2021 CA Dental Programs for KP FEHB Members

Two great dental programs

For 2021 Kaiser Permanente Federal Members You must be enrolled in one of Kaiser Permanente’s medical plans to elect KPIC Dental Insurance Plan or DeltaCare® USA dental coverage

We keep you smiling® Kaiser Permanente is pleased to offer Federal employees and eligible Federal retirees and dependents who are currently enrolled or planning to enroll in one of Kaiser Permanente’s medical plans a choice of the dental plans described below. Option 1 is a dental PPO plan underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc., and is administered by Delta Dental of California (Delta Dental). Option 2 is a DeltaCare® USA dental HMO program provided by Delta Dental of California and administered by Delta Dental Insurance Company. (These companies are financially responsible for their own products.) These benefits are neither offered nor guaranteed under a contract with the Federal Employees Health Benefit (FEHB) Program, but are made available to all enrollees and family members who become members of Kaiser Permanente.

During the annual open enrollment period, you have the opportunity to enroll in one of the two plans. If you are already enrolled, you may change plans during this period. Your coverage under the enrolled plan will become effective on January 1, 2021 and will extend through December 31, 2021, subject to your continued premium payments and enrollment in Kaiser Permanente’s traditional HMO Plan. If you are already enrolled under one of the two dental plans and are not planning on changing your coverage, you do not need to complete the enrollment form. If you are changing plans, you must provide 30‑days advance written notice of termination. If you are covered under Option 1, the notice must be sent to Delta Dental (see page 11 for address). If you are covered under Option 2, the notice must be sent to DeltaCare USA (see page 23 for address).

If you are not already enrolled, for questions about KPIC’s Dental Insurance Plan, contact Delta Dental at: 800‑933‑9312 Monday through Friday, 8 a.m. — 4 p.m. Pacific time Your Kaiser Federal plan ID number is #09874

If you are already enrolled in the KPIC Dental Insurance Plan, for more information, contact Delta Dental at: 800‑835‑2244 Monday through Friday, 8 a.m. — 8 p.m. Pacific time Your Kaiser Federal plan ID number is #09874

For questions about DeltaCare USA, contact Delta Dental at: 800‑422‑4234 Monday through Friday 8 a.m. — 8 p.m. Pacific time Your Kaiser Federal plan ID number is #71114 You have two dental plans to choose from:

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KPIC’s Dental PPO Insurance Plan allows you the freedom to DeltaCare USA is a dental HMO program. With DeltaCare see any licensed dentist of your choice. It uses a USA, you select a conveniently located network dentist Table of Allowances that lists the dollar amount KPIC will to provide dental care for you and your family. A list pay for each covered dental service. A copy of the of participating network dentists is enclosed for your review. Table of Allowances is included in this brochure. You must Depending on the service you receive, you pay either a set be enrolled in Kaiser Permanente’s traditional HMO dollar copayment or no copayment at all. With the DeltaCare medical plan to elect this dental coverage. USA program, there are no deductibles and no claim forms. You must be enrolled in Kaiser Permanente’s traditional HMO medical plan to elect this dental coverage.

With KPIC’s Dental PPO Insurance Plan . . . With DeltaCare USA . . . • You have the freedom to choose any licensed dentist. • You select one of the more than 6,400 network dentists • Each family member may visit a different dentist. statewide. • Table of Allowances lists the specific dollar amount • General dental care for the entire family is provided an payable for each covered dental service. assigned Contract Dentist. Specialty care is coordinated • Your out‑of‑pocket costs will usually be lowest if you through your Contract Dentist. visit a Delta Dental PPOTM Dentist (PPO Dentist). If you • You pay a set or no copayment for covered services. can’t find a PPO Dentist, a Delta Dental Premier® Dentist • Orthodontic services (braces) with a copayment of $1,600 (Premier Dentist) is your next best option. PPO and for children under 19 and $1,800 for covered adults and Premier dentists will not bill you above their Delta Dental dependent adult children. contracted fees for covered services. • There are no claim forms to complete. • Find Delta Dental dentists at deltadentalins.com. • There are no deductibles. • Orthodontic services (braces) are not covered. • There are no annual maximums except for accidental • Claims are handled for you when you visit one of Delta injury. Dental’s approximately 47,100 participating dentist locations in California. • Use your 10‑digit Kaiser Permanente Medical Record Number (MRN) or your social security number as your ID (to use your MRN, include the leading zeros). • There is an annual deductible of $50 per person ($150 maximum per family); the maximum coverage annually is $1,000 per person. • There is no deductible for diagnostic and preventive services. • Some procedures are subject to a waiting period.

See KPIC Dental section beginning on page 2 See DeltaCare USA section beginning on page 14

KPIC Dental Insurance Plan Monthly premium* DeltaCare USA Monthly* Quarterly* Self only $35.38 Self only $14.26 $42.77 Self and 1 party $62.71 Self and 1 party $23.87 $71.60 Self and 2 or more $94.26 Self and 2 or more $36.18 $108.53

* Good through December 31 * Good through December 31

These benefits are neither offered nor guaranteed under contract with the FEHB Program. Remember that you are enrolling in your selected dental plan for a minimum of 12 consecutive months. This does not apply if your employment is terminated. Payment for either the KPIC or DeltaCare USA plan may be automatically withdrawn from the checking, savings or credit union account you specify. To review a brochure of the program, visit kp.org/feds.

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KPIC Dental PPO Insurance Plan

One of your non‑FEHB Dental plan options is a About KPIC’s Dental Insurance Plan dental PPO insurance plan underwritten by KPIC, If you’re concerned about the cost of dental treatment for and administered by Delta Dental of California. you and your family, you should know about KPIC’s dental PPO insurance plan. With a low monthly premium, KPIC’s KPIC’s dental PPO insurance plan uses a Table of group dental insurance plan allows you to budget for Allowances and allows you the freedom your annual dental costs. You can do this because KPIC’s dental PPO insurance plan contains a Table of Allowances to see any licensed dentist of your choice. The listing the specific dollar amount KPIC will pay for each Table of Allowances lists the dollar amount covered dental service. Since you receive in advance the KPIC will pay for each covered dental service. complete Table of Allowances for the plan, you’ll know A copy of the Table of Allowances is shown exactly how much of your treatment will be covered. on pages 6 and 8 of this brochure. Because dental fees do vary by dentist, it may be to your advantage to compare your dentist’s fees prior to making The monthly premiums for calendar year 2021 an appointment. are listed below: Who can join KPIC Dental Insurance Plan Monthly premium* As a Federal employee or a Federal retiree enrolled in one of Kaiser Permanente’s Plans, you and your eligible Self only $35.38 dependents are eligible for coverage under KPIC’s dental Self and 1 Party $62.71 PPO insurance plan. Your eligible dependents include your Self and 2 or more $94.26 lawful spouse and children from birth to age 26, including

* Good through December 31, 2021 stepchildren and children placed with you for adoption or foster care. A child 26 years of age or older may continue to These benefits are neither offered nor guaranteed under contract with the FEHB be eligible as a dependent if incapable of self‑support due Program. to a mental or physical disability that commenced prior to age 26, provided that the person is chiefly dependent upon the eligible member, due to a mental or physical disability, Note: This is only a brief description of your and Delta Dental receives notice of the disability. coverage. A certificate of insurance and schedule of coverage setting forth the terms and conditions Free choice of dentists of your coverage will be sent to you after you enroll. You may see any dentist for your covered treatment whether the dentist is a PPO Dentist, Premier Dentist or The dental coverage described in this section of a Non‑Delta Dental Dentist. However, as a PPO plan, the the brochure is underwritten by Kaiser Permanente greatest benefits ‑ including out‑of‑pocket savings ‑ occur Insurance Company, a subsidiary of Kaiser Foundation when you choose a PPO Dentist. You can find Delta Dental Health Plan, Inc. (KFHP). dentists at deltadentalins.com. To use KPIC’s dental PPO insurance plan, simply make an appointment with the dentist of your choice. Be sure to give the dental office your Kaiser Federal plan ID number and social security number or Medical Record Number (MRN).

