Select Plan 1 709s Great value, fixed fees and special features!

Transcription

1 Select Plan 1 709s Great value, fixed fees and special features! Plan Features NO Annual Maximums NO Deductibles NO Waiting Periods NO Claim Forms 2 NO Pre-authorization Paperwork NO Pre-existing Condition Exclusions Select Plan (Same as a DHMO) 1 Choose any in-network dentist from one of the largest DHMO-style networks in the Mid-Atlantic 3 Family members may select different dentists All network dentists are licensed, regulated and must meet Dominion s Credentialing and Quality Assurance Program standards Quality care at predetermined fees Extensive coverage for over 250 procedures No charge for oral exams, routine semi-annual cleanings, bitewing and complete series X-rays, topical fluoride for children or amalgam fillings (silver) Additional cleaning covered for diabetes and expecting mothers Orthodontic benefits provided for adults and children Specialty care is provided at the listed copayment whether performed by a participating general dentist or a participating specialist. Referrals to a specialist must be made by the member s participating general dentist. Out-of-Area Emergency Care: You are covered up to $100 for palliative emergency dental treatment arising from accidental injury or illness while temporarily more than 50 miles from home. The $100 limit does not apply in Pennsylvania. 15% discount on all implant services 1 Same as a DHMO plan with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no claim forms (except in the case of out-of-area emergencies). 2 Out-of-area emergency care reimbursement requires a receipt or other proof of loss. 3 Dominion Dental Services, Inc. Competitive Network Survey, 4th Quarter Mid-Atlantic includes D.C., Delaware, Maryland, Pennsylvania and Virginia. Participating dentists are subject to change. 4 Based on the Captiva context fee schedule s 80th percentile fee information. Savings Comparison Procedure We Work For Your Benefit. For full details of the coverages, limitations and exclusions, please read the enclosed Description of Benefits and Member Copayments. Need to find a participating dentist? Simply visit DominionDental.com. Average Charge 4 Your Fee Your Savings Oral Exam $86 No Charge 100% Bitewing X-rays (2 Films) $40 No Charge 100% Topical Fluoride for ren $42 No Charge 100% Semiannual Cleaning $90 No Charge 100% Complete Series X-rays $130 No Charge 100% Filling (3-Surface/Silver) $194 No Charge 100% Root Canal (Anterior Tooth) $897 $238 73% Perio Scaling/Root Planing $247 $78 68% Crown (Porcelain/Metal) $1,210 $339 72% Complete Denture $1,493 $520 65% Extraction, Erupted Tooth $139 $39 72% Orthodontics $6,244 $3,422 45% Adult Orthodontics $6,244 $3,658 41%

2 How do I enroll? 1. Complete the enclosed enrollment card. List all dependents you want covered. You must choose a primary care dentist before or after enrollment. You can find a current list of dentists online at DominionDental.com/finda-dentist. You can also call us at to request that one be mailed to you. After your effective date, simply call the dental office you selected and make an appointment. Except for out-of-area emergency care, you must receive treatment at the dental office you selected. 2. Return the completed enrollment card to your Benefit Administrator or as directed. 3. A Membership Card, Description of Benefits and Member Copayments and Certificate of Coverage will be mailed to you on or before your first day of eligibility. 4. If you have any questions regarding your date of eligibility, please contact your Benefits Department. Who is eligible? You and your dependents are eligible. Dependents include your spouse and unmarried children under age 26. Refer to your policy documents for further details regarding your dependent coverage. What if I change jobs? If you leave your place of employment, you have the option of converting your coverage to an alternate Dominion program using a different method of payment. Can I make changes on the Internet? Yes. Dominion provides members with secure online access to: ID card requests Plan information Dentist search Dental office transfers Contact information Member services requests and general correspondence All changes are confirmed by return . For more information, visit DominionDental.com. What is my monthly cost? 1 Subscriber Only $32.08 Subscriber and Family $ Includes $1.00 Dominion/FOP administrative fee and $2.10 Prince George s County direct withdrawal processing fee. Dominion Dental Services, Inc. is licensed as a Dental Plan Organization in Virginia, Maryland and Delaware, a Risk Assuming PPO in Pennsylvania and an Accident and Health Insurer in D.C. A New Level of Service 1 Less than 0.1% of our members called with a service issue. ID cards and member packets were mailed within 4 days of enrollment. 98% member retention rate. 97% of Dominion members have access to at least two Select Plan dentists within 10 miles. 1 Dominion Dental Services, Inc. Internal Performance Report, South Union Street, Suite 300 Alexandria, VA (Phone) (Fax) DominionDental.com We Work For Your Benefit. Dominion Dental Services (Dominion) is an agile and innovative administrator of dental and vision benefits in the Mid-Atlantic, offering managed care and indemnity programs, claims adjudication and comprehensive plan administration. Among our 500,000 customers are leading health plans, employer groups, municipalities, associations and individuals. The Dominion group of companies includes Dominion Dental Services, Inc., a licensed issuer of dental plans, and Dominion Dental Services USA, Inc., a licensed administrator of dental and vision benefits. 0112

