Modern Dentistry of Jupiter
Dr. Holovnia’s VIP Insurance Plan
Classic yearly membership with preventive care included, annual savings, and a courtesy discount on needed dental treatment.
Classic Yearly Enrollment Fee$520
Each Additional Family Member$397
Included in Membership Plan
- 2 cleanings per year ($273 savings)
- 1 comprehensive oral exam per year ($155.70 savings)
- 1 routine examination per year ($92.80 savings)
- 2 limited/problem-focused exams per year ($303.40 savings)
- 2 cavity-detecting series of X-rays ($444.40 savings)
- 2 fluoride applications per year ($61.20 savings)
- 1 CBCT scan per year ($365.90 savings)
- 1 panoramic X-ray or full mouth series X-rays per year ($199.10 savings)
Total savings: $1,895.50 per year
Plus 15% Courtesy Discount
15%
Members receive a courtesy discount on needed dental treatment within the benefit year. The discount does not apply to orthodontic treatment.
15% Discounted Treatment & Services
| Service | Cash Fee | VIP Fee | Savings |
|---|---|---|---|
| In-Office Whitening | $625.90 | $399.00 | $226.90 |
| Occlusal Guard | $716.00 | $593.00 | $123.00 |
| One Surface Filling | $276.00 | $234.60 | $41.40 |
| Two Surface Filling | $356.20 | $302.77 | $53.43 |
| Three Surface Filling | $431.00 | $366.35 | $65.65 |
| Four Surface Filling | $503.70 | $428.15 | $75.55 |
| Porcelain Crown | $1,789.20 | $1,520.82 | $268.38 |
Patient Name
Date
Patient Signature
Date
Effective Date: ________________________________________________
Non-transferable. No refunds issued. All benefits of your VIP Membership Plan must be used within your benefit year.