Special advantages from Delta Dental dentists KPIC’s dental PPO insurance plan is administered by Delta Dental of California, and you get special advantages when you go to one of the more than 47,100 Delta Dental dentist locations in California. These participating dentists have agreed to handle all your claims paperwork and to charge you no more than their Delta Dental contracted fees. As KPIC’s administrator, Delta Dental reimburses these dentists directly, so you are responsible only for the amount of the charge that exceeds the covered amount shown in

2 KPIC Dental the Table of Allowances and any deductible, non‑covered I. Diagnostic and preventive benefits services and/or amount over the annual maximum. Your Diagnostic out‑of‑pocket costs will usually be lowest if you visit a Delta • oral examinations Dental PPO Dentist. If you can’t find a PPO Dentist, a Delta • x‑rays Dental Premier Dentist is your next best option. PPO and • diagnostic casts Premier Dentists will not bill you above their Delta Dental • biopsy/tissue examinations contracted fees for covered services (no “balance billing”). • specialist consultations You may use your 10‑digit Kaiser Permanente Medical Record Number (MRN) or your social security number Preventive as your ID number (to use your MRN, include the leading • prophylaxis treatments (cleanings) zeros). Find Delta Dental dentists at deltadentalins.com. • fluoride treatments If you go to a Non‑Delta Dentist (a dentist not contracted • space maintainers with Delta Dental), you are responsible for the entire charge Limitations on diagnostic and preventive benefits and must submit a claim to Delta Dental for reimbursement. • Benefits for oral examinations are limited to two Delta Dental will reimburse you directly for the amount exams in any calendar year while the patient is shown in the Table of Allowances. Since a majority of covered under any KPIC dental insurance plan. See California’s dentists are Delta Dental dentists, your current “Additional benefits during pregnancy.” dentist is probably already participating. Ask your dentist if he or she is a Delta Dental dentist. • Benefits for cleanings or a procedure for cleaning are limited to two in any calendar year while the patient Predictable costs is covered under any KPIC dental insurance plan. With KPIC’s dental PPO insurance plan you know exactly See “Additional benefits during pregnancy.” Routine how much KPIC will pay for a covered dental service. Just cleanings are covered as diagnostic and preventive refer to the Table of Allowances on pages 6 to 8 of this and periodontal cleanings are covered as a basic brochure to see how much KPIC will pay for each covered benefit. dental service. • Fluoride treatments are limited to two in any calendar year while the patient is covered under any KPIC No deductible on diagnostic and dental insurance plan. preventive services Your calendar year deductible is $50 per person, up to a • Full mouth x‑rays are covered only after five years maximum of $150 for the family. There is no deductible on have elapsed following any prior provision of full diagnostic and preventive services. Your benefits cover a mouth x‑rays under any KPIC dental insurance plan. maximum of $1,000 of dental services for each covered Bitewing x‑rays are covered on request by the dentist, enrollee per calendar year. but not more than twice in a calendar year for children through 18, and once in a calendar year for When you enroll in KPIC’s dental PPO insurance plan, adults, while the patient is an eligible person under you are enrolling for a minimum period of 12 consecutive any KPIC dental insurance plan. months. This does not apply if your employment is terminated. • Panoramic x‑rays are provided as an individual service only after five years have elapsed since any Waiting periods prior panoramic x‑ray was provided under any KPIC Some of the covered dental services listed in the Table dental insurance plan. of Allowances are subject to a waiting period. This is the • Additional benefits during pregnancy: If you are period of time that you and your covered dependents are pregnant, KPIC will pay for additional services to required to have been continuously covered under KPIC’s help improve your oral health during pregnancy. The dental PPO insurance plan before a specific dental service additional services each calendar year while you are will be a covered benefit. Consult the Table of Allowances eligible in this KPIC dental insurance plan include: one on pages 6 and 8 of this brochure for the specific dental additional oral examination and either one additional services that are subject to a waiting period. routine cleaning or one additional periodontal scaling Benefits and root planing per quadrant. Written confirmation KPIC’s dental PPO insurance plan covers the following of your pregnancy must be provided by you or your benefits when they are provided by a licensed dentist dentist when the claim is submitted. and when necessary and customary by the standards of generally accepted dental practice:

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II. Basic benefits • Prosthodontic appliances that were provided under any KPIC program will be replaced only after five (5) Oral surgery years have passed, except when KPIC determines • extractions and certain other surgical procedures, that there is such extensive loss of remaining teeth including pre‑ and post‑operative care or change in supporting tissue that the existing fixed Restorative bridge or denture cannot be made satisfactory. Fixed • amalgam, synthetic porcelain and plastic restorations prosthodontic appliances are limited to Enrollees (fillings) for treatment of carious lesions (visible age 16 and older. Replacement of a prosthodontic destruction of hard tooth structure resulting from the appliance not provided under a KPIC program will process of dental decay) be made if KPIC determines it is unsatisfactory and Endodontics cannot be made satisfactory. • treatment of the tooth pulp (root canal treatment) • KPIC dental PPO insurance plan will pay the Periodontics listed allowance toward the dentist’s fee for a • treatment of gums and bones supporting the teeth standard cast chrome or acrylic partial denture or a standard complete denture. (A “standard” Sealants complete or partial denture is defined as a removable • protective coating for posterior molar teeth prosthetic appliance provided to replace missing Emergency natural, permanent teeth and which is constructed • palliative treatment using accepted and conventional procedures and materials.) Limitations on basic benefits • KPIC will not pay for implants (artificial teeth • Periodontal scaling and root planing is a benefit implanted into or on bone or gums), their removal once for each quadrant each 24‑month period. See or other associated procedures, but KPIC will credit “Additional benefits during pregnancy.” the cost of a crown, pontic or standard complete • Basic restorative benefits are subject to a six‑month or partial denture toward the cost of the implant waiting period. associated appliance i.e., the implant supported • Sealants are available for first molars for eligible crown or denture. The implant appliance is not persons through age 8 and for second molars for covered. eligible persons through age 15. The benefit includes V. General limitations — optional services the application of sealants only to permanent first • If an eligible person selects a more expensive plan of and second molars with no caries (decay), with no treatment than is customarily provided, or specialized restorations and with the occlusal surface intact. techniques rather than standard procedures, KPIC will The sealants benefit does not include the repair or pay the listed allowance for the lesser procedure, and replacement of a sealant on any tooth within two the patient is responsible for the remainder of the years of its application. dentist’s fee (examples: a crown where a silver filling III. Crowns, inlays, onlays and cast restoration would restore the tooth or a precision denture where benefits a standard denture would suffice). • crowns, inlays, onlays and cast restorations will VI. General exclusions be covered when teeth cannot be restored with • Treatment of injuries covered by Workers’ amalgam, synthetic porcelain or plastic restorations Compensation or Employer’s Liability Laws. Limitations on crowns, inlays, onlays and cast • Services which are provided to the Covered Person restoration benefits by any Federal or State Governmental Agency or are • Crowns, inlays, onlays and cast restoration benefits provided without cost to the Covered Person by any are subject to a six‑month waiting period municipality, county or other political subdivision, unless this exclusion is prohibited by law. IV. Prosthodontic benefits Procedures for construction or repair of fixed bridges, • Services for congenital (hereditary) or developmental partial or complete dentures (following birth) malformations, including but not limited to cleft palate, upper and lower Limitations on prosthodontic benefits jaw malformations, enamel hypoplasia (lack of • Prosthodontic treatment is subject to a six‑month development), fluorosis (a type of discoloration of waiting period. See Table of Allowances for further the teeth) and anodontia (congenitally missing teeth), reference. except those services provided to newborn children