3 Dominion Dental Services, Inc. Alexandria, VA DENTAL SELECT PLAN ENROLLMENT CARD Last Name First Name M.I. Social Security Number Sex M F Birthdate (MM/DD/YY) Home Address Home Phone City State ZIP Work Phone Address Hire Date Dental Office Name & Code # (As indicated on Your Dentist Directory) List All Your Eligible Dependents Below Last Name (if different) First Name M.I.. Social Security Number Sex (M/F) Birthdate (MM/DD/YY) Spouse If I am voluntarily paying 100% of the cost of this Plan, without employer contribution, I agree to remain in Plan a minimum of twelve (12) months. If I cancel before the end of the 12 month period, I may be responsible for the usual, customary and reasonable charges for services received, reduced by the sum of the subscription dues and copayments paid. I understand and agree that my signature on this enrollment form serves as my legal commitment to the Plan and its terms. Further, this signature represents my authorization for the release of information regarding services provided to me or my covered dependents by dentists and other providers of dental services. Information will be released to Dominion Dental Services, Inc., for the purpose of investigation or evaluation of care in connection with a claim or complaint. Authorization will be limited to the term of coverage of this contract. A copy of this form will be made available to subscriber or their authorized representative upon request. Signature Date PAPERLESS? Yes No Agent/Broker # Group # Group Name Coverage Eff. Date Prince George s County FOP Dominion Dental Services, P.O. Box Charlotte, NC Delaware - Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony. District of Columbia - WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. Maryland - Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Pennsylvania - Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information,or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Virginia - It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. 12DAPP

4 Plan 709s Description of Benefits & Member Copayments ADA MEMBER CODE BENEFIT COPAYMENT(S) DIAGNOSTIC/PREVENTIVE D9439 Office visit... 0 D0120 Periodic oral eval - established patient... 0 D0140 Limited oral eval - problem focused... 0 D0145 Oral eval for a patient under 3 years of age... 0 D0150 Comprehensive oral eval - new or established patient... 0 D0160 Detailed and extensive oral eval - problem focused... 0 D0170 Re-evaluation - limited, problem focused... 0 D0210 Intraoral - complete series (including bitewings)... 0 D0220 Intraoral - periapical first film... 0 D0230 Intraoral - periapical each add. film... 0 D0240 Intraoral - occlusal film... 0 D0250/60 Extraoral - first film and each add. film... 0 D Bitewing x-rays - 1 to 4 films... 0 D0277 Vertical bitewings - 7 to 8 films... 0 D0330 Panoramic film D0340 Cephalometric Film... 0 D0350 Oral/facial photographic images... 0 D0460 Pulp vitality tests... 0 D0470 Diagnostic casts... 0 D1110 Prophylaxis (cleaning) - adult... 0 D1110* Additional cleaning (expecting mothers or Diabetics) D1120 Prophylaxis (cleaning) - child... 0 D1203 Topical application of fluoride - child... 0 D1204 Topical application of fluoride - adult... 0 D1206 Topical fluoride varnish for mod/high risk caries patients... 0 D1310 Nutritional counseling for control of dental disease... 0 D1320/30 Oral hygiene instructions... 0 D1351 Sealant - per tooth D1352 Prev resin rest. mod/high caries risk perm. tooth SPACE MAINTAINERS D1510/20 Space maintainer - fixed/removable - unilateral D1515/25 Space maintainer - fixed/removable - bilateral D1550 Re-cementation of space maintainer RESTORATIVE DENTISTRY (FILLINGS) AMALGAM RESTORATIONS (SILVER) D2140 Amalgam - one surface, prim. or perm... 0 D2150 Amalgam - two surfaces, prim. or perm... 0 D2160 Amalgam - three surfaces, prim. or perm... 0 D2161 Amalgam - >=4 surfaces, prim. or perm... 0 RESIN/COMPOSITE RESTORATIONS (TOOTH COLORED). D2330 Resin-based composite - one surface, anterior D2331 Resin-based composite - two surfaces, anterior D2332 Resin-based composite - three surfaces, anterior D2335 Resin-based composite - >=4 surfaces, anterior D2391 Resin-based composite - one surface, posterior D2392 Resin-based composite - two surfaces, posterior D2393 Resin-based composite - three surfaces, posterior D2394 Resin-based composite - >=4 surfaces, posterior D2940 Sedative filling D2951 Pin retention - per tooth, in addition to restoration D3110/20 Pulp cap - direct/indirect (excl. final restoration) CROWN & BRIDGE D2390 Resin-based composite crown, anterior D2510 Inlay - metallic - one surface D2520 Inlay - metallic - two surfaces D2530 Inlay - metallic - three or more surfaces D2542 Onlay - metallic-two surfaces D2543 Onlay - metallic-three surfaces D2544 Onlay - metallic-four or more surfaces D2610 Inlay - porcelain/ceramic - one surface D2620 Inlay - porcelain/ceramic - two surfaces D2630 Inlay - porcelain/ceramic - >=3 surfaces D2642 Onlay - porcelain/ceramic - two surfaces D2643 Onlay - porcelain/ceramic - three surfaces D2644 Onlay - porcelain/ceramic - >=4 surfaces D2650 Inlay - resin-based composite - one surface D2651 Inlay - resin-based composite - two surfaces D2652 Inlay - resin-based composite - >=3 