements by which a participating dentistwaives any
or all of the co -payment or deductible chargeable under the terms of a dental
prepayment, insurance, or healthcare service corporation program shall be
considered in determining what constitutes the dentist's "usual fee."
b) CUSTOMARY: A fee is customary when it is within the range of usual fees charged
and received by Participating Dentists within the same geographic area for the same
Covered Service.
c) REASONABLE: A fee is reasonable if it is usual and customary, or if it falls above
customary if it is justifiable considering special circumstances, or extraordinary
difficulty of the case in question.
Section 8. PREVAILING FEE is the fee for a single procedure which satisfies the majority of dentists
in Colorado, and is determined by Delta based upon confidential fee listings from
Participating Dentists (the 51 st percentile).
4
Delta Dental Plan of Colorado
Organizational Chart
Board of Trustees
President
Kathryn Paul
VP Administration VP Finance I VP Operations I I VP Marketing
Barbara Springer Russell J. Schreier Linda M. Arneson Dennis R. Phillips
Compliance I r--1 Accounting I U Customer Relations I H Sales
Human Investments Data/Audit Account Support
Resources
Underwriting Edit
IS -PC LAN Eligibility
Processing
IT -Claims
Execsummaryrfp.doc
VP Professional
Affairs
Terry Batliner
Provider Relations
Claims Review
Section 9. PREFERRED OPTION DENTIST'S FEE means the fee which the Preferred Option dentist
has contractually agreed with Delta to accept for treating Covered Persons under this
program, or the fee actually charged, whichever is less, for a single procedure.
Section 10. COVERED AMOUNT
a) Payment for completed Covered Services provided by a Participating Dentist will be
based upon the Participating Dentist's Usual and Customary fee or the fees actually
charged, whichever is less.
b) Payment for completed Covered Services provided by a dentist who is not a
Participating Dentist will be based upon the Non -Participating Dentist's fee not to
exceed the Prevailing Fee charged by Participating Dentists.
Section 11. ELIGIBLE DEPENDENT UNIT is the group of Eligible Dependents, as defined in PART IV,
ELIGIBILITY hereof, attributable to an Eligible Employee, as defined in said PART IV.
Section 12. ENROLLED EMPLOYEE, or ENROLLED ELIGIBLE EMPLOYEE, is an Eligible Employee,
as defined in PART IV, ELIGIBILITY hereof, enrolled as a member or employee of the
Group, and covered by the Group Dental Care Plan provided in accordance with this
Agreement.
Section 13. COVERED PERSON means Enrolled Eligible Employees, Retirees, and enrolled Eligible
Dependents or a person ceasing to be eligible who elects continued coverage as provided
in PART IV, ELIGIBILITY, and for whom the appropriate monthly payment specified in
PART I, ADMINISTRATIVE AGREEMENT, Section 4. is received.
Section 14. AGREEMENT YEAR is the 365-successive-day period (or, if a February 29 is
encompassed, the 366-successive-day period) beginning on the day and month set forth
in this Agreement, PART I, Section 2.
Section 15. ANNIVERSARY DATE shall be the first day of each Agreement Year subsequent to the
initial Agreement Year.
Section 16. ACTIVE for purposes of'PART IV, ELIGIBILITY, Section 1. ELIGIBLE PERSONS, means
performing in the customary manner on the Group's scheduled work days, all of the regular
duties of the employee's employment with the Group either at one of the Group's business
establishments or at some location to which the Group's business requires the employee
to travel. An employee will be considered active on a day which is not one of the Group's
scheduled work days only if he was performing in the customary manner all of the regular
duties of his employment on the next preceding scheduled work day.
W
Section 17. PREDETERMINATION means review by Delta of a dentist's statement, including
diagnostic material, describing his planned treatment and expected charges for the
purpose of determining benefits available under the terms of this Agreement.
Section 18. RETIREE means an Employee who has ten (10) or more years of eligible service
completed with the Employer in a classified position or an unclassified management
position, and who is eligible to file without penalty for receipt of retirement benefits and who
has been covered under the Plan continuously and immediately prior to retirement for
twelve (12) consecutive months; or who is totally and permanently disabled and has ten
(10) or more years of eligible service completed with the Employer in a classified position
or unclassified management position and has exhausted his/her COBRA continuation
period.
PART III
Lei 4► .0 ►• • • •
Section 1. TERMS OF AGREEMENT - This Agreement shall continue for the period specified in
Part I, ADMINISTRATIVE AGREEMENT.
Section 2. RENEWAL - The Agreement shall be renewed for four successive one year periods
unless during any Agreement year either party elects not to renew by giving the
other party written notice of such election at least one hundred twenty (120) days
prior to the end of the current Agreement year. In the event that Delta shall desire
to change the rates or other terms and conditions of this Agreement effective on an
Anniversary Date, advice of any such proposed changes shall be given in writing no
fewer than sixty (60) days in advance of the of the notice of renewal.
Section 3. TERMINATION - This Agreement shall be terminated as follows:
a► At the end of the original Term of Agreement provided the required notice of
non -renewal has been given.
b) At the end of any renewal year provided the required notice of non -renewal is
given.
c) In the event any payment due pursuant to PART I, ADMINISTRATIVE
AGREEMENT, Section 4. MONTH DUES of this Agreement is not paid within
twenty (20) days of the due date, Delta may give written notice that payment
is due, and if such payment is not received within ten (10) days after such
notice, Delta may at its option, terminate all further obligations. The date of
termination shall be specified by Delta.
d) By election of the Group if Delta defaults in providing the Benefits under the
Agreement and such default is not corrected within sixty (60) days of such
default, the termination date shall be specified by the Group.
e) At any time by either party with sixty (60) days advance written notice.
In the event of termination by Delta as stated in Part III, Section 3, paragraph a, all
Benefits shall terminate and Delta shall be released from all further obligations of this
Contract, however, Delta shall make payment to dentist for dental services
authorized by Delta prior to termination and performed in reliance of such
authorization. Applicant shall remain liable to Delta for the greater of:
a. the unpaid payments applicable for the period this Agreement was in effect prior
to termination; or
7
b. the full amount of all Dentist's statements paid or otherwise discharged by Delta during
the full term of this Contract, plus $7.00 per paid claim (to compensate Delta for its
administration forthe dental program), less amounts actually paid by the Group to Delta
during the term of the Agreement.