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for medically diagnosed congenital defects or birth • Charges incurred for oral hygiene instruction, a abnormalities. plaque control program, preventive control programs • Treatment to stabilize teeth, treatment to restore including home care times, dietary instruction, x‑ray tooth structure lost from wear (abrasion, erosion), duplications, cancer screening, tobacco counseling or or treatment to rebuild or maintain chewing broken appointments. surfaces due to teeth out of alignment or occlusion. • Orthodontic treatment. Examples include but are not limited to: equilibration, • Treatment plans that are more expensive than those periodontal splinting, occlusal adjustments or occlusal customarily provided or specialized techniques guards and abfraction. used instead of standard procedures; for example, a • Any Single Procedure, provided prior to the date precision denture where a standard denture would the Enrollee became eligible for services under this suffice. program. • Maxillofacial prosthetics. • Prescribed drugs, medication, pain killers, • Provisional and/or temporary restorations except an antimicrobial agents, or experimental/investigational interim removable partial denture is covered only to procedures. replace extracted anterior permanent teeth during • Experimental procedures. the healing period. • Charges by any hospital or other surgical or • Cosmetic surgery or procedures for purely cosmetic treatment facility and any additional fees charged by reasons. the Provider for treatment in any such facility. • Laboratory processed crowns for Enrollees under age • Charges for anesthesia, except for general anesthesia 12. administered by a licensed Provider in connection • Fixed bridges and removable partials for Enrollees with covered oral surgery procedures. under age 16. • Extraoral grafts (grafting of tissues from outside the • Interim implants. mouth to oral tissues). • Indirectly fabricated resin‑based inlays and onlays. • Services for implants (prosthetic appliances placed • Treatment by someone other than a Provider or a into or on the bone of the upper or lower jaw to person who by law may work under a Provider’s retain or support dental prosthesis) their removal or direct supervision. other associated procedures. • Services or supplies covered by any other health plan • Services for any disturbance of the of the Contract holder. temporomandibular (jaw) joints or associated musculature, nerves and other tissues (TMJ). • Procedures having a questionable prognosis based on a dental consultant’s professional review of the • Replacement of existing restoration for any purpose submitted documentation. other than active tooth decay. • Any tax imposed (or incurred) by a government, state • Intravenous sedation, occlusal guards and complete or other entity, in connection with any fees charged occlusal adjustment. for Benefits provided under the Contract, will be • Hypnosis. the responsibility of the Enrollee and not a covered • Dental practice administrative services including benefit. but not limited to, preparation of claims, any • Deductibles, amounts over plan maximums and/or non‑treatment phase of dentistry such as provision of any service not covered under the dental plan. an antiseptic environment, sterilization of equipment • Services covered under the dental plan but exceed or infection control, or any ancillary materials used Benefit limitations or are not in accordance with during the routine course of providing treatment such processing policies in effect at the time the claim is as cotton swabs, gauze, bibs, masks or relaxation processed. techniques such as music. • Procedures not shown on the Table of Allowances. • Charges for speech therapy. To determine how much your out‑of‑pocket costs will • Charges for lost or stolen appliances. be and what services will be covered, ask your dentist to • Services for which no charge is normally made in the obtain a pre‑treatment estimate from Delta Dental. absence of insurance.

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KPIC Dental Insurance Plan 2021 Table of Allowances The amounts in the Allowance column shown below are what KPIC will pay for covered services subject to the limitations and exclusions of the plan. Enrollees are responsible for paying the remainder of the Accepted Fee, the amount the attending Dentist agrees to accept as payment in full for services rendered. Please refer to your Certificate of Insurance for further clarification of benefits. Enrollees should discuss all treatment options with their Dentist prior to services being rendered. Text that appears in brackets { } below is specifically intended to clarify the delivery of benefits under the Delta Dental program and is not to be interpreted as CDT 2021 procedure codes, descriptors or nomenclature that are under copyright by the American Dental Association. The American Dental Association may periodically change CDT codes or definitions. Such updated codes, descriptors and nomenclature may be used to describe these covered procedures in compliance with federal legislation.

Code Description Allowance Code Description Allowance

D0100 – D0999 Diagnostic D1555 Removal of fxed space maintainer $23.00 Clinical oral evaluations D0120 Periodic oral evaluation — established patient $18.00 D2000 – D2999 Restorative D0140 Limited oral evaluation — problem focused $25.20 {Restorative procedures are subject to a 6 month waiting period} D0145 Oral evaluation for a patient under 3 years of age and counseling $18.00 Amalgam restorations (including polishing) with primary caregiver D2140 Amalgam — 1 surface, primary or permanent $35.00 D0150 Comprehensive oral evaluation — new or established patient $25.20 D2150 Amalgam — 2 surfaces, primary or permanent $43.00 D0160 Detailed and extensive oral evaluation — problem focused, by $21.00 report D2160 Amalgam — 3 surfaces, primary or permanent $52.00 D0170 Re‑evaluation — limited, problem focused (established patient; $21.00 D2161 Amalgam — 4 or more surfaces, primary or permanent $58.00 not post‑operative visit) Resin-based composite restorations-direct D0180 Comprehensive periodontal evaluation — new or established $21.00 D2330 Resin‑based composite — 1 surface, anterior $46.00 patient D2331 Resin‑based composite — 2 surfaces, anterior $46.00 Pre-diagnostic services D2332 Resin‑based composite — 3 surfaces, anterior $46.00 D0190 Screening of a patient $12.60 D2335 Resin‑based composite — 4 or more surfaces or involving incisal $68.00 D0191 Assessment of a patient $12.60 angle (anterior) Diagnostic imaging D2390 Resin‑based composite crown, anterior $114.00 D0210 Intraoral — complete series of radiographic images $45.00 D2391 Resin‑based composite — 1 surface, posterior $47.00 D0220 Intraoral — periapical frst radiographic image $12.00 D2392 Resin‑based composite — 2 surfaces, posterior $64.00 D0230 Intraoral — periapical each additional radiographic image $5.00 D2393 Resin‑based composite — 3 surfaces, posterior $80.00 D0240 Intraoral — occlusal radiographic image $12.00 D2394 Resin‑based composite — 4 or more surfaces posterior $80.00 D0250 Extra‑oral — 2D projection radiographic image created using a $19.00 Inlay/onlay restorations stationary radiation source, and detector D2510 Inlay — metallic — 1 surface $99.00 D0270 Bitewing — 1 radiographic image $11.00 D2520 Inlay — metallic — 2 surfaces $133.00 D0272 Bitewings — 2 radiographic images $17.00 D2530 Inlay — metallic — 3 or more surfaces $150.00 D0273 Bitewings — 3 radiographic images $20.50 D2542 Onlay — metallic — 2 surfaces $191.00 D0274 Bitewings — 4 radiographic images $24.00 D2543 Onlay — metallic — 3 surfaces $191.00 D0277 Vertical bitewings — 7 to 8 radiographic images $45.00 D2544 Onlay — metallic — 4 or more surfaces $191.00 D0290 Posterior‑anterior or lateral skull and facial bone survey $19.00 D2650 Inlay — resin‑based composite — 1 surface $34.00 radiographic image D2651 Inlay — resin‑based composite — 2 surfaces $50.00 D0330 Panoramic radiographic image $37.00 D2652 Inlay — resin‑based composite — 3 or more surfaces $63.00 Oral pathology laboratory D2662 Onlay — resin‑based composite — 2 surfaces $50.00 D0472 Accession of tissue, gross examination, preparation and $59.00 D2663 Onlay — resin‑based composite — 3 surfaces $63.00 transmission of written report D2664 Onlay — resin‑based composite — 4 surfaces $63.00 D0473 Accession of tissue, gross and microscopic examination, $59.00 Crowns — single restoration only preparation and transmission written report D2710 Crown — resin‑based composite (indirect) $80.00 D0474 Accession of tissue, gross and microscopic examination, $59.00 including assessment of surgical margins for presence of D2712 Crown — ¾ resin‑based composite (indirect) $80.00 disease, preparation and transmission of written report D2720 Crown — Resin with high noble metal $182.00 Risk assessment D2721 Crown — resin with predominantly base metal $163.00 D0601 Caries risk assessment and documentation, with a fnding of low $3.00 D2722 Crown — resin with noble metal $177.00 risk D2740 Crown — porcelain/ceramic substrate $192.00 D0602 Caries risk assessment and documentation, with a fnding of $3.00 D2750 Crown — porcelain fused to high noble metal $182.00 moderate risk D2751 Crown — porcelain fused to predominantly base metal $163.00 D0603 Caries risk assessment and documentation, with a fnding of $3.00 D2752 Crown — porcelain fused to noble metal $177.00 high risk D2780 Crown — ¾ cast high noble metal $186.00 D1000 – D1999 Preventive D2781 Crown — ¾ cast predominantly base metal $186.00 Dental prophylaxis D2782 Crown — ¾ cast noble metal $186.00 D1110 Prophylaxis — adult $43.20 D2790 Crown — full cast high noble metal $183.00 D1120 Prophylaxis {child through age 13} $33.60 D2791 Crown — full cast predominantly base metal $170.00 Topical fuoride treatment (ofce procedure) D2792 Crown — full cast noble metal $178.00 D1206 Topical application of fuoride varnish $10.80 D2794 Crown — titanium $183.00 D1208 Topical application of fuoride — excluding varnish $10.80 Other restorative services Other preventive services D2910 Recement or re‑bond inlay, onlay, veneer or partial coverage $27.00 D1351 Sealant — per tooth $20.00 restorations D1352 Preventive resin restoration in a moderate to high caries risk $24.00 D2915 Recement or re‑bond indirectly fabricated or prefabricated post $27.00 patient — permanent tooth and core Space maintenance (passive appliances) D2920 Recement or re‑bond crown $27.00 D1510 Space maintainer — fxed — unilateral $115.00 D2921 Reattachment of tooth fragment, incisal edge or cusp $51.00 D1515 Space maintainer — fxed — bilateral $191.00 D2929 Prefabricated porcelain/ceramic crown — primary tooth $90.00 D1520 Space maintainer — removable — unilateral $143.00 D2930 Prefabricated stainless steel crown — primary tooth $65.00 D1525 Space maintainer — removable — bilateral $187.00 D2931 Prefabricated stainless steel crown — permanent tooth $74.00