surfaces D2662 Onlay - resin-based composite - two surfaces D2663 Onlay - resin-based composite - three surfaces D2664 Onlay - resin-based composite - >=4 surfaces D2710 Crown - resin based composite (indirect) D2712 Crown - 3/4 resin-based composite (indirect) ADA MEMBER CODE BENEFIT COPAYMENT(S) D2720/21/22 Crown - resin with metal D2740 Crown - porcelain/ceramic substrate D2750/51/52 Crown - porcelain fused metal D2780/81/82 Crown - 3/4 cast with metal D2783 Crown - 3/4 porcelain/ceramic D2790/91/92 Crown - full cast metal D2910/20 Recement inlay, onlay/crown or partial coverage rest D2930 Prefab. stainless steel crown - prim. tooth D2931 Prefab. stainless steel crown - perm. tooth D2932 Prefabricated resin crown D2950 Core buildup, including any pins D2952 Cast post and core in addition to crown D2954 Prefab. post and core in addition to crown D2955 Post removal (not in conj. with endo. therapy) D2970 Temporary crown (fractured tooth)... 0 D2980 Crown repair, by report PROSTHETICS (DENTURES) D5110/20 Complete denture - maxillary/mandibular D5130/40 Immediate denture - maxillary/mandibular D5211/12 Maxillary/mandibular partial denture - resin base D5213/14 Maxillary/mandibular partial denture - cast metal D5225/26 Maxillary/mandibular partial denture - flexible base D5281 Rem. unilateral partial denture - one piece cast metal D5410/11 Adjust complete denture - maxillary/mandibular D5421/22 Adjust partial denture - maxillary/mandibular D5510/5610 Repair broken denture base (complete/resin) D5520 Replace missing or broken teeth - complete denture D5620 Repair cast framework D5630/60 Clasp repaired, replaced or added D5640 Replace broken teeth - per tooth D5650 Add tooth to existing partial denture D5670/71 Replace all teeth and acrylic on cast metal framework D5710/11 Rebase complete maxillary/mandibular denture D5720/21 Rebase maxillary/mandibular partial denture D5730/31 Reline complete maxillary/mandibular denture (chairside) D5740/41 Reline maxillary/mandibular partial denture (chairside) D5750/51 Reline complete maxillary/mandibular denture (lab) D5760/61 Reline maxillary/mandibular partial denture (lab) D5810/11 Interim complete denture - maxillary/mandibular D5820/21 Interim partial denture - maxillary/mandibular D5850/51 Tissue conditioning - maxillary/mandibular BRIDGE & PONTICS D6000-D6199 ALL IMPLANT SERVICES - 15% DISCOUNT (incl. D0360-D0363 cone beam imaging w/ implants) D6210/11/12 Pontic - metal D6240/41/42 Pontic - porcelain fused metal D6245 Pontic - porcelain/ceramic D6250/51/52 Pontic - resin with metal D6545 Retainer - cast metal for resin bonded fixed prosthesis D6548 Ret. - porc./ceramic for resin bonded fixed prosthesis D6600 Inlay - porc./ceramic, two surfaces D6601 Inlay - porc./ceramic, >=3 surfaces D6602 Inlay - cast high noble metal, two surfaces D6603 Inlay - cast high noble metal, >=3 surfaces D6604 Inlay - cast predominantly base metal, two surfaces D6605 Inlay - cast predominantly base metal, >=3 surfaces D6606 Inlay - cast noble metal, two surfaces D6607 Inlay - cast noble metal, >=3 surfaces D6608 Onlay -porc./ceramic, two surfaces D6609 Onlay - porc./ceramic, three or more surfaces D6610 Onlay - cast high noble metal, two surfaces D6611 Onlay - cast high noble metal, >=3 surfaces D6612 Onlay - cast predominantly base metal, two surfaces D6613 Onlay - cast predominantly base metal, >=3 surfaces D6614 Onlay - cast noble metal, two surfaces D6615 Onlay - cast noble metal, >=3 surfaces D6720/21/22 Crown - resin with metal D6740 Crown - porcelain/ceramic D6750/51/52 Crown - porcelain fused metal D6780 Crown - 3/4 cast high noble metal D6781 Crown - 3/4 cast predominantly base metal D6782 Crown - 3/4 cast noble metal D6783 Crown - 3/4 porc./ceramic D6790/91/92 Crown - full cast metal D6930 Recement fixed partial denture D6970 Post and core in addition to fixed part. dent. ret D6972 Prefab post and core in addition to fixed part. dent. ret Form All fees exclude the cost of noble and precious metals. An additional fee will be charged if these materials are used.

5 Plan 709s ADA MEMBER CODE BENEFIT COPAYMENT(S) D6973 Core build up for retainer, including any pins D6975 Coping - metal D6976 Each add. indirectly fabricated post - same tooth D6977 Each add. prefab post - same tooth D6980 Fixed partial denture repair, by report ADJUNCTIVE GENERAL SERVICES D9110 Palliative (emergency) treatment of dental pain D9210/15 Local anesthesia... 0 D9211 Regional block anesthesia... 0 D9212 Trigeminal division block anesthesia... 0 D9220 Deep sedation/general anesthesia - first 30 min D9221 Deep sedation/general anesthesia - each add. 15 min D9241 Intravenous conscious sedation/analgesia - first 30 min D9242 IV conscious sedation/analgesia - each add. 15 min D9230 Analgesia, anxiolysis, inhalation of nitrous oxide D9310 Consultation (diagnostic service by nontreating dentist) D9910 Application of desensitizing medicament D9930 Treatment of complications (post-surgical) D9990 Broken office appointment ENDODONTICS 1 D3220 Therapeutic pulpotomy (excl. final restor.) D3221 Pulpal debridement, prim. and perm. teeth D3310 Endodontic therapy, anterior tooth D3320 Endodontic therapy, bicuspid tooth D3330 Endodontic therapy, molar D3333 Internal root repair of perforation defects D3346 Retreat of prev. root canal therapy, anterior D3347 Retreat of prev. root canal therapy, bicuspid D3348 Retreat of prev. root canal therapy, molar D3410 Apicoectomy/periradicular surgery, anterior