If Group notifies Delta in writing of its intention to terminate this Agreement as of any
date other than the end of the Agreement Term, such termination shall be treated as
termination for failure to pay the Service Fee, and the notice by Group of the intention
to terminate shall constitute a waiver of notification and billing by Delta.
In the event of termination of this Agreement for any cause, Delta shall not be required
to authorize services beyond the termination date or to pay for services provided
beyond such termination date, except for the completion of single procedures started
while this Agreement was in effect, which are otherwise Benefits under the terms of this
Agreement.
If on termination of this Agreement for any cause, Group has not paid Fees to Delta
applicable to a period of time before the termination date, Group shall, within thirty (30)
days after termination, remit such portion of the Fees on claims, if any.
Section 5. REINSTATEMENT
Acceptance by Delta of the proper amount of Service Fee after the termination of this
Agreement and without requiring a new application shall reinstate the Contract as though
it never terminated, unless Delta shall, within five (5) business days of receipt of such
payment, either refund the payment made or issue to Applicant a new Contract
accompanied by written notice stating clearly those respects in which the new Contract
differs from the terminated Agreement in Benefits, coverage, or otherwise. If Applicant
does not approve the new Contract, Delta shall refund the payment made.
Section 6. GENERAL PROVISIONS
a) Clerical errors or delays in keeping or relating data relative to coverage shall not
validate or invalidate coverage which would otherwise be in force. Upon discovery of
'such errors or delays, an equitable adjustment of Service Fees shall be made.
b) Any notice under this Agreement shall be sufficient if given by either the Applicant or
,Delta to the other (or in the case of the Applicant, to its designated agent) addressed
as stated below and shall be effective forty-eight (48) hours after deposit in the United
States mail with postage fully prepaid thereon.
Group: City of Fort Collins
200 West Mountain Ave., Ste A
Fort Collins, CO 80522-0580
C
DELTA: The Delta Dental Plan of Colorado
Colorado Dental Service Inc.
4582 S. Ulster Street Suite 800
Denver, CO 80237
c) Notice to Covered Persons shall be in writing and sent by regular U.S. mail to their
addresses last shown in the records of Delta. Such notice shall be deemed to be
delivered when deposited in the United States Mail, addressed to the Covered Person
at such address with postage thereon prepaid.
d) No action at law or inequity shall be brought to recover on this Agreement prior to the
expiration of sixty (60) days afterfinal notice of claims has been filed in accordance with
the requirements of this Agreement; nor shall such action be brought at all unless
brought within three (3) years from the date the claim for benefits was presented to
Delta.
e) All statements made by the Group or by an individual shall be deemed representations
and not warranties. No such statement shall be used in defense to a claim under this
Agreement unless it is contained in a written application.
f) This Agreement shall be the entire, full, and complete agreement between Delta and
the Group concerning group dental care. This Agreement may not be orally amended
or changed. This Agreement may at any time be amended and changed by written
agreement between Delta and the Group. Any such amendment shall be binding on
all Covered Persons regardless of the date their coverage became effective.
g) No agent or employee of Delta has the authority to change the Agreement or its
provisions. No change in the Agreement shall be valid unless approved in writing by
the President of Delta.
h) The Group agrees to permit Delta, by its auditors or other authorized representatives,
upon reasonable advance written notice, to inspect records of the Group pertinent to
eligibility in order to verify the accuracy of lists of Covered Persons prepared by the
Group and submitted to Delta. Delta agrees to keep all information regarding the
Group confidential.
i) Delta agrees that the Group or its designated representative, upon reasonable advance
written notice, shall have the right of access to all files and records pertinent to the
Group for examination and audit.
j) Any dispute arising out of or relating to this Agreement or the breach thereof between
Delta, a Participating Dentist, and Covered Person or any of them, including any
disagreement with a claim determination made by Delta after exhaustion of the
9
procedure outlined in PART VII, CONDITIONS UNDER WHICH BENEFITS SHALL BE
PROVIDED, Section 1. Payment of Claims (a) of this Agreement, shall be settled by
arbitration in accordance with the Commercial Arbitration Rules of the American
Arbitration Association, and judgment upon the award rendered by the Arbitrators) may
be entered in any Court having jurisdiction thereof. Arbitration may be initiated by any
party to a dispute by giving notice to each other party two copies of such notice with the
American Arbitration Association and by complying with other applicable provisions of
the Association's rules.
k) Delta shall furnish to the Applicant on the Effective Date of this Agreement and at
reasonable times thereafter a directory of Participating Dentists and Preferred Option
Dentists who have agreed to provide services described in this Agreement. The
directory of Preferred Option Dentists shall be furnished by Delta in such quantities that
the Applicant may distribute a copy to each Eligible Employee. It is understood that the
composition of such directory may be subject to change from time to time, and Delta
reserves the right to change the directory without prior notice to the Applicant, but shall
give notice within reasonable time of any provider's termination or breach of contract,
or inability to perform, which will materially and adversely affect the Applicant. Current
information concerning the Participating Dentist status of any dentist may be obtained
by telephoning Delta. The dentists providing or contracting to provide dental services
under this Agreement shall be solely responsible therefor, and in no case shall Delta
or the Applicant be liable for any act or omission by such dentists, their agents or
employees.
1) Delta will issue to the Group, and the Group .will make available to each Eligible
Employee, an evidence of coverage summarizing the benefits to which the employee
is entitled and other provisions of this Agreement. If any amendment of this Agreement
shall materially affect any benefits described in such evidence of coverage, a corrected
evidence of coverage, riders, or inserts showing the change shall be issued to the
Group.
m) Delta, at its own expense, will have the right and opportunity to examine any individual
for whom claim or request for predetermination of benefits is pending under this
Agreement when and so often as it reasonably may require and to make an autopsy
in case of death where it is not prohibited by law.
n) Where applicable herein, the use of the singular shall include the plural, the plural the
singular, and the use of any gender shall include all genders.
o) This Agreement is not to be construed as satisfying any requirement for coverage by
worker's compensation insurance.
10
p) The Group shall compile and furnish Delta on or prior to the first day of every month,
commencing on the effective date, a list of all Eligible Employees, showing their social
security numbers, the dates of hire, and if applicable, the location code. The Group
shall also furnish a monthly list of all persons electing continued coverage pursuant
to PART IV, ELIGIBILITY, Section 4. Delta agrees to keep all information regarding
the Group confidential.
q) This agreement shall be constructed in accordance with and governed by laws of the
State of Colorado. Delta agrees to comply with all applicable Federal, State and local
laws, rules, regulations or ordinances, and all provisions required thereby to be
included herein, are hereby incorporated by reference. Delta agrees to indemnify and
hold GROUP harmless from any loss, damage or liability resulting from a violation on
the part of Delta of such laws, rules, regulations or ordinances.
r) All obligations of the City of Fort Collins hereunder are expressly conting nt upon the
annual appropriation of funds sufficient and intended to carry out the ame by th,�
City Council of the city of Fort Collins, in its discretion.