The above CDT codes and nomenclature are copyright of the American Dental Association. Note: Some nomenclature has been abbreviated. This appendix represents codes and nomenclature excerpted from the version of Current Dental Terminology (CDT) in efect on the date that this Contract or amendment was issued. CDT coding and nomenclature are the copyright of the American Dental Association, and have been accepted as the standard for data transmission purposes under federal Administrative Simplifcation regulations. For the purposes of this Appendix, Delta Dental’s administration of Benefts, Limitations and Exclusions under this Contract will at all times be based on the current version of CDT whether or not a revised Appendix B is provided. Notes in brackets { } have been added by Delta Dental for clarifcation.

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Code Description Allowance Code Description Allowance D2932 Prefabricated resin crown $80.00 D4245 Apically positioned fap $159.00 D2933 Prefabricated stainless steel crown with resin window $90.00 D4249 Clinical crown lengthening — hard tissue $96.00 D2934 Prefabricated esthetic coated stainless steel crown — primary $90.00 D4260 Osseous surgery (including elevation of a full thickness fap and $342.00 tooth closure) — 4 or more contiguous teeth or tooth bounded spaces D2950 Core buildup, including any pins when required $43.00 per quadrant D2951 Pin retention — per tooth, in addition to restoration $20.00 D4261 Osseous surgery (including elevation of a full thickness fap and $205.00 D2952 Post and core in addition to crown, indirectly fabricated $92.00 closure) — 1 to 3 contiguous teeth or tooth bounded spaces per quadrant D2954 Prefabricated post and core in addition to crown $75.00 D4264 Bone replacement graft — each additional site in quadrant $47.00 D2960 Labial veneer (resin laminate) — chairside $116.00 D4266 Guided tissue regeneration — resorbable barrier, per site $135.00 D2961 Labial veneer (resin laminate) — laboratory $128.00 D4267 Guided tissue regeneration — nonresorbable barrier, per site $135.00 D2962 Labial veneer (porcelain laminate) — laboratory $161.00 (includes membrane removal) D2980 Crown repair necessitated by restorative material failure $25.00 D4268 Surgical revision procedure, per tooth $135.00 D2981 Inlay repair necessitated by restorative material failure $25.00 D4270 Pedicle soft tissue graft procedure $192.00 D2982 Onlay repair necessitated by restorative material failure $25.00 D4273 Autogenous connective tissue graft procedure (including donor $233.00 D2983 Veneer repair necessitated by restorative material failure $25.00 and recipient surgical sites) frst tooth, implant, or edentulous tooth position in graft D4277 Free soft tissue graft procedure (including recipient and donor $208.00 D3000 – D3999 Endodontics surgical sites), frst tooth, implant, or edentulous tooth position {Endodontic procedures are subject to a 6 month waiting period} in graft Pulpotomy D4278 Free soft tissue graft procedure (including recipient and donor $156.00 D3220 Therapeutic pulpotomy (excluding fnal restoration) — removal $38.00 surgical sites), each additional contiguous tooth, implant, or of pulp coronal to the dentinocemental junction and application edentulous tooth position in same graft site of medicament Non-surgical periodontal services D3221 Pulpal debridement, primary or permanent teeth $41.00 D4341 Periodontal scaling and root planing — 4 or more teeth per $59.00 D3222 Partial pulpotomy for apexogenesis — permanent tooth with $38.00 quadrant incomplete root development D4342 Periodontal scaling and root planing — 1 to 3 teeth per quadrant $35.00 Endodontic therapy on primary teeth D4355 Full mouth debridement to enable comprehensive evaluation $36.00 D3230 Pulpal therapy (resorbable flling) — anterior, primary tooth $38.00 and diagnosis (excluding fnal restoration) Other periodontal services D3240 Pulpal therapy (resorbable flling) — posterior, primary tooth $38.00 D4910 Periodontal maintenance $41.00 (excluding fnal restoration) D4920 Unscheduled dressing change (by someone other than treating $36.00 Endodontic therapy (including treatment plan, clinical procedures and follow-up dentist or their staf) care) D3310 Endodontic therapy, anterior tooth (excluding fnal restoration) $193.00 D3320 Endodontic therapy, bicuspid tooth (excluding fnal restoration) $227.00 D5000 – D5899 Prosthodontics, removable {Prosthodontic removable procedures are subject to a 12 month waiting period} D3330 Endodontic therapy, molar tooth (excluding fnal restoration) $306.00 Complete dentures (including routine post-delivery care) D3333 Internal root repair of perforation defects $56.00 D5110 Complete denture — maxillary $240.00 Endodontic retreatment D5120 Complete denture — mandibular $241.00 D3346 Retreatment of previous root canal therapy — anterior $193.00 D5130 Immediate denture — maxillary $240.00 D3347 Retreatment of previous root canal therapy — bicuspid $227.00 D5140 Immediate denture — mandibular $241.00 D3348 Retreatment of previous root canal therapy — molar $306.00 Partial dentures (including routine post-delivery care) Apexifcation/recalcifcation procedures D5211 Maxillary partial denture — resin base (including any $203.00 D3351 Apexifcation/recalcifcation — initial visit (apical closure/calcifc $56.00 conventional clasps, rests and teeth) repair of perforations, root resorption etc.) D5212 Mandibular partial denture — resin base (including any $212.00 D3352 Apexifcation/recalcifcation — interim medication replacement $56.00 conventional clasps, rests and teeth) (apical closure/calcifc repair of perforations, D5213 Maxillary partial denture — cast metal framework with resin $287.00 root resorption, pulpal space disinfection, etc.) denture bases (including any conventional clasps, rests and D3353 Apexifcation/recalcifcation — fnal visit (includes completed $56.00 teeth root canal therapy — apical closure/calcifc repair of D5214 Mandibular partial denture — cast metal framework with resin $287.00 perforations, root resorption, etc) denture bases (including any conventional clasps, rests and Apicoectomy/periradicular services teeth) D3410 Apicoectomy — anterior $240.00 D5225 Maxillary partial denture — fexible base (including any clasps, $216.00 rests and teeth) D3421 Apicoectomy — bicuspid (frst root) $257.00 D5226 Mandibular partial denture — fexible base (including any clasps, $216.00 D3425 Apicoectomy — molar (frst root) $294.00 rests and teeth) D3426 Apicoectomy (each additional root) $50.00 D5281 Removable unilateral partial denture — 1 piece cast metal $120.00 D3427 Periradicular surgery without apicoectomy $57.00 (including clasps and teeth) D3430 Retrograde flling — per root $57.00 Adjustments to dentures D3450 Root amputation — per root $166.00 D5410 Adjust complete denture — maxillary $13.00 Other endodontic procedures D5411 Adjust complete denture — mandibular $13.00 D3920 Hemisection (including any root removal), not including root $121.00 D5421 Adjust partial denture — maxillary $14.00 canal therapy D5422 Adjust partial denture — mandibular $14.00 Repairs to complete dentures D4000 – D4999 Periodontics D5511 Repair broken complete denture base mandibular $31.00 {Periodontic procedures are subject to a 6 month waiting period} D5512 Repair broken complete denture base mandibular $31.00 Surgical services (including usual postoperative services) D5520 Replace missing or broken teeth — complete denture (each $25.00 D4210 Gingivectomy or gingivoplasty — 4 or more contiguous teeth or $128.00 tooth) bounded teeth spaces per quadrant D4211 Gingivectomy or gingivoplasty — 1 to 3 contiguous teeth or $77.00 Repairs to partial dentures bounded teeth spaces per quadrant D5611 Repair resin partial denture base, mandibular $30.00 D4212 Gingivectomy or gingivoplasty to allow access for restorative $77.00 D5612 Repair resin partial denture base, maxillary $30.00 procedure, per tooth D5621 Repair cast partial framework, mandibular $25.00 D4240 Gingival fap procedure, including root planing — 4 or more $159.00 D5622 Repair cast partial framework, maxillary $25.00 contiguous teeth or bounded teeth spaces per quadrant D5630 Repair or replace broken clasp — per tooth $36.00 D4241 Gingival fap procedure, including root planing — 1 to 3 $95.00 D5640 Replace broken teeth — per tooth $27.00 contiguous teeth or bounded teeth spaces per quadrant D5650 Add tooth to existing partial denture $31.00