D3421 Apicoectomy/periradicular surgery, bicuspid (first root) D3425 Apicoectomy/periradicular surgery, molar (first root) D3426 Apicoectomy/periradicular surgery (each add. root) D3430 Retrograde filling - per root D3450 Root amputation - per root D3920 Hemisection, not inc. root canal therapy D3950 Canal prep/fitting of preformed dowel or post PERIODONTICS 1 D0180 Comp. periodontal eval - new or established patient D4210 Gingivectomy or gingivoplasty - >3 cont. teeth, per quad D4211 Gingivectomy or gingivoplasty - <=3 teeth, per quad D4240 Gingival flap proc., inc. root planing - >3 cont. teeth, per quad D4241 Gingival flap proc, inc. root planing - <=3 cont. teeth, per quad D4260 Osseous surgery - >3 cont. teeth, per quad D4261 Osseous surgery - <=3 cont. teeth, per quad D4268 Surgical revision proc., per tooth D4274 Distal or proximal wedge procedure D4341 Perio scaling and root planing - >3 cont teeth, per quad D4342 Perio scaling and root planing - <= 3 teeth, per quad D4355 Full mouth debridement D4381 Localized delivery of chemotherapeutic agents D4910 Periodontal maintenance D9940 Occlusal guard, by report D9950 Occlusion analysis - mounted case D9951 Occlusal adjustment - limited D9952 Occlusal adjustment - complete ORAL SURGERY 1 D7111 Extraction, coronal remnants - deciduous tooth D7140 Extraction, erupted tooth or exposed root D7210 Surgical rem. of erupted tooth req. bone cut D7220 Removal of impacted tooth - soft tissue D7230 Removal of impacted tooth - partially bony D7240 Removal of impacted tooth - completely bony D7241 Removal of imp. tooth - completely bony, with unusual surg. complications D7250 Surgical removal of residual tooth roots D7270 Tooth reimplant./stabiliz. of acc. evulsed/displaced tooth D7280 Surgical access of an unerupted tooth D7291 Transseptal fiberotomy/supra crestal fiberotomy, by report...27 D7310/20 Alveoloplasty, per quad D7510 Incision and drainage of abscess - intraoral soft tissue D7960 Frenulectomy (frenectomy/frenotomy) - separate proc Specialty care is provided at the listed copayment whether performed by a Participating General Dentist or a Participating Specialist. Referrals to a specialist must be made by a member s Participating General Dentist. See Plan Exclusion #13. ADA MEMBER CODE BENEFIT COPAYMENT(S) ORTHODONTICS 2 D8660 Pre-orthodontic treatment visit D8070 Comp. ortho. treatment - transitional dentition D8080 Comp. ortho. treatment - adolescent dentition D8090 Comp. ortho. treatment - adult dentition D8670 Periodic ortho. treatment visit (as part of contract) D8680 Orthodontic retention (rem. of appl. and placement of retainer(s)) Phase I Treatment (D D8050) is provided at a 15% reduction from the orthodontist s UCR fees. See exclusion #15 for additional coverage exclusions. Plan Exclusions 1. Services which are covered under Medicare, worker s compensation, employer s liability laws, or the Pennsylvania Motor Vehicle Financial Responsibility Law (Pennsylvania policyholders only). 2. Services which, in the opinion of the attending dentist, are not necessary for the patient s dental health. 3. Cosmetic, elective or aesthetic dentistry except as required due to accidental bodily injury to sound natural teeth. 4. Oral surgery requiring the setting of fractures or dislocations. 5. Services with respect to malignancies, cysts or neoplasms, hereditary, congenital, anodontic, mandibular prognathism or development malformations where, in the opinion of the Participating Dentist, such services should not be performed in a dental office. 6. Dispensing of drugs. 7. Hospitalization for any dental procedure. 8. Treatment required for conditions resulting from major disaster, epidemic, war, acts of war, whether declared or undeclared, or while on active duty as a member of the armed forces of any nation. 9. Replacement due to loss or theft of prosthetic appliance. 10. Procedures not listed as covered benefits under this Plan. 11. Services obtained outside of the dental office in which enrolled and that are not preauthorizedby such office or Dominion Dental Services, Inc. (with the exception of out-of-area emergency dental services). 12. Services related to the treatment of TMD (Temporomandibular Disorder). 13. Services performed by a Participating Specialist without a referral from a Participating General Dentist (with the exception of Orthodontics). A referral form is only required in Maryland. Participating dentists should refer to Specialty Care Referral Guidelines. 14. Elective surgery including, but not limited to, extraction of nonpathologic, asymptomatic impacted teeth. 15. The Invisalign system and similar specialized braces are not a covered benefit. Patient copayments will apply to the routine orthodontic appliance portion of services only. Additional costs incurred will become the patient s responsibility. Plan Limitations 1. Two (2) evaluations are covered per calendar year including a maximum of one (1) comprehensive evaluation. 2. One (1) problem focused exam is covered per calendar year. 3. Two (2) teeth cleanings (prophylaxis) are covered per calendar year (one additional cleaning is covered during pregnancy and for diabetic patients). 4. One (1) topical fluoride or fluoride varnish is covered per calendar year. 5. Two (2) bitewing x-rays are covered per calendar year. 6. One (1) set of full mouth x-rays or panoramic film is covered every three (3) years. 