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Insurance

Your treatment plan will include a breakdown of all applicable fees, and we will inform you of all costs before treatment is administered. Charges are payable at the time of treatment. For your convenience, we accept Cash, Checks (except first visit) Credit Cards and online payments.
Dr. David Tse and patient
Dr. David Tse and child

We strive to find a payment option suitable to your needs; therefore, we also take CareCredit.

If special arrangements are needed, please talk to our office manager prior to receiving service.

Additionally, we take all major PPO dental plans and participate with Guardian, BCBS Anthem (Complete and GRID+), Cigna DPPO, Delta Dental Premier, Humana, Principal, Ameritas, United Healthcare, Lincoln, Careington, and more.

If you don’t see your insurance listed, please give us a call to verify that we accept your insurance. If you have any questions or concerns, please ask our office manager during your visit. We will submit all insurance claims for you.

We will attempt to help you receive full insurance benefits; however, you are personally responsible for your account, and we encourage you to contact us if your policy has not paid within 30 days.

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Tricare Retiree Dental Program
Tricare Active Reservists
Reliance Standard Life
Regence Blue Cross/Blue Shield of Oregon (out of State Providers)
Public Employee Health Program (PEHP)
Principal
PrimeWest
PrimeCare, Wisconsin State and Federal Employees and Medicaid
Medicaid of Utah
Managed DentalGuard
Level
UniCare
UFT Welfare Fund
Standard Insurance Co. of New York
Standard Insurance
Skygen USA
SelectHealth
Securian/Patriot Dental
Decare Dental Health International (DDHI)
Delta Dental of New York
Delta Dental of New Jersey
Delta Dental of Indiana
Delta Dental Ins. Co. - Georgia
Delta Dental Ins. Co. - Florida
Delta Dental of Delaware
TRICARE Dental Program (TDP)
Sun Life Financial (United Concordia)
Securian Dental
Oklahoma DRS Doc
North Dakota Dental Service
Molina
Minnesota Blue Cross Dental (UCCI)
Phoenix Health Plans (DentaQuest)
Medicaid of Wisconsin, PrimeCare
Medicaid of Connecticut
Humana
Hershey Healthsmile
Healthsource Provident
HealthScope Benefits (Tribute Health Plan)
HealthScope Benefits/ Morris Associates
HealthScope Benefits / EHC Repricing
HealthScope Benefits/ACPMO
HealthScope Benefits
HealthChoice Oklahoma
Healthcare Highways
Physicians Mutual (Dental)
Florida Combined Life (Dental)
First Reliance Standard
Empire Blue Cross/Blue Shield
Direct Dental Administrators, Inc.
Deseret Mutual Benefit Administrators
DentaQuest - Government
Dental Guard Preferred
Delta Dental (Northeast - ME, NH, and VT)
DDIC
Medicaid of Texas - MCNA
Medicaid of Texas - DentaQuest
Medicaid of Tennessee, BlueCare
Medicaid of New York
Medicaid of Minnesota
Medicaid of Michigan
Medicaid of Indiana
Medicaid of Alabama
International Brotherhood of Electrical Workers (IBEW), Local 38 Health & Welfare Fund
Humana Specialty Benefits State of Florida Dental
Humana Specialty Benefits Florida Healthy Kids Dental
Humana CompBenefits Federal Plan Dental
HDS Medicaid
Hawaii Dental Service
Guardian Life Insurance Co. of America
Golden West Dental
Delta Dental of South Carolina
DeltaCare USA - Encounters
Delta Dental of Washington DC
Delta Dental Ins. Co. - Texas
Blue Shield of Washington / Regence of Washington Health
United Healthcare Global (Inside U.S.)
United Healthcare
United Concordia - Tricare Dental Plan
MetLife
Medicaid of Wisconsin, Humana / TDC
Medicaid of Wisconsin - DentaQuest
Medicaid of Washington
Managed Care of North America, Inc. (MCNA)
Delta Dental of California
Delta Dental Ins. Co. - Alabama
Indiana/Kentucky/Ohio Regional Council of Carpenters Welfare Fund
Connecticut General (CIGNA)
Advantica
AARP Dental Insurance Plan
3M Dental Services
32 BJ
Delta Dental of West Virginia
Delta Dental of Washington
Delta Dental of Virginia
Delta Dental Ins. Co. - Utah
Blue Cross Blue Shield of Illinois
Blue Cross Blue Shield of Wisconsin FEP - Anthem
Blue Cross Blue Shield of Virginia - Anthem
Blue Cross Blue Shield of Ohio - Anthem
Guardian
Blue Shield
Blue Cross
Anthem
Ameritas
Principa
Humana
Careington
United Healthcare
Aetna
Metlife
Delta Dental
Cigna

Dental Savers Program

At Short Pump Family Dentistry, we understand the importance of dental health and its effect on our overall well being. As a result, Dr. Tse has developed a special program called “Dental Savers” for individuals that may not have dental insurance and do not have access to regular dental services. This program assists our patients by providing individuals and families access to affordable, quality dental care.