7 KPIC Dental

Code Description Allowance Code Description Allowance D5660 Add clasp to existing partial denture — per tooth $37.00 D6930 Recement or re-bond fixed partial denture $33.00 Denture rebase procedures D6940 Stress breaker $38.00 D5710 Rebase complete maxillary denture $94.00 D6980 Fixed partial denture repair necessitated by restorative material $50.00 failure D5711 Rebase complete mandibular denture $93.00 D5720 Rebase maxillary partial denture $89.00 D5721 Rebase mandibular partial denture $91.00 D7000 – D7999 Oral and maxillofacial surgery Denture reline procedures {The folllowing procedures are subject to a 6 month waiting period} Extractions D5730 Reline complete maxillary denture (chairside) $46.00 (includes local anesthesia, suturing, if needed, and routine postoperative care) D5731 Reline complete mandibular denture (chairside) $45.00 D7111 Extraction, coronal remnants — deciduous tooth $20.00 D5740 Reline maxillary partial denture (chairside) $45.00 D7140 Extraction, erupted tooth or exposed root (elevation and/or $39.00 D5741 Reline mandibular partial denture (chairside) $47.00 forceps removal) D5750 Reline complete maxillary denture (laboratory) $70.00 Surgical extractions (includes local anesthesia, suturing, if needed, and routine D5751 Reline complete mandibular denture (laboratory) $70.00 postoperative care) D5760 Reline maxillary partial denture (laboratory) $71.00 D7210 Surgical removal of erupted tooth requiring removal of $74.00 bone and/or sectioning of tooth, and including elevation of D5761 Reline mandibular partial denture (laboratory) $71.00 mucoperiosteal flap if indicated Interim prosthesis D7220 Removal of impacted tooth — soft tissue $90.00 D5820 Interim partial denture (maxillary) $85.00 D7230 Removal of impacted tooth — partially bony $117.00 D5821 Interim partial denture (mandibular) $85.00 D7240 Removal of impacted tooth — completely bony $134.00 Other removable prosthetic services D7250 Surgical removal of residual tooth roots (cutting procedure) $78.00 D5850 Tissue conditioning — maxillary $25.00 Other surgical procedures D5851 Tissue conditioning — mandibular $24.00 D7260 Oroantral fistual closure $225.00 D5863 Overdenture — complete maxillary $240.00 D7261 Primary closure of a sinus perforation $225.00 D5864 Overdenture — partial maxillary $287.00 D7270 Tooth reimplantation and/or stabilization of accidentally evulsed $132.00 D5865 Overdenture — complete mandibular $241.00 or displaced tooth D5866 Overdenture — partial mandibular $287.00 D7272 Tooth transplantation (includes reimplantation from one site to $98.00 another and splinting and/or stabilization) D7280 Surgical access of unerupted tooth $176.00 D6200 – D6999 Prosthodontics, fixed Each retainer and each pontic constitutes a unit in a fixed partial denture D7285 Incisional biopsy of oral tissue — hard (bone, tooth) $136.00 {Fixed prosthodontic procedures are subject to a 6 month waiting period} D7286 Incisional biopsy of oral tissue — soft $108.00 Fixed partial denture pontics Alveoloplasty — surgical preparation of ridge for dentures D6210 Pontic — cast high noble metal $171.00 D7310 Alveoloplasty in conjunction with extractions — per quadrant $59.00 D6211 Pontic — cast predominantly base metal $138.00 D7311 Alveoloplasty in conjunction with extractions — 1 to 3 teeth or $36.00 D6212 Pontic — cast noble metal $168.00 tooth spaces, per quadrant D6214 Pontic — titanium $171.00 D7320 Alveoloplasty not in conjunction with extractions — per quadrant $96.00 D6240 Pontic — porcelain fused to high noble metal $176.00 D7321 Alveoloplasty not in conjunction with extractions — 1 to 3 teeth $58.00 D6241 Pontic — porcelain fused to predominantly base metal $155.00 or tooth spaces, per quadrant D6242 Pontic — porcelain fused to noble metal $170.00 Vestibuloplasty D6250 Pontic — resin with high noble metal $176.00 D7340 Vestibuloplasty — ridge extension (secondary epithelialization) $82.00 D6251 Pontic — resin with predominantly base metal $155.00 D7350 Vestibuloplasty — ridge extension (including soft tissue grafts, $218.00 D6252 Pontic — resin with noble metal $170.00 muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) Fixed partial denture retainers — inlays/onlays D6545 Retainer — cast metal for resin bonded fixed prosthesis $88.00 Surgical excision of intra-osseous lesions D6549 Resin retainer — for resin bonded fixed prosthesis $88.00 D7450 Removal of benign odontogenic cyst or tumor — lesion diameter $131.00 up to 1.25 cm D6602 Retainer inlay — cast high metal, 2 surfaces $121.00 D7451 Removal of benign odontogenic cyst or tumor — lesion diameter $273.00 D6603 Retainer inlay — cast high metal, 3 or more surfaces $135.00 greater than 1.25 cm D6604 Retainer inlay — cast predominantly base metal, 2 surfaces $121.00 Excision of bone tissue D6605 Retainer inlay — cast predominantly base metal, 3 or more $135.00 surfaces D7471 Removal of lateral exostosis (maxilla or mandible) $162.00 D6606 Retainer inlay — cast noble metal, 2 surfaces $121.00 D7472 Removal of torus palatinus $162.00 D6607 Retainer inlay — cast noble metal, 3 or more surfaces $135.00 D7473 Removal of torus mandibularis $162.00 D6610 Retainer onlay — cast high noble metal, 2 surfaces $288.00 Surgical incision D6611 Retainer onlay — cast high noble metal, 3 or more surfaces $288.00 D7510 Incision and drainage of abscess — intraoral soft tissue $48.00 D6612 Retainer onlay — cast predominantly base metal, 2 surfaces $288.00 Other repair procedures D6613 Retainer onlay — cast predominantly base metal, 3 or more $288.00 D7960 Frenulectomy — also known as frenectomy or frenotomy — $115.00 surfaces separate procedure not incidental to another procedure D6614 Retainer onlay — cast noble metal, 2 surfaces $288.00 D7970 Excision of hyperplastic tissue — per arch $88.00 D6615 Retainer onlay — cast noble metal, 3 or more surfaces $288.00 D7971 Excision of pericoronal gingiva $43.00 D6624 Retainer inlay — titanium $135.00 D6634 Retainer onlay — titanium $288.00 Fixed partial denture retainers — crowns D9000 – D9999 Adjunctive general services Unclassified treatment D6720 Retainer crown — resin with high noble metal $180.00 D9110 Palliative (emergency) treatment of dental pain-minor procedure $41.00 D6721 Retainer crown — resin with predominantly base metal $161.00 D6722 Retainer crown — resin with noble metal $175.00 Anesthesia D6750 Retainer crown — porcelain fused to high noble metal $181.00 D9222 Deep sedation/general anesthesia - first 15 minutes $36.00 D6751 Retainer crown — porcelain fused to predominantly base metal $161.00 D9223 Deep sedation/general anesthesia — each 15 subsequent minute $36.00 D6752 Retainer crown — porcelain fused to noble metal $175.00 increment D6780 Retainer crown — ¾ cast high noble metal $181.00 Professional visits D6781 Retainer crown — ¾ cast predominantly base metal $181.00 D9310 Consultation — diagnostic service provided by dentist or $43.00 D6782 Retainer crown — ¾ cast noble metal $181.00 physician other than requesting dentist or physician D6790 Retainer crown — full cast high noble metal $180.00 D9430 Office visit for observation (during regularly scheduled hours) — $24.00 no other services performed D6791 Retainer crown — full cast predominantly base metal $159.00 D9440 Office visit — after regularly scheduled hours $49.00 D6792 Retainer crown — full cast noble metal $175.00 D6794 Retainer crown — titanium $180.00