7. One (1) sealant or preventative resin restoration per tooth is covered per lifetime, up to age 16 (limited to permanent 1 st and 2 nd molars). 8. Replacement of a filling is covered if it is more than two (2) years from the date of original placement. 9. Replacement of a bridge, crown or denture is covered if it is more than seven (7) years from the date of original placement. 10. Crown and bridge fees apply to treatment involving five or fewer units when presented in a single treatment plan. Additional crown or bridge units, beginning with the sixth unit, are available at the provider s Usual, Customary, and Reasonable (UCR) fee, minus 25%. 11. Relining and rebasing of dentures is covered once every 24 months. 12. Retreatment of root canal is covered if it is more than two (2) years from the original treatment. 13. Root planing or scaling is covered once every 24 months per quadrant. 14. Full mouth debridement is covered once per lifetime. 15. Procedure Code D4381 is limited to one (1) benefit per tooth for three teeth per quadrant or a total of 12 teeth for all four quadrants per twelve (12) months. Must have pocket depths of five (5) millimeters or greater. 16. Periodontal surgery of any type, including any associated material, is covered once every 36 months per quadrant or surgical site. 17. Periodontal maintenance after active therapy is covered twice per calendar year, within 24 months after definitive periodontal therapy. Only current ADA CDT codes are considered valid by Dominion Dental Services, Inc. Current Dental Terminology American Dental Association.

6 Washington / Baltimore Metropolitan Area Select Plan 1 Dentist Directory General Dentists *Not accepting new members. 6000x and 5000x Program not accepted. 6000x and 5000x Program only. We are continually expanding our network of dentists. For the most up-to-date listing of all participating general dentists and specialists visit us on the web at DominionDental.com. A printed list can also be requested by calling our Member Services Department toll-free at VirginiA Alexandria City Alexandria #50340 (571) Alexandria Dental Care PLLC 715 Pendleton St Alexandria, VA #144 (703) Duke St, Ste 210 Alexandria, VA # (703) Landmark Dental Care 101 S Whitting St, Ste 100 Alexandria, VA #239 (703) Nathan Tsui DDS 5249 Duke St, Ste 10 Alexandria, VA #2274 (703) Phuong Phan D.MD PC 1225 Martha Custis Dr, #C-6 Alexandria, VA #215 (703) Ronald E Tolson DDS 5246 Dawes Ave Alexandria, VA #1269 (703) Said M Khalefa DDS PC 4600 Pincrest Office Park Dr, Ste B Alexandria, VA # (703) Smiley Du Dental 3610 Forest Dr, Ste 4A Alexandria, VA #342 (703) Thomas S. Kwon, D.D.S Kenmore Ave, Ste 122 Alexandria, VA Arlington county Arlington #233 (703) Carl G Lebo DDS PC 3801 N Fairfax Dr, Ste 72 Arlington, VA # (703) Elegant Smiles Dental Care 3801 N Fairfax Dr, Ste 42 Arlington, VA #37711 (703) Mira Dental Care 1901 N Moore St, Ste 501 Arlington, VA Fairfax county Alexandria #78281 (703) Elegant Smiles Dental Care 4810 Beauregard St, Ste 300 Alexandria, VA #50839* (703) Impression Dental Inc Fuller Ct Alexandria, VA #50919 (703) Kingstowne Family & Cosmetic Dentistry 5960 Kingstowne Town Center, Ste 140 Alexandria, VA #1891 (703) Virginia Dental Center 6230-C N King s Hwy Alexandria, VA Annandale #61339 (703) Navdeep Aulakh DDS PLLC 4231 Markham St, Ste 214 Annandale, VA #50376 (703) Springdale Dentistry 5105 C Backlick Rd Annandale, VA Burke #50466 (703) Alireza Palizi DDS PC 5216-A Lyngate Ct Burke, VA #50454 (703) Dental First Associates LLC 9570-A Burke Rd Burke, VA #74 (703) Hashem Sedaghatpour, D.M.D D Burke Centre Pkwy Burke, VA #37680 (703) Young Smile Dental 9000 Fern Park Dr, A2 Burke, VA Centreville # (703) Brite Smile Dental Group Lee Hwy, Ste 116 Centreville, VA #1452* (703) Jim J. Soltani, D.D.S. & Associates, P.C Centreville Crest Ln Centreville, VA #61402 (703) V Care Dental LLC Lee Hwy, Ste 117 Centreville, VA Chantilly #37667* (703) Diamond Dental Care Lee Jackson Memorial Hwy Chantilly, VA #1387* (703) Donald Chaenkwok, D.D.S B Sullyfield Cir Chantilly, VA # (703) Grace Dental of Virginia 4530 Walney Rd, Ste 102 Chantilly, VA Fairfax #2529 (703) Chuck C. Joo, D.M.D Lee Jackson Mem. Hwy, 104 Fairfax, VA #523 (703) Howard Hoffman DDS PC 9661 C Main St Fairfax, VA #50398 (703) Minjeong Suk DDS PC 4001 Fair Ridge Dr, Ste 105 Fairfax, VA # (703) Westfields Dental 3903 Fair Ridge Dr, Ste 214 Fairfax, VA Falls Church #50547 (703) Apt Dental Associates 7115 Leesburg Pk, Ste 216 Falls Church, VA #33844 (703) Arlington Dental Care PLLC 6060 Arlington Blvd Falls Church, VA #815 (703) Drs. Seigel & Moller 7641 Leesburg Pk Falls Church, VA #1103 (703) Drs. Whiston, Patterson & Corcoran 6400 Arlington Blvd, Plaza 1 Lower Level Falls Church, VA #2845 (703) Falls Church Family and Comprehensive Dentistry 6400 Arlington Blvd, Ste 944 Falls Church, VA #50943* (703) Gentle Touch Dentistry for All Ages 6521 Arlington Blvd, Ste 112 Falls Church, VA #37710 (703) Mira Dental Care 5671 Columbia Pk, 101 Falls Church, VA #70486 (703) Nguyen and Associates Dental 2901 Telstar Ct, Ste 120 Falls Church, VA #2124 (703) Optimum Dental 7389 Lee Hwy, Ste 101 Falls Church, VA #1544 (703) Smile Dental Clinic 3817-A S George Mason Dr Falls Church, VA #72077 (703) Your Family Dentist 5666 Columbia Pk, Ste A Falls Church, VA Herndon #92 (703) Park Center Rd, Ste 137 Herndon, VA Mc Lean #51125 (571) Mira Dental Care at Tysons Corner 8201 Greensboro Dr, Ste 710 Mc Lean, VA Reston #61412 (703) A B Dental H Baron Cameron Ave Reston, VA #79058 (571) Family and Cosmetic Dentistry 1800 Michael Faraday Dr Reston, VA #926 (703) Sherry Anoushfar, D.D.S., PC 1984 Isaac Newton Square, Ste 201 Reston, VA Springfield #524 (703) Howard Hoffman DDS PC 6340 Brandon Ave Springfield, VA #48 (703) Said M. Khalefa, D.D.S., P.C Backlick Rd Springfield, VA Vienna #97844 (703) Beulah Dental 1300 Beulah Rd Vienna, VA #145 (703) Gallows Rd, Ste 320 Vienna, VA #115* (703) Le Smile 2070 Chain Bridge Rd, Ste 530 Vienna, VA #50928 (703) Mazin Alayssami DMD & Associates PC Specialists 2230 Gallows Rd, Ste 320 Vienna, VA #97164 (703) Richard J Hong DMD PC 8230 Boone Blvd, Ste 208 Vienna, VA Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no claim forms (except in the case of out-of-area emergencies) Dominion Dental Services, Inc. 115 South Union Street Suite 300 Alexandria, VA As of 9/1/2013 (703) Toll Free (888) Fax (855) DominionDental.com Page 1

7 #1302 (703) Sherry Anoushfar, D.D.S., PC 133 E Maple Ave, Ste 206 Vienna, VA #33870 (703) Tysons Corner Dentists 8296-A Old Courthouse Rd Vienna, VA Fairfax City Fairfax #217 (703) Drs Berman & Miller DDS 9942 Main St Fairfax, VA #37738 (703) Family Dentistry of Fairfax, PC Democracy Ln, Ste A Fairfax, VA #37759 (703) Thomas Yoon Dental Main St, 200 Fairfax, VA Falls Church City Falls Church #358* (703) Albert M. Boyce, D.D.S. 313 Park Ave, Ste 101 Falls Church, VA #1322 (703) Ali Sarraj, D.M.D. & Associates, P.C. 932 W Broad St Falls Church, VA #61384 (703) Dynamic Dental PC 159 Hillwood Ave Falls Church, VA Fauquier county Warrenton #78269 (540) Marlin F Rekow DDS PC 127 E Shirley Ave Warrenton, VA Fredericksburg City Fredericksburg #1730 (540) Dental One Associates Fredericksburg PC 201 Park Hill Dr Fredericksburg, VA #68492 (540) Tranquility Dental Center PLLC 2557 Cowan Blvd Fredericksburg, VA Loudoun county Ashburn #37695 (703) Gateway Dental Premier Plaza, 140 Ashburn, VA Chantilly #37730 (703) South Riding Dental Associates, P.C Riding Plaza Dr, Ste 270 Chantilly, VA Leesburg #2290 (703) Amirreza Rafaat, D.D.S., P.C Deerfield Ave, Ste 465 Leesburg, VA Sterling #157 (703) Pidgeon Hill Dr, Ste 200 Sterling, VA #2123 (703) Drs Partovi & Kianpour Benedict Dr, Ste 230 Sterling, VA #1808 (703) Marie Hooshmand, D.D.S., P.C Whitfield Pl, Ste 101 Sterling, VA #1912 (703) Truc Duong, D.D.S., PC Whitfield Pl, Ste 103 Sterling, VA Manassas City Manassas #1729 (703) Dental One Associates Manassas PC 7800 Sudley Rd, Ste 7810 Manassas, VA #50777 (703) Kevin Mendes DDS & Associates PLLC 8609 Sudley Rd, Ste 102 Manassas, VA #50778 (703) Kevin Mendes DDS & Associates PLLC 8404 Dorsey Cir Manassas, VA Prince William county Dale City #2416* (703) Hanna Hannania, D.D.S., P.C Dale Blvd Dale City, VA Dumfries #51112 (703) The Dentist Office LLC Main St, Ste A Dumfries, VA Woodbridge #2131 (703) Dental Center at Lake Ridge Darby Brooke Ct Woodbridge, VA #1731 (703) Dental One Associates Woodbridge PC Smoketown Rd Woodbridge, VA #456 (703) Joel R Braunfeld DDS 2239-L Tackett s Mill Dr Woodbridge, VA #81562 (703) Light Family Dental Jefferson Davis Hwy, Ste 16 Woodbridge, VA #451* (703) Raymond C. Haston, Jr., D.D.S Hereford Rd Woodbridge, VA #33879 (703) Sameer Kwatra, D.D.S., PC 2970 Prince William Pkwy Woodbridge, VA Spotsylvania county Fredericksburg #147 (540) Frank D. Romano, D.D.S Heatherstone Dr Fredericksburg, VA Spotsylvania #37958 (540) Hill Top Plaza Way Spotsylvania, VA Stafford county Fredericksburg #428* (540) Raymond C Haston Jr DDS PC 560 Celebrate Virginia Pkwy, 107 Fredericksburg, VA Stafford # (540) Aquia Dental Care 2712 Jefferson Davis Hwy, Ste 201 Stafford, VA #156 (540) Garrisonville Rd, Ste 205 Stafford, VA #854 (540) Elizabeth M Attreed DDS 2832 Jefferson Davis Hwy, Aquia Towne Center Stafford, VA District of Columbia Washington #185 (202) Andrew M. Lasky, D.D.S., P.C Th St Nw #201 Washington, DC #1659 (202) Capitol City Dental Center 7723 Alaska Avenue, Nw Washington, DC #37679 (202) E G Harrison DMD 3230 Pennsylvania Ave Se, Suite230 Washington, DC #69560 (202) Eastern Family Dental 7826 Eastern Ave Nw, Ste 202 Washington, DC #61282 (202) Elizabeth Perry-Dodson DDS 7310 Alaska Ave Nw Washington, DC # (202) Fred M Lee DDS 1824 Calvert St Nw, St Level Washington, DC #2739 (202) Georgetown Smile 4400 Macauthur Blvd, Ste 200 Washington, DC #2769 (202) Georgia Avenue Dental Clinic 7304 Georgia Ave Nw, Ste 2 Washington, DC #512* (202) Hillcrest Dental Assoc Pennsylvania Ave, Ste 2 Washington, DC #50740 (202) Larry F McNair DDS 2033 Hamlin Street, Ne Washington, DC #281 (202) Michael G. Landy, D.D.S., F.A.G.D Connecticut Ave Nw Washington, DC #51049 (202) Petworth Dental PLLC 800 Butternut St Nw Washington, DC #51048 (202) Petworth Dental PLLC 4018 Georgia Ave Nw Washington, DC #37585 (202) Prosthetic and TMJ Management 1800 I St, Ste 801 Washington, DC #1406 (202) Roy Baptiste DDS 3130 Mlk Ave, Se Washington, DC #1691 (202) Sharmin Dental Clinic/Rahim Sharmin, D.D.S Harvard Street, Nw, Ste 108 Washington, DC #338 (202) Shelton R Penn DDS 5 Barney Cir Se Washington, DC #50966 (202) Smile Dental PC Th St Nw, Ste 1 Washington, DC #273 (202) Yousefi Washington Clinic 3 Washington Cir, Ste G Washington, DC maryland Allegany county Cumberland #454 (301) Frank A LaParle DDS PA 500 Memorial Ave., #401 Cumberland, MD Lavale #429* (301) Lynne S. Brodell, D.D.S Winchester Rd #103 Lavale, MD Anne Arundel county Crofton #479 (410) Ulery Dental & Orthodontics 1286 Md Rt. 3 S, Ste 7 Crofton, MD Gambrills #2216 (410) Gambrills Family Dentistry 959 Annapolis Rd Gambrills, MD Glen Burnie #17299 (410) Jacques P Exposito DDS 1404 Crain Hwy S, Ste 110 Glen Burnie, MD #50372 (410) Ulery Dental and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie, MD Laurel #284* (301) George M. Stephens, D.D.S Ft. Meade Rd, Ste 211 Laurel, MD #446* (301) Saideh Tehrani, D.M.D Fort Meade Rd #202, Ste 202 Laurel, MD Dominion Dental Services, Inc. 115 South Union Street Suite 300 Alexandria, VA As of 9/1/2013 (703) Toll Free (888) Fax (855) DominionDental.com Page 2