11
PART IV
ELIGIBILITY
Section 1. ELIGIBLE PERSONS
a) Eligible Employees are defined as follows:
All full-time permanent active employees working a minimum of twenty (20) hours per
week shall become eligible the first day of the month following thirty (30) days of
employment.
Employees who have been absent from work due to strike, lay-off or leave of absence,
and who return to work, will become eligible on the first day of the month following the
return to work, provided the absence does not exceed six (6) months. If an absence
exceeds six (6) months, then such employees shall be considered newly hired
employees in every respect and must fulfill the eligibility requirements and application
of deductibles, maximum benefit payments and waiting periods. Services provided
during the period such employees were not eligible due to strike, lay-off or leave of
absence shall not be covered by this Agreement, unless the employee or any
dependents have elected continued coverage as provided in the Continued Coverage
Option Rider attached hereto.
b) Eligible Dependents are defined as follows:
1) The Eligible Employee's lawful spouse.
2) The Eligible Employee's unmarried children wholly dependent upon the employee
for support and maintenance until the end of the month to which they attain
nineteen (19) years of age or any unmarried children, nineteen (19) years of age
until the end of the month to which they attain twenty-five (25) years who attend an
accredited educational institution on a full-time basis. This includes any stepchild,
foster child, or legally adopted child who lives with the employee in a regular parent -
child relationship.
A covered unmarried child reaching the age of nineteen (19) years may continue to
be eligible as a dependent if he is incapable of self-support because of physical
handicap or mental incapacity that commenced prior to reaching age nineteen (19)
and if he is chiefly dependent on the Eligible Employee for support and
maintenance, provided proof of such handicap or incapacity and dependency is
submitted within thirty-one (31) days after a request by either Delta or Applicant,
and subsequentlyas may be required by either Delta or the Applicant, but not more
frequently than annually after the handicapped or incapacitated and dependent child
iM
has attained age twenty-one (21). Upon failure to submit such required proof or to
permit such an examination, or when the child ceases to be so incapacitated,
coverage with respect to such child shall cease.
No one may be covered as a dependent and also as an employee. If both parents
are covered as employees, children may be covered as dependents under both
employees.
Persons in active military service will not be considered as Eligible Dependents.
"Dependent" also means any child for whom the employee or spouse is responsible
for medical or other health care benefits under a Qualified Medical Child Support
Order.
c) Eligible Retirees are covered as follows:
All Retirees and their eligible Dependents with coverage at the time of retirement may
elect to continue coverage in that plan or switch to the other plan available to the
Group. After this time, coverage must remain under the same plan. Once coverage
is terminated, it may not be reinstated.
Section 2. ENROLLMENT OF DEPENDENTS
a) You must select the same level of dependent coverage as chosen for medical
coverage.
b) Newly acquired dependents who are enrolled in the medical plan provided by this
employer must be enrolled within thirty-one (31) days of acquisition. Newborn children
must be enrolled within thirty-one (31) days of birth.
c) Any eligible dependents that suffer involuntary loss of coverage through anothersource
will be allowed to enroll with satisfactory proof of coverage loss. Such dependents
must be enrolled within thirty-one (31) days of the loss of coverage and must be
enrolled in the medical plan provided by this employer.
Section 3. EFFECTIVE DATE OF INDIVIDUAL COVERAGE
a) Coverage for Eligible Employees becomes effective the first day of the month
coincident with or next following the date such persons become eligible as defined in
PART IV, ELIGIBILITY, Section 1. ELIGIBLE PERSONS.
b) Coverage for Eligible Dependents becomes effective on the date the employee's
coverage becomes effective. Dependents acquired after the employee effective date
13
shall become eligible on the first day of the month following attainment of dependent
status.
Section 4. TERMINATION OF INDIVIDUAL COVERAGE
a) Coverage for Enrolled Eligible Employees will terminate on the earliest date of the
following:
1) The last day of the month that eligibility is terminated in accordance with the
eligibility rules of this Agreement, unless the Eligible Employee elects continued
coverage under the Continued Coverage Option Rider.
2) The last day of the month for which Service Fees have been paid.
3) The day this Agreement is terminated.
b) Coverage for enrolled eligible dependents will terminate on the earliest of the following:
1) The day the Enrolled Eligible Employee's coverage under which they are covered
terminates in accordance with the above.
2) The last day of the month during which the enrolled eligible dependent ceases to
be eligible in accordance with the eligibility rules of this Agreement unless continued
coverage is elected by or on behalf of any dependent under the Continued
Coverage Option Rider.
14
SIGNATURE PAGE
City of Fort Collins
We have read and complied with all the specifications in the Request for Proposal for the client
referenced above.
Any exceptions are noted below.
1) There are no exceptions.
Delta Dental Plan of Colorado
Name of Carrier
August 25,2003
Date
PART V
BENEFITS, LIMITATIONS AND EXCLUSIONS
Subject to the limitations and exclusions hereinafter set forth, the following completed dental services
are Benefits when provided by a dentist (or other person legally permitted to perform such services by
authority of license) and are determined under the standards of generally accepted dental practice to be
necessary. THE SPECIFIC DENTAL PROCEDURES ARE SET FORTH IN APPENDIX A - COVERED
SERVICES.
Section 1. DIAGNOSTIC, PREVENTIVE AND ADJUNCTIVE BENEFITS
Delta shall pay or otherwise discharge Eighty Percent (80%) of the Dentist's Usual,
Customary and Reasonable fees or the fees actually charged, whichever is less, or One
Hundred Percent (100%) of the Preferred Option Dentist's Fees for the following Covered
Services:
a) Diagnostic - certain services performed to assist the dentist in evaluating the existing
conditions and determining the dental care required. Appendix A, Section I.
Preventive - certain services performed to prevent the occurrence of dental
abnormalities or disease. Appendix A, Section II.