The above CDT codes and nomenclature are copyright of the American Dental Association. Note: Some nomenclature has been abbreviated. This appendix represents codes and nomenclature excerpted from the version of Current Dental Terminology (CDT) in effect on the date that this Contract or amendment was issued. CDT coding and nomenclature are the copyright of the American Dental Association, and have been accepted as the standard for data transmission purposes under federal Administrative Simplification regulations. For the purposes of this Appendix, Delta Dental’s administration of Benefits, Limitations and Exclusions under this Contract will at all times be based on the current version of CDT whether or not a revised Appendix B is provided. Notes in brackets { } have been added by Delta Dental for clarification.

8 KPIC Dental

Code Description Allowance

Drugs D9610 Therapeutic parenteral drug, single administration $6.00 D9612 Therapeutic parenteral drugs, two or more administrations, $6.00 diferent medications Miscellaneous services D9930 Treatment of complications (post‑surgical) — unusual $19.00 circumstances, by report D9951 Occlusal adjustment — limited $32.00 D9995 Teledentistry‑synchronous; real‑time encounter No Copay D9996 Teledentistry‑asynchronous; information stored and forwarded to No dentist for subsequent review Copay

9 KPIC Dental

How to enroll in KPIC’s Dental Insurance Plan You may choose to have your monthly premiums deducted 1. Complete the enrollment form on page 11, or you from your checking, savings or credit union account on the also have the option to enroll online by visiting 10th of each month prior to the coverage month (e.g., April dentalinfo.biz/kpic_enrollment.html. If you are already dues will be deducted on March 10). Please complete the a Kaiser Permanente member, please include a copy Automatic Payment Authorization form on page 12 of this of your Kaiser Permanente ID card. If you are not yet brochure. a Kaiser Permanente member, please include a copy If you do not have a checking, savings or credit union of your Medical Enrollment Form (Form SF 2809). You account, you may submit payments via a personal check, must be a Federal member of Kaiser Permanente to money order, etc. When completing the enrollment form, enroll. write DIRECT PAY across the top of page 12, “Automatic 2. Sign the form to authorize automatic payment from Payment Authorization.” You will be sent monthly invoices your checking, savings or credit union account. Be sure to submit with your premium payments. Premiums must to enclose a voided blank check or deposit form from be paid by the 10th of each month prior to the coverage this account. Call your bank to obtain the automatic month. deposit routing number and write the number on the payment authorization form. 3. Return the first month’s payment and enrollment materials by December 21, 2021, to: KPIC Federal Employee Dental Insurance Plan Wolfpack Insurance Services, Inc. P.O. Box 720 Belmont, CA 94002‑0720 4. If your payment and enrollment materials are received by KPIC’s Administrator by December 21, 2021, your effective date of coverage (including your eligible dependents) will be January 1, 2021.

Monthly rates for calendar year 2021

KPIC Dental Insurance Plan Monthly premium* 1 person $35.38 2 persons $62.71 3 or more persons $94.26

* Good through December 31, 2021

Payment of monthly charges The dental coverage described in this brochure will not become effective until KPIC or its Administrator receives the initial premium from the eligible Federal Employee. The due date for subsequent premiums is the 10th day of each month. The Insured agrees to pay subsequent premiums no later than 31 days following the premium due date, unless the Insured has given notice requesting termination of dental coverage under the Certificate in accordance with the Termination section of the Certificate. The Insured will be responsible for the payment of the pro rata premium for the time dental coverage under the Certificate was in force during the 31‑day grace period.

Billing To ensure timely processing of your benefits and claim payments, it is necessary that premiums be paid during the month prior to the coverage month. There are two payment options. 10 KPIC Dental

Notes

11 KPIC Dental

Enrollment form

Instructions: Please complete this Group Dental Enrollment form and return a signed copy with your first month’s payment by December 21, 2021 to Wolfpack Insurance Services Inc., P.O. Box 720, Belmont, CA 94002-0720.

Kaiser Permanente Insurance Company Oakland, California

Dental PPO enrollment

Enrollment information: Failure to accurately complete the questions on the enrollment form may delay the effective date of your coverage under the KPIC Dental Insurance Plan.

Full name Social security number or 10‑digit Kaiser Permanente medical record number Mailing address City, state, zip Phone number Male Female Date of birth

Please list eligible dependents to be covered in addition to yourself: Spouse Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth

Enrollment — Coverage not elected below will be assumed refused if not specifically refused. Yes, I would like to enroll in the Kaiser Permanente Insurance Company (KPIC) Dental PPO Plan for Federal Employees. I understand that enrollment is voluntary. By electing to enroll, I agree to participate in the KPIC Trust (and/or any successor Trust), which holds the KPIC Dental Policy. I understand that to be eligible for the Plan, I must be enrolled along with any of my dependents to be covered, in Kaiser Permanente’s Traditional HMO Plan for Federal Enrollees. I further understand that my continued eligibility, and that of my covered dependents, is contingent on our continued enrollment in Kaiser Permanente’s Traditional HMO Plan for Federal Enrollees. I also understand that some covered dental services are subject to waiting periods. I certify that to the best of my knowledge and belief, any information disclosed on this enrollment form, is accurate and that my answers are correct, true and complete. No, I do not wish to participate. I understand that I will not be entitled to any benefits under the KPIC Dental Plan and will not be able to enroll until the next annual renewal period. (Coverage not elected will be assumed refused, even if not specifically refused.)

