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Your orthodontic benefits
Get Braces, and Enhance Your Smile
Orthodontic treatment is available for both
children and adults.
Go to a Great Orthodontist
You’ll receive excellent care, because all of our local
participating orthodontic offices are independently owned
and adhere to our Quality Assurance program.
What is orthodontia?
Most people think of braces, and for most people with
less-than-straight teeth, braces are a good solution.
Scientifically speaking, orthodontia is the art and science
of correcting deviations and malpositions of the teeth
and bite. Teeth may not be in the normal biting
relationship (malocclusion) because of deviations in the
position of teeth or deviations in the relationship of the
jaws.
See Your Savings
Code
Description
Regular Fees*
Your Copayment**
Savings
D8070D8080
Full banded - child, up to age 19 conventional 24 month treatment
$4877
$ 3395
$1482
D8090
Full banded - Adult - conventional 24 month
treatment
$4997
$3495
$1502
* Regular fees were taken from the National Dental Advisory Service and reflect costs in the 50th percentile, within the 98104 Seattle zip code.
** These fees are for banding of the braces and do not reflect the cost of x-rays, study models or retainers.
800-637-6453 | 206-633-2300 | www.smartsmile.com
0712WM046
Participating orthodontists & applicable exclusions and limitations
Auburn Avenue Dental
130 3rd St NE
Auburn, 98002
253-833-3680
Federal Way Dental
2016 S 320th St, Ste F
Federal Way, 98003
253-839-8106
Bright Now! Dental
10228 156th St E, Ste 101
Puyallup, 98374
253-840-0540
Bright Now! Dental
4545 S Union Ave
Tacoma, 98409
253-475-7500
Bright Now! Dental
3820 124th Ave SE
Bellevue, 98006
425-201-1700
Bright Now! Dental
25610 104th Ave SE
Kent, 98030
253-850-9777
Redmond Gentle Dental
15640 Redmond Way
Redmond, 98052
425-881-5533
Bright Now! Dental
16400 Southcenter Pkwy Ste 103
Tukwila, 98188
206-575-0400
Bright Now! Dental
4291 Meridian St, Ste 101
Bellingham, 98226
360-715-8400
Bright Now! Dental
709 A SR 9 NE
Lake Stevens, 98258
425-249-4129
Bright Now! Dental
9503 192nd Ave
Bonney Lake, 98391
253-299-3033
Bright Now! Dental
18910 28th Ave W, Ste 200
Lynnwood, 98036
425-775-5557
Bright Now! Dental
401 NE Northgate Way,
#570
Seattle, 98125
206-336-2100
Straight Pearls Orthodontics &
Kids Dentistry
6720 Fort Dent Way, Ste 120
Tukwila, WA 98188
206-242-2838
Edmonds Orthodontics
21920 76th Ave W #201
Edmonds, 98026
425-977-2505
College Place Orthodontics,
LLC
19720 68th Ave W, Ste E
Lynnwood, 98036
425-670-2033
Gateway Orthodontics
Seattle
700 5th Ave #1616
Seattle, 98104
206-467-6877
Bright Now! Dental
2101 NE 129th St, Ste 101
Vancouver, 98636
360-574-4574
Oliver Orthodontics
10812 19th Ave SE
Everett, 98208
425-338-5414
Pellegrini Orthodontics
827 128th St SW, Ste B
Everett, 98204
425-374-8218
Bright Now! Dental
1507 S 348th St, Ste K2-102
Federal Way, 98003
253-835-3377
Jennifer Meader, DDS
16006 Ash Way, Ste 102
Lynnwood, 98087
425-744-1124
Lynnwood Gentle Dental
19723 Highway 99, Ste A
Lynnwood, 98036
425-775-3456
Bright Now! Dental
4210 Martin Way E, Ste 101
Olympia, 98516
360-455-9544
Reflections Dental Centre
2600 SW Barton St #E-20
Seattle, 98126
206-923-3684
Bright Now! Dental
7407 Division St
Spokane, 99208
509-464-2001
Affordable Dental Care
3425 18th St
Tacoma, 98409
253-471-2655
Bright Now! Dental
3250 SE 164th Ave, Ste 102
Vancouver, 98683
360-891-1999
Bright Now! Dental
17740 Garden Way NE
Woodinville, 98072
425-492-2000
Straight Pearls Orthodontics
17000 140th Ave NE, Ste 204
Woodinville, 98072
425-487-0908
For a full list of dental and orthodontic exclusions and limitations, please reference your Schedule of Covered Services and Copayments.
Orthodontic Limitations
Orthodontic Exclusions
The following are limitations on covered
benefits.
The following are not covered by your dental plan.
A.
B.
C.
D.
E.
F.
Cephalometric x-rays, dental x-rays.
Tracings and photographs.
Study models.
Changes in treatment necessitated
by accident of any kind.
Services which are compensable
under Worker’s Compensation or
employer liability laws.
Malocclusions too severe or
mutilated which are not amenable
to ideal orthodontic therapy.
A.
B.
C.
D.
E.
F.
Replacement of lost or broken appliances.
Retreatment of orthodontic cases.
Treatment of a case in progress at inception of eligibility.
Treatment and/or surgical procedures related to cleft palate, micrognathia or microdontia.
Treatment related to Temporomandibular joint disturbances and/or hormonal imbalances.
Any dental procedures considered to be within the field of general dentistry, including but not limited to:
1.
2.
3.
4.
G.
Myofunctional therapy.
General anesthetics including intravenous and inhalation sedation.
Dental services of any nature performed in a hospital.
Services which are compensable under Worker’s Compensation or employer liability laws.
Payment by Dental Health Services or any special discounted orthodontic copayment for treatment rendered or required after enrollee is no longer eligible for coverage (i.e. current premium unpaid). The cost
of treatment in progress will be prorated and converted to the Orthodontist’s actual fee-for-service
amount.