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New Patient Paperwork

DC4K Dental Plans

     – In-House Insurance Plans
               o Preventative Plan (Semi-Annual Routine Care)
               o Ortho Plan (Quarterly Routine Care for Patients in Braces)

Insurance Filing

We participate with all PPO Dental Insurance plans. We are contracted or have arrangements with several Insurance Carriers. Our office is more than happy to collect details of your plan and reach out to your insurance company to verify eligibility, benefits and gain an understanding of the coverage your child has. For new patients, we ask that we have insurance information provided to our office at least 2 business days prior to the dental visit. For existing patients that experience a change in their family’s dental insurance, we ask that we are notified of the change when they are made aware so we are well prepared at the next appointment.

We file all insurance claims electronically to the insurance carrier on the day of the visit. In some instances, the insurance carrier will not allow what is called “an assignment of benefits”, which means that payment for services will be sent to the subscriber (Patient) and not the provider (Dentist). For these situations, we ask that services are paid-in-full at the time of the visit and within 10-14 days the payment should reach the family directly from Insurance. For plans that do accept an assignment of benefits, which is the majority, we ask that only the patient-portion of the balance be paid at the time services are performed.


Payment for services is due at the time services are rendered. For those with dental insurance, the payment required will be the estimated patient portion after accounting for the anticipated payment from the insurance plan. Once we receive the explanation of benefits back from insurance, if there is any additional patient portion, we send a billing statement that is due upon receipt. In some instances, insurance pays more than we anticipated, and we gladly mail refund checks to the families for amounts over $20. In cases when the family has an appointment soon or the credit is small, we hold the credit on the account for the next visit. Cash and check payers (no insurance) receive a 10% discount off services. We encourage our uninsured families to consider our In-house plans that are a great value for our families, especially with multiple children discounts available.

Payment Options

– Cash / Personal Check
– Visa / Mastercard / American Express / Discover


– Health Savings Account (HSA Card)
– Care Credit (6 months no interest financing)