Dr. Samuel L. Koth DDS MAGD
Dr. Amber Meyer DDS

712-476-2749
1302 10th Street
www.rockvalleydental.com

Our Dental Savings Plan is designed to

make quality dental services more accessible and affordable

Rock Valley Dental Savings Plan Includes:                                        

• Two Exams per year
• Two Cleanings per year
• All Bitewings/pa X-rays taken during re-care appointments
• Fluoride Varnish

10%

Discount on Additional Services

*The plan does not include 3D imagining or panoramic x-ray, but would receive 10% off.

Plan Conditions:

• Patient portion due at time of service - otherwise they will be billed full office fees
• Cannot be combined with another dental plan or insurance
• No refunds issued if participant does not utilize plan services
• No cancellations for 6 months
• Ask about periodontal therapy
• Can not be used for referral specialist or treatment outside the realm of our doctor's capability
• Does not apply to any hospital charges
• Does not include product inventory

This is a membership plan, not dental insurance!

	Office Price	Discount Price
Periodic Exam-adult	$59	2 included in plan
Periodic Exam-child	$47	2 included in plan
Perioprophy	$151	2 included in plan (getting this service at a $99 value!)
Prophy-adult	$104	2 included in plan
Prophy-child	$76	2 included in plan
Bitewing Xray	$78	Included during recare appointments $67
PA Xray	$36	Included during recare appointments $32
Two Surface Filling	$264	$238
Crown	$1,155	$1,040
Implant & Crown	$4,000	$3,600
Denture Complete (Max & Mand)	$4,108	$3,697

*These are just estimates! Price may vary from case-to-case

Rock Valley Savings Plan

	Annual
Adult	$350
Additional Family (dependants under 21)	$300

New Patients will have a one time administration fee of $83

WHY CHOOSE ROCK VALLEY DENTAL SAVINGS PLAN?

• No Annual Maximums
• No Deductible
• No Waiting Periods
• No Claim Forms
• No Exclusions
• No Prior Authorizations

Delta Dental's Most Popular Plan

	Monthly	Annually
Adult	$41.76	$501
Child	$32.02	$385