Adjunctive - certain additional services including emergency palliative treatment
performed as a temporary measure which does not effect a definite cure. Appendix A,
Section IX.
b) Limitations on Diagnostic, Preventive and Adjunctive Benefits:
1) Benefits for oral examinations and prophylaxis treatment shall not be provided
more than twice each in any twelve-month period except for special need as
determined by Delta. Allowance separate from the allowance for oral examination
shall not be made for diagnosis, treatment planning or consultation by the treating
dentist, which for purposes of this Agreement, are considered components of a
complete examination service.
2) Topical fluoride application is a benefit only through age fifteen (15) and only once
in twelve (12) months.
3) Benefit for full mouth x-rays is made only after sixty (60) months have elapsed
following any prior provision of payment for full mouth x-rays under any Delta
program. Benefit for supplementary bite -wing individual x-rays is provided on
request by the dentist, but not more than once every twelve (12) months while the
W
patient is under any Delta program. A panoramic survey (which may include
bitewing x-rays and/or periapical) is considered a full mouth x-ray for purposes of
this Agreement. Total allowance for individual periapical and/or bitewing x-rays
shall not exceed allowance for full mouth x-rays. Exception to this Limitation may
be made in documented cases of special need, but only as determined by DELTA.
4) X-rays and other specific and/or usual diagnostic services associated with
determination of the need for treatment covered by an Amendment or Rider may
be covered only under terms of such Amendment or Rider and only when such an
Amendment or Rider is made a part of this Agreement but only when such
services are included in such Amendment or Rider.
5) Payment of a separate charge for examination shall not be made when performed
in conjunction with any covered Adjunctive Service.
6) Benefit for Covered Diagnostic Services may be applied toward the cost of special
diagnostic services or techniques and the patient shall be responsible for the
portion of the dentist's fee in excess of the Delta allowance.
7) Benefit for space maintainers shall only be made for premature loss of primary
(deciduous) teeth for children through age thirteen (13).
8) Sealant Benefits are described as topically applied resin, composite or other
material used to seal developmental grooves and pits in teeth for the purpose of
preventing dental decay and are available only to Covered Persons under the age
of fifteen (15).
9) Sealant Benefits include the application of sealants only to intact occlusal surfaces
of permanent molar teeth when those teeth have no caries (decay) and no
restorations on any surface.
1'0) Separate benefit shall not be made for any preparation or conditioning of the tooth
or any other procedure associated with sealant application.
11) Sealant Benefits do not include any repair or replacement of a sealant on any
tooth within thirty-six (36) months of its application under this Contract. Such
repair or replacement is considered included in the fee for the initial placement of
the sealant.
12) Payment of Benefits for Adjunctive Services provided in relation to or as a result
of another category of Covered Services, or Covered Services provided under any
Amendment or Rider, shall be made at a percentage no greater than the related
category of Covered Services or Amendment or Rider.
16
Section 2. BASIC RESTORATIVE BENEFITS
Delta shall pay or otherwise discharge Sixty Percent (60%) of the dentist's Usual,
Customary and Reasonable fees or the fees actually charged, whichever is less, or Eighty
Percent (80%) of the Preferred Option Dentist's Fees for the following Covered Services:
a) Basic Restorative - amalgam restorations (fillings) on posterior teeth, intraorally cured
resin or plastic restorations (fillings) on anterior teeth and preformed shell crowns for
treatment of carious lesions (visible destruction of hard tooth structure resulting from
the process of dental decay or loss of tooth structure due to fracture). Appendix A,
Section III -A.
b) Limitations on Basic Restorative Benefits
1) Benefit for the same Covered Basic Restorative Service shall not be provided
more than once in any twelve (12) month period.
2) Allowance for amalgam or intraorally cured resin or plastic restorations may be
made toward the cost of more expensive procedures or materials selected, and
the patient shall be responsible for the portion of the dentist's fee in excess of the
Delta allowance.
Section 3. ORAL SURGERY, ENDODONTIC AND PERIODONTIC BENEFITS
Delta shall pay or otherwise discharge Sixty Percent (60%) of the dentist's Usual,
Customary and Reasonablefees or the fees actually charged, whichever is less, or Eighty
Percent (80%) of the Preferred Option Dentist's Fees for the following Covered Services:
a) Oral Surgery - extractions and certain other surgical services and associated covered
anesthesia and/or related covered services. Appendix A, Section VIII and IX.
Endodontic -certain services for treatment of non -vital tooth pulp. Appendix A, Section
IV.
Periodontic - certain services for treatment of gums and bone supporting teeth.
Appendix A, Section V.
b) , Limitations on Endodontic and Periodontic Benefits
1) Unless special need is documented, benefit for Covered Surgical Periodontic
Services shall not be provided more than once in any thirty-six (36) month period
and for Covered Adjunctive Periodontic Services not more than once in a twenty-
four (24) month period while the patient is an Covered Person.
2) Benefit for pulpotomy/pulpectomy shall be made only for primary (deciduous)
teeth.
17
3) No Benefits shall be provided for teeth retained in relation to an overdenture.
4) Nonsurgical periodontal procedures which include any component of prophylaxis
are limited to Part V, Section 1.,b), paragraph 1).
Section 4. SPECIAL RESTORATIVE BENEFITS
Delta shall pay or otherwise discharge Fifty Percent (50%) of the dentist's Usual,
Customary and Reasonable fees or the fees actually charged, whichever is less, or Sixty
Percent (60%) of the Preferred Option Dentist's Fees for the following Covered Services.
a) Special Restorative - crowns, jackets, cast, fused or other laboratory processed
restorations (except preformed shell crowns) for treatment of carious lesions (visible
destruction of hard tooth structure resulting from the process of dental decay) or
significant loss of tooth structure due to fracture which cannot be restored with
amalgam or intraorally cured resin restorations. Appendix A, Section III-B.
b) Limitations on Special Restorative Benefit
1) In the event that more than one such restoration is used to restore a tooth,
allowance shall not exceed the Covered Amount for a Single Covered Service.
2) Benefit for placement of Special Restorative Services will be made only after sixty
(60) months have elapsed following any prior provisions of these procedures or
any prior provision of Covered Prosthodontic Services involving the same teeth.
3) Benefit for Special Restorative Services shall not be made for these services
when provided for children under twelve (12) years of age.
4) A patient shall be eligible for Special Restorative Benefits immediately following
enrollment under this Agreement.
5) No Benefits shall be provided for teeth retained in relation to an overdenture.
