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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.