DETAILS
  • Immediate eligibility (no need to wait for prior authorizations)
  • No yearly maximums or deductibles
  • No claim forms to submit
  • Discount on ALL services performed in our office

Roots Dental Membership Plan

We are very excited to offer you an exclusive dental plan that provides the care you need at an affordable price you want! How can we do this? By offering this plan directly to you, we avoid the cost and hassle of a middleman. There are no copays or deductibles to worry about. Plus, no dealing with denial of claims, pre-approvals, or annual maximums. Best of all, there is no waiting.

Enroll today and your benefits begin immediately!

1. Plan Summary

Care Plan: Child Complete
Effective Dates: 02/17/2021 – 02/16/2022
Renewal Date: 02/17/2022
Subscription: $324/year or $27/month
Value: $527
Savings: $203

2. Benefits and Included Products & Services

Description CDT Code Qty Value You Pay
Professional Cleanings D1120 2 $174 $0
Regular Exams D0120 1 $128 $0
Fluoride Treatment D1208 1 $98 $0
Routine X-rays D0272 1 $127 $0
10% off all other services
Total $527 $0

3. Discounts Off Other Services

The tables below show the discounts provided by procedure category and some pricing examples for our most popular procedures. You will have access to all procedure pricing once you join the membership plan.

Procedure Category Discount
Diagnostic 10%
Orthodontics 10%
Adjunctive General Services 10%
Preventive 10%
Restorative 10%
Endodontics 10%
Periodontics 10%
Removable Prosthodontics 10%
Implant Services 10%
Fixed Prosthodontics 10%
Oral and maxillofacial Surgery 10%
CDT Procedure Normal Fee Member Fee Savings
D2391 Resin-based composite - one surface, posterior $228 $205 $23
D2392 Resin-based composite - two surfaces, posterior $287 $258 $29
D2740 Crown - porcelain/ceramic substrate $1398 $1258 $140
D2750 Crown - porcelain fused to high noble metal $1386 $1247 $139
D3320 Endodontic therapy, bicuspid tooth (excluding final restoration) $1064 $957 $107
D3330 Endodontic therapy, molar (excluding final restoration) $1294 $1164 $130
D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant $788 $709 $79
D4240 Gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant $917 $825 $92
D4341 Periodontal scaling and root planing - four or more teeth per quadrant $316 $284 $32
D5110 Complete denture - maxillary $2186 $1967 $219
D5211 Maxillary partial denture - resin base (including any conventional clasps, rests and teeth) $1734 $1560 $174
D6010 Surgical placement of implant body: endosteal implant $2380 $2142 $238
D6063 Abutment supported cast metal crown (predominantly base metal) $1656 $1490 $166
D6067 Implant supported metal crown (titanium, titanium alloy, high noble metal) $1863 $1676 $187
D6210 Pontic - cast high noble metal $1396 $1256 $140
D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) $233 $209 $24
D7220 Removal of impacted tooth - soft tissue $393 $353 $40
D9215 Local anesthesia in conjunction with operative or surgical procedures $78 $70 $8

4. Disclosures

  • The membership plan is not (i) insurance, (ii) a qualified health plan under the Affordable Care Act, (iii) pre-payment for future services, or (iv) payment for access to discounted services. Rather, the membership plan is a direct payment arrangement between you and your dentist for services, products and care provided.

  • The membership plan is administered by Kleer, LLC for your dentist. Kleer is located at 992 Old Eagle School Road, Wayne, PA 19382. You can learn more about Kleer at http://www.kleer.com/ or by calling 1-844-965-5337.

  • Your dentist has established his or her own membership fees, treatment fees, and terms. Kleer does not make payments to dentists for medical services. You pay dentists for medical services and Kleer charges dentists fees for use of the Kleer platform and administrative services.

  • You can receive a full refund up to 30 days after purchase if no services of the plan have been used. If services have been used, you may be eligible to receive a refund equivalent to a pro rata portion of your purchase. Refunds after 30 days will be at the discretion of your dentist.

  • The membership plan runs for 12 months and includes an auto renewal feature. You can opt out of the auto renewal at anytime from the Member Portal. You will receive an email reminder 45 days prior to the renewal date.

  • Your membership plan payments must be current to receive the services and discounts included in the membership plan.

  • Payment for treatment not included in the membership plan is due at the time of service.

  • The pricing offered by your dentist may not be combined with any other offers or discounts.1Value is based on your dentist’s standard professional fees.
COMMITMENT

Single Memberships are $249.00
Additional Memberships are $199.00 **(this is intended for immediate family members including
spouses/partners, and children under the age of 18)

Your membership is active for 1 year from the date of enrollment
Members of the Dental Savers Program are eligible for free preventive services including:

  • Routine Comprehensive Exams with Oral Cancer Screenings (twice yearly)
  • Digital X-rays (once yearly/as needed)
  • Cleanings (twice yearly)
  • Fluoride Treatments (twice yearly for age 14 and under)
  • Emergency/Limited Exams & X-rays (shares frequency with other exams. Additional exams are discounted)

‍
Members are also eligible for discounts on ALL additional services performed in our office including but not limited to:

  • Restorations (fillings)
  • Extractions
  • Crowns (caps)
  • Implants
  • Bridges
  • Root canals
  • Partials/Dentures
  • Oral Surgery

After your membership year expires, you may choose to re-enroll for another year. The Dental Savers Program is nonrefundable.