Section 5. PROSTHODONTIC BENEFITS
Delta shall pay or otherwise discharge Fifty Percent (50%) of the dentist's Usual,
Customary and Reasonable fees or of the fees actually charged, whichever is less, or Sixty
Percent (60%) of the Preferred Option Dentist's Fees for the following Covered Services:
a) Prosthodontic - certain services for construction or repair of fixed bridges, and
removable partial and complete dentures to replace completely extracted or missing
natural permanent teeth, or natural permanent teeth missing from their normal
functioning position in the dental arch. Appendix A, Section VI and VII.
18
b) Limitations on Prosthodontic Benefits:
1) Benefit for replacement of prosthodontic appliances will be made only after sixty
(60) months have elapsed following any prior provisions of such appliances,
subject to individual consideration determined by Delta where there is such
extensive loss of remaining teeth or change in supporting tissues that the existing
appliance cannot be made satisfactory. Benefits for replacement will be made for
a prosthodontic appliance more than sixty (60) months old or one not provided
under this Delta Agreement only if it is unsatisfactory and cannot be made
satisfactory.
2) Benefit for a covered prosthodontic appliance shall be made only after sixty (60)
months have elapsed following any prior payment of covered Special Restorative
Benefit for the same teeth.
3) Delta will pay the applicable percentage of the dentist's fee for a standard cast
base metal and/or acrylic partial denture or a standard complete denture, up to a
maximum fee allowance for a standard denture. (A "standard" complete or partial
denture is defined as a removable prosthodontic appliance provided to replace
missing natural, permanent teeth and which is constructed using accepted and
conventional procedures and materials). The portion of the dentist's fee in excess
of the Delta allowance for any denture and/or related service for which a charge
is made which exceeds this allowance is considered the responsibility of the
patient.
4) Removable temporary partial dentures are a benefit only when anterior teeth are
missing. An allowance limited to the Covered Amount for a removable appliance
may be made toward the cost of other procedures performed and the patient is
responsible for the portion of the dentist's fee in excess of the Delta allowance.
5) Benefit based on the cost of a covered standard removable partial denture may
be made toward the cost of implants and appliances constructed in association
therewith. If benefit is made for such an appliance, benefit will not be made or any
replacement within sixty (60) months thereafter.
6) Benefit for reline or rebase of a prosthodontic appliance will be made only once
in any thirty-six (36) month period.
7) A patient shall be eligible for Prosthodontic Benefits immediately following
enrollment under this Agreement.
8) Fixed bridges and/or cast metal framework partial dentures are not a benefit for
persons under age sixteen (16).
19
9) Fixed and removable Prosthodontic appliances are not a benefit in the same arch
except in cases of special need as determined by Delta. Allowance will be limited
to that for a removable appliance.
10) Allowance in cases using overdenture appliances shall be limited to allowance for
standard appliances.
Section 6. GENERAL LIMITATIONS - ALL SERVICES
a) If an Covered Person selects a service that is not provided for under the terms of this
Agreement or specialized techniques rather than standard services, Delta will pay the
applicable percentage of the fee for the least costly commonly performed Covered
Service and the patient is responsible for the remainder of the dentist's fee.
b) When services involving veneers, facings, or any other cosmetic services posterior to
the first molar are provided, allowance shall be limited to the Covered Amount for
Covered Service without veneers, facings or cosmetic component, or the service
actually performed, whichever is less. The patient is responsible for the remainder of
the Dentist's fee.
c) If the expenses to be incurred for the performance of Covered Services (except
Covered Diagnostic and Emergency Services) which can reasonably be expected to
total Four Hundred Dollars ($400.00) or more, those expenses may be paid, provided
Delta agrees through Predetermination prior to the performance of the service, to
accept those expenses as Covered Services. If Delta does not so agree through
Predetermination, or if a description of the proceduresto be performed and an estimate
of the Dentist's charges are not submitted in advance, then the amount of expenses
included as Covered Services will be determined by Delta, taking into account alternate
procedures, services, or courses of treatment based upon professionally endorsed
standards of dental care.
d) Local anesthesia is considered a component of any procedure in which it is used.
e) The Covered Amount for a Covered Service started but not completed shall be limited
to the amount determined by Delta.
f) A temporary dental service will be considered an integral part of a complete dental
service rather than a separate service, and separate payment shall not be made for a
temporary service unless otherwise included as a Covered Service of this Agreement.
g) Allowance for assistant surgeon when determined by Delta to be a Covered Benefit
shall not exceed 20% of the surgeon's fee for the same Covered Service.
Rej
Section 7. EXCLUSIONS - The following services are not benefits
a) Services for injuries or conditions which are compensable under Worker's
Compensation or employer's liability laws, no-fault auto insurance, or services which
are provided to the Covered Person by any federal or state government agency or are
provided without cost to the Covered Person by any municipality, county or other
political subdivision, or any services for which the Covered Person would have no
obligation to pay in absence of this coverage, except as such exclusion may be
prohibited by law, such as Medicaid.
b) Any Covered Service or any portion thereof started during any period when the
person was not eligible for such service under this Agreement.
c) Services for treatment of congenital (present at birth) or developmental (following
birth) malformations, except intraoral dental services for treatment of a condition
which is related to or developed as a result of cleft lip and/or cleft palate, unless
otherwise included as a Covered Service of this Agreement.
d) Services for cosmetic reasons.
e) Services for restoring tooth structure lost from wear or for any services related to
protecting, altering, correcting, stabilizing, rebuilding or maintaining teeth due to
improper alignment, occlusion or contour or for periodontal stabilization.
f) Habit appliances, night guards, occlusal guards, athletic mouth guards and
gnathological Qaw function) services, bite registration or analysis, or any related
services (except as covered under provisions of an Amendment or Rider).
g) Pre -medication, analgesia, hypnosis or any other patient management services
(except covered anesthetic services).
h) Charges for prescription drugs.
i) Experimental procedures, or any procedures other than those Covered Services for
which the prognosis is good. Any procedures done in anticipation of future need
(except Covered Preventive Services).
j) Hospital costs and any additional fees charged by the dentist or hospital for hospital
services, visits, or charges for use of any facility.
k) Anesthesia other than general anesthesia, intravenous sedation or analgesia
administered in connection with Covered Oral Surgery Services. (See PART V,
BENEFITS, LIMITATIONS AND EXCLUSIONS, Section 3. Oral Surgery).
21
I) Extraoral grafts (grafting of tissues or other substances from outside the mouth to or
into oral tissues), augmentations or implants and/or any associated appliances.
