Dental Plan – Breakdown For Providers
ATTENTION NEW PROVIDERS:
W9 forms must be on file prior to payments being issued.
You can avoid payments being delayed by faxing your W9 form to (918) 280-4899
Submit Electronic Claims to…
Payor ID: PIBF
Group# P19926
Submit Paper Dental claims to:
PIBF
P.O. Box 211573
Eagan, MN 55121
For a More Detailed Breakdown, Click HERE.
Dental Breakdown PDF
PPO Network Name:
DNoA Preferred Network
Network Partners in DNoA Preferred Network
Dental Network of America (DNoA)
Dentemax
United Concordia
Careington
For assistance finding a participating provider visit DNOA or call 1-866-522-6758.
100% / No Deductible
Periodic Exam – every 6 mos.
Prophy – every 6 mos.
All Other Covered Services:
$100 DEDUCTIBLE PER PERSON PER CALENDAR YEAR
$1,000.00 MAXIMUM PER PERSON PER CALENDAR YEAR
EFFECTIVE 1/01/11 > NO YEARLY MAXIMUM FOR CHILDREN 18 AND UNDER
PAYABLE AT 80% IN-NETWORK / 70% OUT-OF-NETWORK
- DIAGNOSTIC
- DENTURE REPAIRS
- PREVENTIVE
- DENTURES & PARTIALS
- EXTRACTIONS
- CROWNS
- FILLINGS
- ENDODONTICS
- PALLIATIVE
- ORAL SURGERY
- GENERAL ANESTHESIA (All anesthesia is covered)
- PERIODONTIA
- OCCLUSAL GUARD (For Bruxism Only)
Other Services NOT Covered:
- ORTHODONTIC TREATMENT
- DENTAL IMPLANTS / BONE GRAFTS AND CROWNS FOR IMPLANTS
- TEMPORARIES AND TMJ
- NIGHT GUARDS FOR BRUXISM ONLY