July 24, Dear Participant:

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1 Plumbers & Steamfitters Local 486 Medical Fund 911 Ridgebrook Road Sparks, Maryland Toll Free Telephone (888) admin.com July 24, 2017 Dear Participant: On the reverse side of this letter you will find the new Participating Dental Provider Listing, effective January 1, There are two sections to the Participating Dental Provider Listing. The first section consists of dentists that have reviewed our dental schedule and have agreed to accept the allowances as payment in full. The second section of the listing consists of dentists that have agreed to accept payment in full for all procedures, except they charge a co payment for full and partial denture, root canals, crowns and pontics. The co payment is determined by each individual dentist. Always discuss the required copayment with your dentist prior to having the dental work performed. Dental Benefits are paid based on a Fee Schedule. A Fee Schedule lists all dental procedures and gives each procedure on the schedule a maximum amount that is paid to the dentist. An example of how a Fee Schedule works is for procedure code 0110 an initial oral examination, there is a maximum payment made of $ All dentists on the Participating Dental Provider Listing would accept the $28.00 as payment in full. Participants can go to dentists who are not listed on the Participating Dental Provider Listing. However, the Fund will only pay the amount listed on the Fee Schedule and the participant will be responsible for the balance. The maximum amount allowed is $1, per person per year. The maximum lifetime orthodontic benefit is $1, per person. The Fund Office is always interested in adding new providers to our listing, if your dentist is interested in becoming a participating provider please have them contact the Fund Office. Dental forms can be obtained from the Fund Office by calling (888) Sincerely, Fund Office L486 Dental DW/bns

2 Plumbers & Steamfitters Local 486 Participating Dental Provider Listing Section I The Following Dentists Do Not Charge Any Co Payments John C. Brummer, DDS John C. Brummer, DDS Robert Cook, DDS 6304 Kenwood Ave Belair Road 615 Hammonds Lane Baltimore, MD Balto. MD Baltimore, MD Periodontist Loch Raven Dental S H Moen, DDS Herbert Livingston 8600 LaSelle Road Smile 4 Ever Dentistry 1001 North Point Blvd Towson, MD Lincoln Ave 2 nd Floor Dundalk, MD Rutherford, NJ Paul Chyzus, DDS Charles Seidman, DDS Maria C Duckett DDS 1003 North Point Blvd 2222 Baltimore Blvd 9110 Philadelphia Road Dundalk, MD Finksburg, MD Suite Baltimore, MD Link Duckett, DDS Richard Nichols, DDS Payam Nourmand, DDS 9110 Philadelphia Road 9110 Philadelphia Road 9110 Philadelphia Road Suite 214 Suite 214 Suite 214 Baltimore, MD Baltimore, MD Baltimore, MD Sheldon Freed, DDS Premier Dental Partners Niu Dentistry 5601 Loch Raven Blvd 8615 Ridgley s Choice Dr 420 S. Crain Hwy Baltimore, MD Suite 209 Suite Nottingham, MD Glen Burnie, MD THE FOLLOWING DENTISTS CHARGE A CO PAYMENT ON FULL & PARTIAL DENTURES, ROOT CANALS, CROWNS AND PONTICS. BE SURE TO DISCUSS CO PAYMENT WITH DENTIST BEFORE YOU HAVE THE WORK STARTED! Ampili G. Abraham Robert Akman, DDS Dwight Berry, DDS 1025 Ingleside Ave Old Court Rd. 420 Crain Highway #6 Balto. MD Suite 305 Glen Burnie, MD Pikesville, MD Aleksey Bobenko, DDS William Burdt, DDS Churchville Family Dent 3608 Greenmount Ave W. Old Liberty 1301 Churchville Road Balto. MD Sykesville, MD Baltimore, MD

