PDF Schedule of Benefits | Savon Dental Plan

Member Since 1992

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Our Schedule Of Benefits In PDF Format

There are 2 versions of our fee schedule available for download.

Complete 6 page, full color Schedule Of Benefits listing all procedures. This is used by our providers

Condensed 2 page, black & white Schedule Of Benefits listing the most common procedures

There are two Schedules of Benefits for each state. The Urban Schedule is used in any metropolitan area with a population greater than 100,000. The Rural Schedule is used in any area with a population less than 100,000 and at least 50 miles away from an urban area. If a facility is using the rural fee schedule it will be noted with their information on the Provider Locater page.

These Schedule of Benefits are in a PDF format and guaranteed virus free. You will need to have Adobe® Acrobat Reader to open them. If you do not have Acrobat Reader, you may download it for free at www.acrobat.com. Look for the "Get Adobe Reader" icon.

Perspective Members Please Take Note: The fact that we have a fee schedule for every state does not guarantee that we have Preferred Providers in that state. Please be sure to check our Provider Locater and call the dental office to insure their participation in Savon Dental Plan.