Removal of implants or any services associated therewith.
m) Orthodontic services including any related diagnostic, preventive or interceptive
services (surgical and other treatment of malalignment of teeth and/or jaws) except
as covered under provisions of an Orthodontic Amendment or Rider. Myofunctional
therapy or speech therapy.
n) Services for the treatment of any disturbances of the temporomandibular joint (jaw
joint) facial pain, or any related conditions, including any related diagnostic,
preventive or interceptive services (except as covered under provisions of an
Amendment or Rider).
o) Services not performed in accordance with the laws of the State of Colorado, services
performed by any person other than a person authorized by license to perform such
services, or services performed to treat any condition, other than an oral or dental
disease, malformation, abnormality or condition.
p) Oral hygiene instructions or dietary instructions.
q) Completion of forms, providing diagnostic information or records, or duplication of x-
rays or other records.
r) Replacement of lost, stolen or damaged appliances.
s) Preparation for placement or replacement, removal or repair, or any other procedure
related in any way to any procedure or service not included in Covered Services.
t) Any services not specifically included in Covered Services.
u) Services to the extent that payment for which under this Agreement is prohibited by
any law of the jurisdiction in which the Covered Person resides at the time the
expenses are incurred.
v) Services for which charges would not have been made if this coverage had not
existed, except for services as provided under Medicaid.
w) Services for which legal payment obligations have been reduced due to a
professional or courtesy discount, or for services by a relative as the provider.
x) Services which result from an act of declared or undeclared war or armed aggression.
22
y) Services which result, whether the insured person is sane or insane, from an
intentionally self-inflicted injury or sickness.
z) Charges for failure to keep a scheduled visit with your Dentist.
aa) Any payable expense under any other group or individual plan, medical or dental
plan, whether claimed or not.
23
PART VI
DEDUCTIBLE MAXIMUM AMOUNT AND COORDINATION OF BENEFITS
Section 1. DEDUCTIBLE
Delta shall not be obligated to pay, in whole or in part, the first Twenty -Five ($25.00) of fees
for Benefits received by a Covered Person during the calendar year of the Agreement.
Fees shall be computed on the basis of the Preferred Option Dentist's Fees by a Preferred
Option Dentist and the Covered Amount for all other Dentists. If a patient received services
from a Preferred Option Dentist or a Non -Preferred Option Dentist, the deductible will not
apply to Diagnostic, Preventive, and Orthodontic Services. The Twenty -Five ($25.00)
annual deductible is limited to Fifty ($50.00) per family.
Section 2. MAXIMUM BENEFIT PAYMENT
Delta will pay up to a maximum of One Thousand Dollars ($1,000.00) per calendar year for
each Covered Person.
Section 3. COORDINATION OF BENEFITS
a) If an Covered Person is entitled to coverage under two or more plans, then the
benefits of this Agreement shall be coordinated with other plan benefits.
"PLAN" means any plan providing dental care benefits under group, blanket or
franchise coverage; or service type plans or other group pre -paid plans; or coverage
under any governmental plan or required by laws; or "No -Fault" motor vehicle
insurance.
b) Order of Benefit Determination if the other coverage is by a dental insurance policy
or prepaid dental care program:
1) The policy or program covering the patient as an employee shall be primary over
the policy or program covering the patient as a dependent;
2) For dependent children's expenses the order of benefit determination shall be as
follows:
(a) The policy of the parent whose birthday (excluding year of birth) occurs
earlier in the year shall be primary, or;
24
CHECKLIST OF ITEMS INCLUDED WITH PROPOSAL
Yes No Description of Item
X Proposal for Group Life Insurance, AD&D and Supplemental Life
X Proposal for Group Voluntary Life
X Proposal for Voluntary Group Life and AD&D
X Proposal for Group Long Term Disability
X
Proposal for Group Dental, Exhibit 4
X
Proposal for Vision Care
X
Proposal for Transplant Coverage
X
Proposal for Long Term Care
X
Signed Proposal Compliance Letter, refer to Signature Page, Exhibit 2
X
Signed Plan Design Confirmation, refer to Signature Page, Exhibit 2
X
Completed and Signed Questionnaire(s),Exhibit 5
X
Dental Network Access Analysis (if applicable), Exhibit 8
X
Vision Network Access Analysis (if applicable)
X
Copy of your EOB for Dental and/or Vision Services (if applicable), Exhibit 8
X
Proposed Implementation Timeline for The City, Exhibit 8
X
Audited Financial Statements and/or Department of Insurance
filings,'Not Available for the past two years (Only if requested by The City)
Exhibit 8
'NA
Provider "Report Cards" used to provide feedback on clinical and
on -clinical performance measures
X
Copy of your Policy Assuring Member Satisfaction
X
Samples of all Standard and Optional Reports you are proposing
to provide on an account specific basis, Exhibit 8
X
Copy of your Banking Services Agreement, Exhibit 7
"NA
Copy of your Customer Satisfaction Survey
X
Copy of your Administrative Services Agreement or Insurance
Contract that will be in effect January 1, 2004, Exhibit 8
* Not Available
Signature of Authorized Representative:
City of Fort Collins, RFP 2003
(b) If the parents are separated or divorced, the policy of the parent who is
ordered by court decree to take financial responsibility for dental expenses
shall be primary, or;
(c) The policy of the parent with custody is primary and if said parent has
remarried, the step -parent's plan is secondary and the plan of the parent
without custody pays third.
3) If the above rules do not establish an order of benefit determination, the plan that
has covered the person for the longer period of time shall be primary with the
following exception:
The plan covering the person as a laid -off or retired employee or dependent of
such person, shall be determined after the benefits of any other plan covering the
person or employee.
4) Any group plan that does not contain a coordination of benefits provision is
automatically primary.
If this plan is primary as provided above, this plan shall provide Benefits without
regard to benefits provided by any other plan. If this plan is secondary, this plan will
provide benefits which together with the other plan(s) will not exceed 100% of the
covered dental expense or this plan's maximum benefit whichever is less.
25
PART VII
CONDITIONS UNDER WHICH BENEFITS
SHALL BE PROVIDED
Section 1. PAYMENT OF CLAIMS
a) "Covered Services will not include, and no payment will be made for expenses
incurred for the performance of any dental service not provided for in this Agreement,
including any attached Appendix, Amendment, or Rider, unless Delta agrees to
accept such expenses as covered services. To submit the expenses to Delta for
consideration, the dental service must be identified in terms of the American Dental
Association Uniform Code on Dental Procedures and Nomenclature and/or by
narrative description. If expenses incurred for a dental service not provided for in this
Agreement are accepted by Delta, the Benefit for the dental service will be
determined by Delta and will be consistent with those for dental services listed in this
Appendix and in PART V, BENEFITS, LIMITATIONS AND EXCLUSIONS.
