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Join Comfort Care Dental Group’s In-House Premier Dental Coverage
• All Health Conditions Accepted!
• You Cannot Be Denied Coverage!
• No Deductibles!
• No Health Questions!
• You Cannot Be Singled Out for Rate Increases or Cancellations!
• Comprehensive Exam (once every six months)
• Fluoride Treatment for Children (under the age of 18, once every six months)
Our Affordable Coverage Includes the Following Services at No Charge:
• X-Rays (once every 12 months)
• Cleaning (Prophylaxis) (once every six months)
1. Child’s First Name __________________________
Middle Initial ______________ Son / Daughter
Date of Birth ______________________________
2. Child’s First Name __________________________
Middle Initial ______________ Son / Daughter
Date of Birth ______________________________
3. Child’s First Name __________________________
Middle Initial ______________ Son / Daughter
Date of Birth ______________________________
4. Child’s First Name __________________________
Middle Initial ______________ Son / Daughter
Date of Birth ______________________________
We are located on Seventh Street, just off Charleston Boulevard,
with plenty of free parking.
ID# 4313 © November 2016 chrisad, inc., marin co., ca all rights reserved.
Enroll Today!
As Low as
$16.58/mo.
AffordableDental CoverageFor You & Your Entire Family
Low-Cost Dental Coverage
As Low as $16.58/mo.Please List All UnmarriedChildren Up to Age 20
Complete This Form toBegin Coverage Today
We’re Making Excellence in Dentistry Affordable for You!
803 South 7th Street, Las Vegas, NV 89101
702-384-4721ccdgp.com
Make check or money order payable toComfort Care Dental Group.
Complete This Form toBegin Coverage Today!
Patients agree that Comfort Care Dental Group fees stated must be paid at the time services are rendered. Any service not paid for at the time of service will be billed at usual & customary fees. Coverage fees are valid only when paid at the time of enrollment. All family members must reside in the same household. This is not an insurance product. Membership renews annually on the day & month of initial enrollment. Membership renews automatically unless member formally requests otherwise in advance.
First Name ________________________________________
Last Name _________________________________________
Middle Initial _________________________ Female / Male
Home Address _____________________________________
__________________________________________________
City _____________________ State ______ Zip ________
Phone ____________________________________________
Email _____________________________________________
Date of Birth _____/_____/_____ S.S.#_____-_____-_____
Spouse First Name ___________________________________
Last Name _________________________________________
Middle Initial _________________________ Female / Male
Date of Birth _____/_____/_____ S.S.# _____-_____-_____
Enrollment Period _______________ to _______________
Signature (member & spouse)
__________________________________ Date ___________
__________________________________ Date ___________
American Express / Discover / MasterCard / Visa
Card Number ______________________________________
Expiration Date ____________________________________
Affordable Dental Coverage for the Whole Family!
Please Inquire About Services Not Listed Here!
Low-Cost Dental Coverage• Individual ~ $199/yr. or $16.58/mo.*
• Individual & Spouse ~ $339/yr. or $28.25/mo.*
• Additional Child in Family ~ $40/yr. or $3.33/mo.**Monthly payment plan is available to patients providing direct deposit or credit card access.
Now you can join our low-cost dental coverage for a nominal membership fee. Our coverage entitles you to preventive dental care at no cost! Corrective services are available for small co-payments that are far less than the usual, customary fees. Our professional staff is qualified to care for all of your dental needs!
To enroll, simply fill out the enclosed enrollment form & return it with your check, money order or credit card information. Please make check or money order payable to Comfort Care Dental Group.
Examination . . . . . . . . . . . . . . . No Charge . . . . . . . . . . . $102
X-Rays (every 12 months). . . . . . . No Charge . . . . . . . . . . . $152
Adult Cleaning . . . . . . . . . . . . . No Charge . . . . . . . . . . . $103(every six months)
Children’s Cleaning . . . . . . . . . No Charge . . . . . . . . . . . .$72(every six months)
Fluoride Treatment . . . . . . . . . No Charge . . . . . . . . . . . .$50 for Children (every six months)
Preventive Dentistry
ServiceCo-Payment“Basic Care”
Regular Feesas High as
1-Surface Filling . . . . . . . . . . . . . . .$159 . . . . . . . . . . . . . $198
Crown . . . . . . . . . . . . . . . . . . . . . . .$975 . . . . . . . . . . . .$1,219
Crown Buildup . . . . . . . . . . . . . . . .$228 . . . . . . . . . . . . .$285
Root Canal–Anterior . . . . . . . . . . .$712 . . . . . . . . . . . . .$890
Denture–Top . . . . . . . . . . . . . . . . $1,480 . . . . . . . . . . $1,850
Restorative Dentistry
ServiceCo-Payment“Basic Care”
Regular Feesas High as
Periodontal Maintenance . . . . . . . .$131 . . . . . . . . . . . . . $163(gum treatment)
Periodontics
ServiceCo-Payment“Basic Care”
Regular Feesas High as
Invisalign® . . . . . . . . . . . . . . . . . . $4,995 . . . . . . . . . . $5,800(financing available as low as $199/mo.)
Orthodontics
ServiceCo-Payment“Basic Care”
Regular Feesas High as
Cosmetic Whitening . . . . . . . . . . .$395 . . . . . . . . . . . . .$730
Sealants (per tooth) . . . . . . . . . . . . . $45 . . . . . . . . . . . . . .$56
Other Treatments
ServiceCo-Payment“Basic Care”
Regular Feesas High as
803 South 7th Street, Las Vegas, NV 89101
702-384-4721ccdgp.com
Get 10% off the coverage plan price when you pay in full up front!
