at  Humana.com/sb .
Out-of-network dentists have not  
agreed to provide services at  
contracted fees. Benefits received  
out-of-network are subject to any  
in-network benefits maximums,  
limitations, and/or exclusions.  
You may be billed by the  
out-of-network provider for any  DEN373 
•0% of the cost for  
comprehensive oral evaluation  
or periodontal exam up to 1  
every 3years. 
•0% of the cost for panoramic  
film or diagnostic x-rays up to 1  
every 5years. 
•0% of the cost for bitewing