In-Network: 
DEN613 
•0% coinsurance for scaling and root planing (deep cleaning) up to 1  
per quadrant every 3years. 
•0% coinsurance for comprehensive oral evaluation or periodontal  
exam, scaling for moderate inflammation up to 1every 3years. 
•0% coinsurance for panoramic film or diagnostic x-rays up to 1  
every 5years. 
•0% coinsurance for bitewing x-rays, intraoral x-rays up to 1set(s)  
per year. 
•0% coinsurance for emergency diagnostic exam up to 1per year.