In any event, expenses incurred for dental services which do not have uniform
professional endorsement will not be accepted by Delta as Covered Services.
b) The Employer, or his designee(s) shall have authority for determination of Benefits
in any case involving disputed Benefits. The Covered Person may appeal this
determination by filing a written notice with the Dental Director, in which event the
matter may be submitted to the Executive Committee of Delta for determination of
Benefits. Any matter relating to the necessity, appropriateness or adequacy of
covered services provided or to be provided under this Agreement may be referred
to a peer review committee of the appropriate dental society or association which will
accept jurisdiction and Delta agrees to be bound by the decision of such a peer
review committee.
c) , Payment for completed Covered Services:
1) provided by a Participating Dentist or a Preferred Option Dentist shall be made
directly to the Dentist upon receipt of claim or claims signed by the Dentist for
such services.
2) provided by a dentist who is not a Participating Dentist or a Preferred Option
Dentist shall be made to the Eligible Employee upon receipt of claim or claims
signed by the dentist for such services and shall not be assignable. Since Delta
does not pay a non -participating dentist, the Covered Person shall be liable to the
dentist for the cost of service.
Keel
3) provided by a dentist in another state or country shall be made directly to the
dentist, unless assigned to the employee, upon receipt of claim or claims signed
by the dentist for such services.
4) Delta shall not be obligated to pay claims submitted more than fifteen (15) months
after the date of providing the service. If a claim is denied due to a Participating
Dentist's failure to make timely submission, the Covered Person shall not be liable
to such dentist for the amount which would have been payable by Delta.
Section 2. EXTENDED COVERAGE
All Benefits shall terminate for any Covered Person in the event that this Contract is
terminated or such person ceases to be eligible under the terms of this Contract, and no
further care or services shall be provided under this plan except completion of any single
procedure in progress, where work has commenced prior to termination of coverage.
Delta shall authorize Attending Dentist's Statement for Benefits when satisfied from the
Attending Dentist's Statement and other data that:
a. the patient is a Covered Person hereunder, provided, however, that Delta may
determine such eligibility on the basis of the most current list of Eligible Employees
received by Delta;
b. the services proposed are Benefits under this Contract; and
c. the total fee to be charged for such services to both Delta and Covered Person do
not exceed the dentist's Usual, Customary and Reasonable fees. Such
authorization shall be for a reasonable period up to a maximum of sixty (60) days,
but shall not be required to extend beyond termination of the patient's eligibility and
may be revoked upon notice of such termination. In no event shall an authorization
period extend beyond the termination date of this Agreement.
Delta shall make no payment for any services provided to a patient who is not a
Covered Person hereunder at the time of providing the service, except to the extent of
services provided during unrevoked period of authorization issued by Delta pursuant to
Part III, section 7, r and Part IV of this Agreement, and except for completion of single
procedures which were commenced at the time a patient was eligible or was entitled
Benefits by reason of such authorization. Applicant shall reimburse Delta for any
erroneous payments made as a result of incorrect eligibility reporting by Applicant.
27
Section 3. AVAILABILITY OF DENTIST
While an Covered Person may elect the service of any licensed dentist, neither Delta
nor Applicant undertakes to guarantee the availability of any particular dentist.
Section 4. RIGHT TO INFORMATION AND RECORDS
As a condition precedent to determination of benefits hereunder, Delta shall be entitled
to receive, to such extent as may be lawful, from any attending or examining dentist, or
from any attending or examining dentist, or from hospitals or clinics in which a dentist's
care is provided, such information and records relating to attendance to or examination
of or treatment proposed or provided to an Covered Person as may be required by Delta
in the administration of such claims, or to require that an Covered Person be examined
by a dental consultant retained by Delta in or near his community or residence;
provided, however, that Delta shall in every case hold such information and records as
confidential.
Section 5. CLAIM FORMS
Delta shall prepare and furnish to each Participating Dentist and to any other Dentist or
Covered Person on request a standard form to complete and submit to Delta at the
address shown herein.
Delta shall advise Participating Dentists as follows:
a. to complete and submit a standardized Attending Dentist's Statement (ADS), prior
to providing service, showing the Covered Person's dental needs and the treatment
necessary in the professional judgement of the Dentist.
b. to notify the patient of all actions taken by Delta with respect to such Attending
Dentist's Statement, and
c. that such ADS need not be submitted prior to providing of services in the case of
emergency service or in the case of brief routine procedures normally completed in
one appointment.
Section 5. SUBROGATION. Delta is entitled to enforce by its direct suit, or as co -plaintiff with
Eligible Employee, the Covered Person's claim against any third party to the extent of
benefit paid for, or on behalf of Eligible Employee by Delta. When Delta provides
benefit payments for injuries sustained by an Eligible Employee and the Eligible
Employee subsequently obtains a settlement from a third party which includes such
costs, the Eligible Employee is obligated to refund to Delta the amount equal to the
benefit payment made to, or on behalf of the Eligible Employee. The Eligible Employee
shall, upon request, execute and deliver such instrument or papers as may be required
and do whatever else is necessary to carry out this provision.
28
APPENDIX A - COVERED SERVICES
Covered Services include only those specific procedures listed
under each category. They do not include any or all procedures
which could be considered to fall under each category. Subject to
all contract limitations and exclusions.
I. Diagnostic
Clinical Oral Examinations
Initial
Periodic
Emergency
Radiographs
Complete Series (full mouth) -
Intraoral/Panoramic
Intraoral or Extraoral, Dental, Single
Film
Bitewings - not in addition to Complete
Series
Sialography
Cephalometric - only in conjunction with
covered orthodontic services
TMJ survey - single procedure including
all necessary films - only in
conjunction with covered TMJ/MPD
services
Tests and Laboratory Services
Diagnostic Casts - not in conjunction with
denture
Histopathologic Examination (microscopic
examination of biopsy specimen)
Pulp vitality tests - not in conjunction
with examination
11. Preventive
Dental Prophylaxis - to include removal of all
deposits and/or stains, and polishing as
a single complete service
Topical Fluoride Treatment - single office
procedure (through age fifteen (15) only)