8 Pasadena #2011 (410) Ulery Dental & Orthodontics 8055 Ritchie Hwy, Ste 102 Pasadena, MD Baltimore county Baltimore #17177 (410) Convenient Dental 1726 N Rolling Rd Baltimore, MD #61388* (410) Dental One Associates Security Blvd LLC 6666 Security Blvd Baltimore, MD #163 (410) Joseph L. Dyson, Jr., D.D.S Liberty Heights Ave Baltimore, MD #2690 (410) Lansdowne Family Dental 2717 Hammonds Ferry Rd Baltimore, MD #291 (410) Maury J. Fechter, D.D.S Belair Road, Ste 105 Baltimore, MD #11212 (410) Ned S Greenberg DDS PA 2100 Eastern Blvd Baltimore, MD #356 (410) Robert Kodeck, D.D.S Rossville Blvd Baltimore, MD #271 (410) S.V. Ramamurthy, D.D.S Harford Rd Baltimore, MD Catonsville #409 (410) Bruce E.Yuille, D.D.S. 700 Geipe Rd, Ste 270 Catonsville, MD #396 (410) The Dental Care Center 4 E Rolling Crossroads, Ste 104 Catonsville, MD Middle River #51041 (410) Thomas G Tzomides DDS LLC 30 Middle River Rd Middle River, MD Owings Mills #51086 (410) Brian C Moore DMD PC Red Run Blvd, Ste 407 Owings Mills, MD #562* (410) Cynthia F. Miller, D.D.S. 6 Park Center Ct, Ste 107 Owings Mills, MD #302 (410) Jules Millman, D.D.S Reisterstown Rd Owings Mills, MD Pikesville #767 (410) Ogden M. Belt, D.D.S. The Commerce Center, 1777 Reisterstown Rd., #220 Pikesville, MD Randallstown #37724 (410) Esquire Family Dental Care, LLC 3673 Offutt Rd Randallstown, MD #9719 (410) Pleet And Freundlich DDS Pa 5310 Old Ct Rd, 202 Randallstown, MD Towson #51098 (410) Charles P McCausland III DDS 312 W Chesapeake Ave Towson, MD #529 (410) Joppa Partners 219 W Joppa Rd Towson, MD Baltimore City Baltimore #1382 (410) Bell & Associates 3326 Auchentoroly Terr Baltimore, MD #68516 (410) Ernest J Colvin & Associates /2 Park Heights Ave Baltimore, MD #68517 (410) Ernest J Colvin & Associates 5808 York Rd, Ste A Baltimore, MD #18764 (410) Fabian F Desbordes DDS 2300 Garrison Blvd, Ste 250 Baltimore, MD #164 (410) Joseph L. Dyson, Jr., D.D.S Pennsylvania Ave Baltimore, MD #37648 (410) Margaret Kromah, D.D.S Moravia Rd, Ste 2 Baltimore, MD #37616 (410) Maury J. Fechter, D.D.S Bel Air Rd Baltimore, MD #37575 (410) Park West Health Systems 3319 W Belvedere Ave Baltimore, MD #1207 (410) Rena K. Langermann, DDS 6606 Cross Country Blvd Baltimore, MD #25390 (410) Robert A Goodman DDS 6301 N Charles St, Ste 3 Baltimore, MD #294* (410) Stephen B. Mastella, D.M.D. & Assoc, PA 1030 N Charles St, Ste 302 Baltimore, MD #69564 (410) Stephen J Hickey DMD 5010 Harford Rd Baltimore, MD #368 (410) Vivencio R. Reyes, D.D.S., P.A. 402 S Highland Ave Baltimore, MD Carroll county Finksburg #68507 (443) Earl M Addicks DDS PC 2025 Suffolk Rd, Ste 12 Finksburg, MD Cecil county Elkton #70916 (410) Delmarva Center for Dental Excellence 230 S Bridge St, Ste A Elkton, MD #2757 (410) Vargha Abbasian, D.D.S., P.C Elkton Rd Elkton, MD Charles county La Plata #410* (301) Metro Dental Center 6620 Crain Hwy #204 La Plata, MD Waldorf #72092 (301) Aegis Dental Group LLC 363 Smallwood Dr Waldorf, MD #70937 (301) Dimitri Dental 149 Smallwood Village Center Waldorf, MD #434 (301) Post Office Lake Dental Assoc. 603 Post Office Rd, Ste 208 Waldorf, MD #2324 (301) Tuan D Pham DMD & Joseph A Maloney DDS LLC 3450 Old Washington Rd, Ste 204 Waldorf, MD Frederick county Frederick #37595 (301) B. Buckeystown Pk Frederick, MD #193 (301) Thomas Johnson Dr, Ste B Frederick, MD #69530 (301) Deep Muko DDS PA 198 Thomas Johnson Dr, Ste 18 Frederick, MD Harford county Aberdeen # (410) Alpha Dental Excellence 122 N Philadelphia Blvd Aberdeen, MD Bel Air #2857 (410) Iwona Kubiczek, D.D.S., P.C B Emmorton Rd, Ste 216 Bel Air, MD Howard county Elkridge #2723 (410) Chartwell Dental Group 8180 Lark Brown Rd, Ste 202 Elkridge, MD #19200* (410) Robert E Skillman, D.D.S., PA 5921 Old Washington Rd Elkridge, MD Ellicott City #22440 (410) Ajmal Dental Care B Baltimore National Pik Ellicott City, MD #37537 (410) Ali R. Sedighian, D.D.S., P.A Chevrolet Dr, Ste 1 Ellicott City, MD #70463 (410) Family Dentistry 9005 Chevrolet Dr, Ste 3 Ellicott City, MD #69942 (410) Sinha Kang DMD 5034 Dorsey Hall Dr, Ste 203 Ellicott City, MD Woodstock #69952 (410) Dr Bluchers Family Dentistry Birmingham Way Woodstock, MD Montgomery county Bethesda #2367 (301) Amisha N. Shroff, D.D.S., P.C Westlake Dr, Ste 109 Bethesda, MD #50668 (301) M Reza Shefaat DDS 7501 Democracy Blvd, Ste 121 Bethesda, MD #50850 (301) Peter S DeMizio DDS Inc 4400 E W Hwy, Ste D Bethesda, MD #460* (301) Reginald W Cole, DDS 4400 East-West Hwy Ste F Bethesda, MD #1405 (301) Roanne Wiczer DMD 8311 Wisconsin Ave, Ste B8 Bethesda, MD Burtonsville #37698 (301) Mon F. Sheik, DMD Spencerville Ct, 101 Burtonsville, MD Gaithersburg #33884 (301) Angamuthu & Associates DDS PA 4 Professional Dr, Ste 121 Gaithersburg, MD #4589 (301) Arnold I Malhmood DDS 474 N Frederick Ave Gaithersburg, MD #50592 (301) Chestnut Street Cosmetic Dentistry 101 Chestnut St, Ste 130 Gaithersburg, MD #2432 (301) Gerry Dubin, DMD, P.C Shady Grove Ct Gaithersburg, MD #463 (301) The Dental Suite Flower Hill Way Gaithersburg, MD #2854 (301) TLC Modern Dentistry Contour Rd Gaithersburg, MD Germantown #4687 (301) Family Dental Care Executive Park Cir Germantown, MD # (240) Oasis Dental Clinic LLC Doctors Dr Germantown, MD Dominion Dental Services, Inc. 115 South Union Street Suite 300 Alexandria, VA As of 9/1/2013 (703) Toll Free (888) Fax (855) DominionDental.com Page 3