3 Sherman Deveas, DDS Dennis Foster, DDS Dennis Foster, DDS 3322 Frederick Ave Harford Rd York Road Balto. MD Baltimore, MD Timonium, MD Joel Goldberg, DDS Michael Scerba, DDS Vida Davis, DDS 1709 Chesaco Ave Old Frederick RD 2933 A. Emmorton Rd. Balto. MD Baltimore, MD Abingdon, MD Vida Davis, DDS Nicholas Garcia, DMD Nicholas Garcia, DDS 212 N. Highland Ave Chesterfield Ave 831 W. 36 th Street Balto. MD Balto. MD Balto. MD James Graves, DDS Angel Dental Care Essam Ibrahim, DDS 1705 Poplar Place 405 Frederick Road 48 Mountain Road Balto. MD Suite 150 Glen Burnie, MD Catonsville, MD Adrienne Jenkins, DDS William Johnson, DDS Michael Kolakowski 6505 York Road 420 S. Crain Hwy Balto.Annap. Blvd. Balto. MD Suite 5 Glen Burnie, MD Glen Burnie, MD Michael Landy, DDS Nalin Patel, DMD Scott Steckler, DDS 4600 Connecticut, NW 122 N Philadelphia Blvd 101 Ridgeley Ave Suite 3 Aberdeen, MD Annapolis, MD Washington, DC Stephen Mastella, DDS Stephen Mastella DDS All Care Family Dentist 101 W. Read St. 532 Balto. Blvd. 11 Old Farm Lane Suite 715 Suite 412 Shrewsbury, PA Balto. MD Westminster,MD John Meredith, DDS Habib Mitri, DDS Fernando Naraval, DDS 604 E. Joppa Rd Connecticut 9690 Deereco Road Towson, MD Washington, DC Timonium, MD Rolando Naraval, DDS Hyung Kim DDS SV Ramamurthy, DDS 9690 Deereco Road 832 N Rolling Road 8713 Harford Rd. Timonium, MD Catonsville, MD Balto. MD SV Ramamurthy, DDS Dominic Raymond II Richard Rubin, DDS 4 W. Rolling Cross Rd. 56 Mileground Rd N. Charles St., Suite 113 Catonsville, MD Morgantown, WV Baltimore, MD

4 Richard Rubin, DDS Dentcare Dental Assoc Gary Scaggs, DDS 2446 Mountain Rd. 420 Crain Hwy Ritchie Hwy. Pasadena, MD Suite 6 Balto. MD Glen Burnie, MD Gary Seiden, DDS Craig Sullivan DDS G.R. Weaver DDS 1224 Eastern Blvd Ridgeland Rd Park Heights Ave. Balto. MD Suite 6 Balto. MD Cockeysvile,MD August Weber, DDS Adly Wilson, DDS Michael Woland, DDS 2208 Emmorton Rd Greenway Ctr.Dr 122 N. Phila Blvd. Suite 104 Suite 201 Aberdeen, MD Bel Air, MD Greenbelt, MD Bruce Yuille, DDS Bruce Yuille, DDS Mehdi Zamani, DDS 4508 Edmondson Ave Old Court Rd. 120 Sister Pierre Dr Balto. MD Suite 203 Suite Randallstown, MD Towson, MD Evan DePadua, DDS Jeffrey Jaicks, DDS Dharani Jasthi, DMD A Baltimore Natl 7401 Osler Drive 832 N Rolling Road Ellicott City, MD Suite 202 Catonsville, MD Towson, MD Dharani Jasthi, DMD Dharani Jasthi, DMD DHA Dental 8628 Liberty Place 2030 Liberty Road 1912 Liberty Road Randallstown, MD Eldersburg, MD Eldersburg, MD Loretta Seymour, DDS Marie Juaneza, DDS Jun Park, DDS 5002 Suitland Road 301 Eastern Blvd 832 N Rolling Road Suitland, MD Essex, MD Catonsville, MD Jun Park, DDS Cynthia Miller, DDS Rion Blagrove DDS 2030 Liberty Road #1 6 Park Center Court 1402 E Churchville RD Eldersburg, MD Owings Mills, MD Belair, MD Edward S Lazer and Associates Vijayalakshmi Angamuthu, DDS Dawn Phillips, DDS 1810 Belair Road 1726 N. Rolling Road 1402 E Churchville RD Suite 201 Baltimore, MD Belair, MD Fallston, MD

5 Ajmal Dental Care Family Dentistry of Annapolis James G. Kokorelis Centennial Square Office Park 200 Forbes Street 9010 Harford Road 10306B Balt. Ntl Pike 40 W Suite 301 Parkville, MD Ellicott City, MD Annapolis, MD Swati Makadia, DMD 9010 Harford Road Parkville, MD

6 Plumbers & Steamfitters Local 486 Medical Fund 911 Ridgebrook Road Sparks, Maryland Dental Fee Schedule Effective January 1, 2012 CODE FEE CODE FEE CODE FEE CODE FEE CODE FEE MAXIMUM: $1,250 PER PERSON, PER YEAR ORTHODONTICS: $1,500 PER PERSON, PER LIFETIME NO PRE AUTHORIZATION REQUIRED

7 *BOLD CODE AMOUNTS THE PLAN PAYS 50% OF THESE RESTORATIVE PROCEDURES THE MEMBER IS RESPONSIBLE FOR THE DIFFERENCE UP TO THE BOLD AMOUNT ALLOWED