Signature of enrollee Date

KPIC — Enroll — 9793 (rev. 08/19)

12 KPIC Dental

Automatic payment authorization

Banking information: Checking account Savings account Credit union account Routing transit number (RTN) (The first two numbers of the RTN must be 01 through 12 or 21) Account number (Verify this number with your bank) Branch name Phone number Branch number

Automatic Payment Authorization — Please enclose a voided check or preprinted deposit slip from the account checked. I (we) hereby authorize Delta Dental/Wolfpack Insurance Services, Inc. to charge the applicable monthly dues for 12 months of dental coverage to my account designated above. I understand that coverage will become and remain effective only if there are sufficient funds at the time of the deduction. I agree to comply with the terms as outlined in the certificate of insurance. This authority is to remain in full force and effect until I notify Delta Dental in writing 30 days prior to termination. (My bank is authorized to make corrections if any should be necessary.)

Signature of enrollee Date

Signature of spouse Date

To enroll in the KPIC DENTAL insurance plan, please complete the enrollment form in this brochure (page 11) and enclose the first month’s payment payable to Wolfpack Insurance Services, Inc. Return the enrollment form and the first month’s payment by December 21, 2021 to Wolfpack Insurance Services Inc., P.O. Box 720, Belmont, CA 94002‑0720.

Note: Please enclose a voided check or preprinted deposit slip from the account checked. Staple it in the space below. Use only a check that corresponds to the banking information you have provided.

Payment instructions: Payments are due retroactively to the month you and/or dependents enrolled in the Kaiser Federal Employee Dental Plan plus one month in advance. After payment and application are received, the first automatic payment will occur on the 10th of the following month and each month thereafter.

James Smith 00-0000/0000 123 122 Main St. Anyplace, NY 10000 Date

PAY TO THE Attach ORDER OF $ voided check DOLLARS or ANYPLACE BANK deposit Anyplace, NY 10000 slip here For . ı: 120000005 ı: 1234567890 || 123

Routing transit Account number number

13 DeltaCare® USA

DeltaCare® USA

One of your non‑FEHB Dental benefit options, About DeltaCare USA DeltaCare USA, is provided by Delta Dental of The DeltaCare USA program is an HMO dental plan that California, and administered by Delta Dental focuses on preventing dental problems and assuring the delivery of quality dental care. Insurance Company. Delta Dental of California has contracted with a network With DeltaCare USA, you select a conveniently of Contract Dentists within the state of California. A listing located network dentist to provide dental of these offices is included for you in the back of this care for you and your family. You pay a set brochure, or you may go to deltadentalins.com to search for a conveniently located network dentist. The network of copayment or, for some services, no copayment. dental offices is composed of established dental practices. There are no deductibles and no claim forms to worry about. Who can join As a Federal member of Kaiser Permanente, you are eligible The dues for calendar year 2021 are listed below: to join the DeltaCare USA program. Your eligible dependents include your lawful spouse and dependent children from birth to 26 years old, including Type Monthly* Quarterly* stepchildren and children placed with you for adoption or Self only $14.26 $42.77 foster care. A child 26 years of age or older may continue to Self and 1 party $23.87 $71.60 be eligible as a dependent if incapable of self‑support due Self and 2 or more $36.18 $108.53 to a mental or physical disability that commenced prior to age 26, provided that the person is chiefly dependent upon * Good through December 31, 2021 the eligible member, and Delta Dental receives notice of the

These benefits are neither offered nor guaranteed under contract with the FEHB disability. Program, but are made available to all eligible enrollees and family members of this Plan. Emergency services Dental emergencies are covered up to a maximum of $100.00 per emergency, per Enrollee, less applicable Note: This is only a brief summary of the program. copayment(s). A Combined Policy and Disclosure Form stating the terms of your program will be sent to you upon No claim forms enrollment. The dental location you choose provides all primary dental services. There are no claim forms to complete or Please read the following information so you will percentage of usual charges for you to pay. know how to get dental care under the DeltaCare USA program. No deductibles With the DeltaCare USA program, there are no required deductibles to pay, so your benefits begin immediately.

No dollar limit of dental benefits No annual maximum, except for accidental injury.

Pre‑existing condition restrictions Pre‑existing conditions are not excluded in the DeltaCare USA program. Exception: work in progress.

Prepaid program saves on dental costs Your out‑of‑pocket savings could be substantial. You know the exact cost prior to treatment, allowing you to predict future dental expenses. When you enroll in this program, you are enrolling for a minimum of 12 consecutive months. This does not apply if your employment is terminated. 14 DeltaCare® USA

Quality review of dental providers • Bitewing x‑rays are limited to not more than one series of On‑site audits of participating dental locations ensure that four films in any six‑month period. established standards of quality are maintained. • Full mouth x‑rays are limited to one set every 24 consecutive months. Specialty services The DeltaCare USA program offers services in dental • Sealants are limited to noncarious, nonrestored specialty areas. These include periodontics (treatment permanent first and second molars through age 15. of diseased gums and bone), endodontics (root canal Exclusions (partial list) therapy) and oral surgery procedures. Specialty services The following services are not covered. must be referred by the assigned Contract Dentist and some procedures may require preauthorization. If an • General anesthesia and the services of a special enrollee is assigned to a dental school clinic for specialist anesthesiologist. services, those services may be provided by a dentist, a • Cosmetic dental care. dental instructor, a clinician or a dental student under the • Dental conditions arising out of and due to the enrollee’s supervision of a dentist. employment or for which Workers’ Compensation is The DeltaCare USA program provides benefits for listed payable. Services which are provided to the enrollee by dental procedures (subject to the provisions, limitations and state government or agency thereof, or are provided exclusions shown in the Combined Policy and Disclosure without cost to the enrollee by any municipality, county Form) if care is provided by your assigned Contract Dentist. or other subdivisions. When you enroll in DeltaCare USA, you select a • Dental services performed in a hospital and related participating dental office from the DeltaCare USA hospital fees. Network directory to take care of dental needs for you and • Loss or theft of fixed and removable prosthetics (crowns, your family. After you have enrolled, you will receive an bridges, full or partial dentures). Combined Policy and Disclosure Form booklet that fully • Dental expenses incurred in connection with any dental describes the benefits of your dental program, a welcome procedure started after termination of eligibility of letter and a DeltaCare USA membership card. The welcome coverage. letter will have the address and telephone number of your participating network dentist. To receive all necessary • Any service that is not specifically listed as a covered dental care covered by the program, simply call your procedure. selected dental office to make an appointment. • Dental expenses incurred in connection with any dental Remember to always contact your assigned Contract procedure started prior to the enrollee’s eligibility. Dentist. With the exception of certain Emergency Dental Example: teeth prepared for crowns, root canals in Services or Urgent Dental Services, treatment received progress, orthodontics. other than from the enrollee’s assigned Contract Dentist • Congenital malformations. or not prior authorized by Delta Dental will not be covered • Dispensing of drugs not normally supplied in a dental under the DeltaCare USA program. office. Limitations of benefits (partial list) • Cases in which, in the professional judgment of the • Prophylaxis is limited to two treatments at no cost in any attending dentist, a satisfactory result cannot be obtained 12 consecutive months; additional treatments are available or where the prognosis is poor or guarded. with a $27 patient copayment. • Dental services received from any dental office other than • Full upper and/or lower dentures are not to exceed one the assigned dental office unless expressly authorized each in any five‑year period. in writing by Delta Dental or as cited under “Emergency • Replacement of partial dentures within any five‑year Dental Services.” period is not covered unless necessary due to natural • Prophylactic removal of impactions (asymptomatic tooth loss where the addition or replacement of teeth to nonpathological). the existing partial is not feasible. • “Consultations” for noncovered services. • Denture relines are limited to one per denture during any • Implant placement or removal, appliances placed on, or 12 consecutive months. services associated with, implants. • Periodontal treatments (root planing/subgingival curettage) are limited to five quadrants during any 12 Orthodontic limitations and exclusions (partial list) consecutive months. • Orthodontic treatment must be provided by a member of the orthodontic network.