Roots Dental Membership Plan

We are very excited to offer you an exclusive dental plan that provides the care you need at an affordable price you want! How can we do this? By offering this plan directly to you, we avoid the cost and hassle of a middleman. There are no copays or deductibles to worry about. Plus, no dealing with denial of claims, pre-approvals, or annual maximums. Best of all, there is no waiting.

Enroll today and your benefits begin immediately!

1. Plan Summary

Care Plan: Adult Complete
Effective Dates: 02/17/2021 – 02/16/2022
Renewal Date: 02/17/2022
Subscription: $564/year or $47/month
Value: $993
Savings: $429

2. Benefits and Included Products & Services

Description CDT Code Qty Value You Pay
Professional Cleanings D1120 2 $174 $0
Regular Exams D0120 1 $128 $0
Oral Cancer screenings D0431 2 $174 $0
Fluoride Treatment D1208 1 $98 $0
Routine X-rays D0272 1 $127 $0
Gingival irrigation D4921 2 $212 $0
10% off all other services
Total $993 $0

3. Discounts Off Other Services

The tables below show the discounts provided by procedure category and some pricing examples for our most popular procedures. You will have access to all procedure pricing once you join the membership plan.

Procedure Category Discount
Diagnostic 10%
Orthodontics 10%
Adjunctive General Services 10%
Preventive 10%
Restorative 10%
Endodontics 10%
Periodontics 10%
Removable Prosthodontics 10%
Implant Services 10%
Fixed Prosthodontics 10%
Oral and maxillofacial Surgery 10%
CDT Procedure Normal Fee Member Fee Savings
D2391 Resin-based composite - one surface, posterior $228 $205 $23
D2392 Resin-based composite - two surfaces, posterior $287 $258 $29
D2740 Crown - porcelain/ceramic substrate $1398 $1258 $140
D2750 Crown - porcelain fused to high noble metal $1386 $1247 $139
D3320 Endodontic therapy, bicuspid tooth (excluding final restoration) $1064 $957 $107
D3330 Endodontic therapy, molar (excluding final restoration) $1294 $1164 $130
D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant $788 $709 $79
D4240 Gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant $917 $825 $92
D4341 Periodontal scaling and root planing - four or more teeth per quadrant $316 $284 $32
D5110 Complete denture - maxillary $2186 $1967 $219
D5211 Maxillary partial denture - resin base (including any conventional clasps, rests and teeth) $1734 $1560 $174
D6010 Surgical placement of implant body: endosteal implant $2380 $2142 $238
D6063 Abutment supported cast metal crown (predominantly base metal) $1656 $1490 $166
D6067 Implant supported metal crown (titanium, titanium alloy, high noble metal) $1863 $1676 $187
D6210 Pontic - cast high noble metal $1396 $1256 $140
D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) $233 $209 $24
D7220 Removal of impacted tooth - soft tissue $393 $353 $40
D9215 Local anesthesia in conjunction with operative or surgical procedures $78 $70 $8

4. Disclosures

  • The membership plan is not (i) insurance, (ii) a qualified health plan under the Affordable Care Act, (iii) pre-payment for future services, or (iv) payment for access to discounted services. Rather, the membership plan is a direct payment arrangement between you and your dentist for services, products and care provided.

  • The membership plan is administered by Kleer, LLC for your dentist. Kleer is located at 992 Old Eagle School Road, Wayne, PA 19382. You can learn more about Kleer at http://www.kleer.com/ or by calling 1-844-965-5337.

  • Your dentist has established his or her own membership fees, treatment fees, and terms. Kleer does not make payments to dentists for medical services. You pay dentists for medical services and Kleer charges dentists fees for use of the Kleer platform and administrative services.

  • You can receive a full refund up to 30 days after purchase if no services of the plan have been used. If services have been used, you may be eligible to receive a refund equivalent to a pro rata portion of your purchase. Refunds after 30 days will be at the discretion of your dentist.

  • The membership plan runs for 12 months and includes an auto renewal feature. You can opt out of the auto renewal at anytime from the Member Portal. You will receive an email reminder 45 days prior to the renewal date.

  • Your membership plan payments must be current to receive the services and discounts included in the membership plan.

  • Payment for treatment not included in the membership plan is due at the time of service.

  • The pricing offered by your dentist may not be combined with any other offers or discounts.1Value is based on your dentist’s standard professional fees.

Questions?

Phone

(804) 326-5426

Address

201 Towne Center W Blvd #709,
Richmond, VA 23233

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