Space Maintainer - passive appliance, including
recementation - primary teeth only
II. Preventive (Cont.)
Sealants - topically applied resin, composite or other
material used to seal developmental grooves
and pits in teeth for purpose of preventing
dental decay
111. Restorative (to include tooth preparation, any special
preparations, bases, liners, conditioning, finishing, polishing
or other related procedures as components of a single
complete service)
A. Restorative - Basic
Amalgam Restorations
One, two, three surface
four or more surface
Silicate Restorations - per tooth
Resin Restorations (filled or unfilled) -
anterior teeth
One, two, three surface
Four or more surface or incisal angle
Prefabricated Crown (resin or stainless
steel)
Sedative Filling - not in conjunction with
other restoration on same tooth
Pin Retention - per tooth, in addition to
Amalgam or Resin Restoration
Temporary (fractured tooth) - not in
conjunction with any laboratory
processed restoration
B. Restorative - Special
Crown - single restoration - metal and/or
porcelain or resin - laboratory
Onlay - metal or porcelain - includes
inlay component as a single
restoration
Recementation
Crown/Onlay repair
IV. Endodontics - excluding final restoration
Pulp Cap - direct - exposed pulp only
Pulpotomy or Pulpectomy - primary teeth only
Appendix A Page 2
IV. Endodontics (Cont.)
Root Canal Therapy - with open/drain - single
procedure
One, two, three canal
Four or more canal
Apexification or Recalcification
Periapical Services
Apicoectomy - with or without retrograde
filling and/or apical curettage -
single procedure
Root Amputation - not in addition to
hemisection
Hemisection - with removal of any roots -
single procedure
V. Periodontics
Surgical Services
Gingivectomy or Gingivoplasty
Gingival Curettage - to include root
planing per quadrant - with or
without flap entry - single procedure
Osseous Surgery
Osseous Graft
Pedicle or Free Soft Tissue Graft
Apically Repositioned Flap Procedure
Adjunctive Services
Root Planing - per quadrant - not in
addition to curettage - to include
scaling/polishing as a single
complete service
Other Periodontal Services
Periodontal maintenance following active
therapy - single procedure
Unscheduled dressing change
W. Prosthodontics - Removable - not to include noble metal
components
Complete Dentures - except overdentures
Partial Dentures - except overdentures
Adjust, Repair, Reline or Rebase Complete or
Partial Denture
Temporary Partial Denture - anterior teeth only
Tissue Conditioning - per denture unit - single
procedure
Appendix A Page 3
VII. Prosthodontics - Fixed
Bridge Pontics - metal or resin/porcelain with
metal
Bridge Retainers
Crown - metal or resin/porcelain with
metal
Cast Metal - for acid etch bridge
Recement or repair bridge
VIII. Oral Surgery
Extractions - including exposed residual roots
Surgical Extractions - including submerged
tooth fragments
Alveoloplasty - surgical preparation for
denture
Vestibuloplasty (ridge extension for denture) -
secondary epithelialization only - not to include grafts,
implants, augmentations, or any tissue reattachment
except mucosa
Excision of Oral Inflammatory Lesion, Tumor,
Cyst, Neoplasm, Exostosis, Hyperplastic Tissue or
Pericoronal Gingiva
Incision and Drainage - soft tissue - intraoral or extraoral -
oral lesion only
Treatment of Fractures - maxilla, mandible,
alveolus
Other Surgical Procedures
Maxillary sinusotomy or Fistula Closure
Removal of foreign body or sequestrum
Tooth Reimplantation and/or stabilization of
tooth or alveolus following trauma
Exposure of Tooth - aid eruption or
orthodontics
Frenulectomy or transseptal fiberotomy
Biopsy of Oral Tissue - soft or hard
Treatment of salivary gland or duct
Repair of traumatic wound
IX. Adjunctive General Services
Palliative (emergency) treatment - minor
procedure
Anesthesia and related services except local
anesthesia - only in conjunction with
covered oral surgery (VIII. Oral Surgery,
above)
Appendix A Page 4
IX. Adjunctive General Services (Cont.)
General Anesthesia
Intravenous Sedation - in lieu of general
anesthesia associated with covered
oral surgery
Analgesia - in lieu of general anesthesia
with covered oral surgery
Desensitize root surface - except restoration
Treatment of unusual postsurgical complication
- following covered surgical service only
Consultation (other than practitioner providing
treatment) - when requested by
attending dentist or Delta
Appendix A Page 5
JRTHODONTIC BENEFIT RIDER
In consideration of the payments specified in PART I, ADMINISTRATIVE AGREEMENT Section 3.,
of the attached Agreement, and subject to all terms and conditions thereof, except as herein otherwise
specified, Delta agrees to provide Orthodontic Benefits as follows:
1) COVERED ORTHODONTICS are defined as the services provided by a licensed dentist
involving orthognathic surgery or appliance therapy for movement of teeth and post-
treatment retention for treatment of malalignment of teeth and/or jaws including any
related diagnostic, preventive or interceptive services except extraction of teeth.
2) Delta will pay or otherwise discharge Fifty Percent (50%) of the lesser of the Covered
Amount or the fees actually charged and received by Participating Dentists, or Fifty
Percent (50%) of the Preferred Option Dentist's Fees. Allowance shall be based on
total case fee to include active treatment and post treatment retention or stabilization
and all payments shall be on a periodic basis, in accordance with the dentist's proposed
period of active treatment. Separate benefit shall not be made for post treatment
stabilization.
3) The maximum amount payable by Delta for all Orthodontics rendered to each Covered
Person shall be One Thousand Dollars ($1,000.00) per lifetime and the limitations on
the maximum amount payable during the calendar year, if any, specified in the attached
Contract shall not apply to Orthodontics.
4) EXCLUSIONS AND LIMITATIONS: In addition to the Exclusions and Limitations stated
in PART V., BENEFITS, LIMITATIONS AND EXCLUSIONS, or the attached Contract
the following exclusions and limitations shall apply to Orthodontic Benefits:
a) Replacement or repair of appliances is not a covered service.
b) Orthodontic care provided in the treatment of periodontal cases or cases
involving treatment or repositioning of the temporomandibular joint or related
conditions is not a covered service.
c) ' The obligation of Delta to make periodic payments for an Orthodontic treatment
plan shall cease upon termination of treatmentfor any reason prior to completion
of the case.
d) The obligation of Delta to make periodic payments for an Orthodontic treatment
plan begun prior to the eligibility date of the patient shall commence with the first
payment due following the patient eligibility date. The above mentioned
maximum amount payable will apply fully to this and subsequent payment.
e) The obligation of Delta to make periodic payments for an Orthodontic treatment
plan shall cease upon termination of the covered person's eligibility.