9 #37733 (301) Peter S. DeMizio, DDS, Inc. 22 Executive Park Ct Germantown, MD #1753 (301) Hedyeh Atashbar, D.D.S Lockwood Dr Silver Spring, MD #37717 (301) Alvin B Williams DDS 9135 Piscataway Rd, #105 Clinton, MD #2523 (301) Tajicks Dental Clinic 7411 Riggs Rd, #108 Hyattsville, MD # (301) Christian Dental Care 3611 Branch Ave, Ste 301 Temple Hills, MD #50893* (301) Smile Design Dental Germantown Rd, Ste 170 Germantown, MD Kensington #14880 (301) Robert Barnett DDS 3720 Farragut Ave, Ste 101 Kensington, MD Olney #50918 (301) Premier Dental Clinic Georgia Ave, Ste 110 Olney, MD Rockville #33849 (301) AA Dental Clinic 751 Rockville Pk, Ste 10A Rockville, MD #2745* (301) Chetan H. Parikh, D.M.D., PA 5808 Hubbard Dr Rockville, MD #50814 (301) Happy Dental 4701 Randolph Rd, Ste 210 Rockville, MD #1041* (301) Hysosik Kim, D.D.S. 785-A Rockville Pk Rockville, MD #97861 (301) Key West Dental Care 9850 Keywest Ave, Ste 302 Rockville, MD #37655* (301) North Potomac Smiles LLC Shady Grove Rd, Ste 408 Rockville, MD #37731 (301) Rockville Family Dental Group 5806 Hubbard Dr Rockville, MD Silver Spring #37792 (301) Aegis Dental Group Layhill Rd Silver Spring, MD #51014 (301) Asma Nuh DDS PA 1016 Merrimac Dr Silver Spring, MD #8779 (301) Aspen Hill General And Cosmetic Dentistry Connecticut Ave, Ste 200 Silver Spring, MD #844 (301) Negin A. Moazami, D.D.S Fenton St, Ste 902 Silver Spring, MD #51079 (301) Silver Spring Dental Care LLC New Hampshire Ave, Ste 201 Silver Spring, MD #50327 (301) TLC Modern Dentistry LLC H-I Georgia Ave Silver Spring, MD Takoma Park #282 (301) Warner Family Dental Center 7000 Carroll Ave Takoma Park, MD #692 (301) William E. Vaughan, D.D.S Maple Ave Ste 6 Takoma Park, MD Wheaton #192* (301) Sterling Dental Centers Georgia Ave Wheaton, MD Prince Georges county Bowie #68505 (301) Kemmerton Family Dentistry 6000 Laurel-Bowie Rd, Ste 101 Bowie, MD #332 (301) Neville McKen, D.D.S Mitchellville Rd, Ste 213 Bowie, MD #14419 (301) Tanzania Davis DDS 3231 Superior Ln, Ste A 22 Bowie, MD Capitol Heights #161 (301) Gentle Dental Care / Dr. Vincent Davis 9146 Edgeworth Dr Capitol Heights, MD #333 (301) Neville McKen, D.D.S Central Ave, Ste L9 Capitol Heights, MD Clinton #2862 (301) Alpha Dental Care LLC 8975 Woodyard Rd Clinton, MD #735* (301) Joseph A. Maloney, D.D.S Piscataway Rd, Ste 739 Clinton, MD College Park #37542 (301) College Park Dental 7305 Baltimore Ave, #204 College Park, MD #346 (301) Daniel J. Lane, D.D.S Baltimore Ave, Ste 113 College Park, MD Forestville #72091 (301) Warner Dental Care LLC 7610 Pennsylvania Ave, Ste 302 Forestville, MD Fort Washington #50328 (240) All Smiles Dental Care Old Fort Rd, Ste 203 Fort Washington, MD #334* (301) Neville McKen DDS 8602 Dover St Fort Washington, MD #330 (301) Pamela V. Hymes, D.D.S., PA Fort Washington Rd, Ste 203 Fort Washington, MD Greenbelt #1187 (301) Greenbelt Dental Care, P.C Greenway Center Dr, Ste 201 Greenbelt, MD Hyattsville #51085 (301) Brian C Moore DMD PC 3311 Toledo Terr, Ste C102 Hyattsville, MD #960* (301) Daniel De Haas, D.D.S Annapolis Rd Hyattsville, MD #407 (301) Friendship Dental 6525 Belcrest Rd, Ste 208 Hyattsville, MD #2370 (301) Hall and Associates 7221 E Ridge Dr Hyattsville, MD Landover Hills #191* (301) Sterling Dental Centers 7503 A Annapolis Rd Landover Hills, MD Largo #186 (301) Harry J. Klapper, D.D.S Mercantile Ln, Ste 100E Largo, MD #1270 (301) Yardee Dental/ Dr. Jemi Sanusi 1400 Mercantile Ln Ste.224 Largo, MD Laurel #1053 (301) Drs. Batz and Weiner Lake Dental 8363 Cherry Ln Laurel, MD #1199 (301) John N. Kim, D.D.S., P.A Cherry Ln Laurel, MD #2118 (301) Ulery Dental & Orthodontics Laurel Bowie Rd Laurel, MD Oxon Hill #324 (301) David G. O Neal, D.D.S., & Assoc Oxon Hill Rd, Ste 200 Oxon Hill, MD #37629 (301) Quentin E Monroe Dental Services 5448 St Barnabas Rd Oxon Hill, MD Riverdale #210* (301) The Dental Group 6200 Baltimore Ave, Ste 200 Riverdale, MD #210* (301) The Dental Group 6200 Baltimore Ave, Ste 200 Riverdale, MD Suitland #16470 (301) Suitland Dental Center 4814 Silver Hill Rd Suitland, MD Temple Hills #37663 (301) All Smiles Dental Care 3847 Branch Ave, Ste 124 Temple Hills, MD #79801 (301) Dental Associates of Greater MD at Temple Hills 6339 Allentown Rd, Ste E Temple Hills, MD #51072 (301) Oral Health Associates 4316 St Barnabas Rd Temple Hills, MD Upper Marlboro #187 (301) Harry J. Klapper, D.D.S Crain Hwy Upper Marlboro, MD Washington county Hagerstown #462 (301) Antietam Valley Dental Center 1246 Maryland Ave Hagerstown, MD Hancock #68461 (301) Antietam Valley Dental Center 257 W Main St Hancock, MD Wicomico county Salisbury #2767 (410) Delaware Maryland Dental 123 W College Ave Salisbury, MD #2319 (410) George C Viertl DDS PC 560 Riverside Dr, Ste B206 Salisbury, MD Worcester county Ocean Pines #33847 (410) Robert D Steinberg DDS Racetrack Rd, Pavillions Ste 102 Ocean Pines, MD Dominion Dental Services, Inc. 115 South Union Street Suite 300 Alexandria, VA As of 9/1/2013 (703) Toll Free (888) Fax (855) DominionDental.com Page 4