15 DeltaCare® USA

• Program benefits cover 24 months of usual and customary orthodontic treatment. • If your coverage is terminated for any reason, and you are receiving any orthodontic treatment at the time, your copayment shall be $2, 300 for dependent children to age 19 (and $2, 500 for covered adults and dependent adult children) and be prorated over the number of months to completion of the treatment. Terms and conditions are arranged between you and the orthodontist. • A consultation fee may be charged if treatment is not required, or if you elect not to start treatment after a diagnosis and consultation have been completed. • Pre‑, mid‑ and post‑treatment records (cephalometric x‑rays, tracings, photographs and study models) are excluded. • Retreatment of orthodontic cases is excluded. • Lost, stolen or broken appliances are excluded. • Orthodontic treatment in progress is limited to new DeltaCare USA enrollees who, at the time of their original effective date, are in active treatment started under their previous employer sponsored dental plan, as long as they continue to be eligible under the DeltaCare USA program. Active treatment means tooth movement has begun. Enrollees are responsible for all copayments and fees subject to the provisions of their prior dental plan. Delta Dental is financially responsible only for amounts unpaid by the prior dental plan for qualifying orthodontic cases.

16 DeltaCare® USA

Schedule A Description of Benefits and Copayments

The benefits shown below are performed as deemed appropriate by the assigned Contract Dentist subject to the limitations and exclusions of the program. Please refer to Schedule B of the Combined Policy and Disclosure Form for further clarification of benefits. Enrollees should discuss all treatment options with their assigned Contract Dentist prior to services being rendered. Text that appears in brackets { } below is specifically intended to clarify the delivery of benefits under the DeltaCare USA program and is not to be interpreted as CDT 2021 procedure codes, descriptors or nomenclature that are under copyright by the American Dental Association. The American Dental Association may periodically change CDT codes or definitions. Such updated codes, descriptors and nomenclature may be used to describe these covered procedures in compliance with federal legislation. Procedure Codes, limitations and exclusions with age restrictions listed in Schedule A and Schedule B are subject to exceptions based on medical necessity.

Code Description Enrollee pays Code Description Enrollee pays

D0100-D0999 Diagnostic D1000-D1999 Preventive D0120 Periodic oral evaluation ‑ established patient No Cost D1110 Prophylaxis cleaning - adult - 2 D1110, D1120 or D4346per 12 No Cost D0140 Limited oral evaluation ‑ problem focused No Cost month period D0145 Oral evaluation for a patient under three years of age and No Cost D1110 Additional prophylaxis cleaning - adult (within the 6 month $27.00 counseling with primary caregiver period) D0150 Comprehensive oral evaluation - new or established patient No Cost D1120 Prophylaxis cleaning - child - 2 D1110, D1120 or D4346 per 12 No Cost D0160 Detailed and extensive oral evaluation - problem focused, by No Cost month period report D1120 Additional prophylaxis cleaning - child (within the 6 month $27.00 D0170 Re-evaluation - limited, problem focused (established patient; No Cost period) not post-operative visit) D1206 Topical application of fluoride varnish- child to age 19; 2 D1206 No Cost D0171 Re-evaluation - post-operative office visit No Cost or D1208 per 12 month period D0180 Comprehensive periodontal evaluation - new or established No Cost D1208 Topical application of fluoride - excluding varnish - child to age No Cost patient 19; 2 D1206 or D1208 per 12 month period D0190 Screening of a patient No Cost D1330 Oral hygiene instructions No Cost D0191 Assessment of a patient No Cost D1351 Sealant - per tooth - limited to permanent molars through age 15 $15.00 D0190 Screening of a patient No Cost D1352 Preventive resin restoration in a moderate to high caries risk $15.00 patient - permanent tooth - limited to permanent molars D0191 Assessment of a patient No Cost through age 15 D0230 Intraoral — periapical each additional radiographic image $5.00 D1353 Sealant repair - per tooth - limited to permanent molars through $15.00 D0240 Intraoral — occlusal radiographic image $12.00 age 15 D0250 Extra‑oral — 2D projection radiographic image created using a $19.00 D1354 Interim caries arresting medicament application - per tooth - No Cost stationary radiation source, and detector child to age 19; 2 per 12 month period D0270 Bitewing — 1 radiographic image $11.00 D1510 Space maintainer - fixed - unilateral - per quadrant $65.00 D0272 Bitewings — 2 radiographic images $17.00 D1516 Space maintainer - fixed - bilateral, maxillary $65.00 D0273 Bitewings — 3 radiographic images $20.50 D1517 Space maintainer - fixed - bilateral, mandibular $65.00 D0274 Bitewings — 4 radiographic images $24.00 D1520 Space maintainer - removable - unilateral - per quadrant $65.00 D0277 Vertical bitewings — 7 to 8 radiographic images $45.00 D1526 Space maintainer - removable - bilateral, maxillary $65.00 D0290 Posterior‑anterior or lateral skull and facial bone survey $19.00 D1527 Space maintainer - removable - bilateral, mandibular $65.00 radiographic image D1551 Re-cement or re-bond bilateral space maintainer - maxillary $20.00 D0330 Panoramic radiographic image $37.00 D1552 Re-cement or re-bond bilateral space maintainer - mandibular $20.00 D0419 Assessment of salivary flow by measurement- 1 every 12 months No Cost D1553 Re-cement or re-bond unilateral space maintainer - per $20.00 D0460 Pulp vitality tests No Cost quadrant D0470 Diagnostic casts No Cost D1556 Removal of fixed unilateral space maintainer- per quadrant $20.00 D0472 Accession of tissue, gross examination, preparation and No Cost D1557 Removal of fixed bilateral space maintainer - maxillary $20.00 transmission of written report D1558 Removal of fixed bilateral space maintainer - mandibular $20.00 D0473 Accession of tissue, gross and microscopic examination, No Cost D1575 Distal shoe space maintainer - fixed, unilateral - per quadrant - $65.00 preparation and transmission of written report child to age 9 D0474 Accession of tissue, gross and microscopic examination, No Cost including assessment of surgical margins for presence of disease, preparation and transmission of written report D2000-D2999 Restorative D0601 Caries risk assessment and documentation, with a finding of low No Cost {Includes polishing, all adhesives and bonding agents, indirect pulp capping, risk - 1 every 12 months bases, liners and acid etch procedures.} D0602 Caries risk assessment and documentation, with a finding of No Cost D2140 Amalgam - one surface, primary or permanent $27.00 moderate risk - 1 every 12 months D2150 Amalgam - two surfaces, primary or permanent $32.00 D0603 Caries risk assessment and documentation, with a finding of No Cost D2160 Amalgam - three surfaces, primary or permanent $37.00 high risk - 1 every 12 months D2161 Amalgam - four or more surfaces, primary or permanent $50.00 D0701 Panoramic radiographic image - image capture only No Cost D2330 Resin-based composite - one surface, anterior $75.00 D0702 2-D cephalometric radiographic image - image capture only No Cost D2331 Resin-based composite - two surfaces, anterior $80.00 D0703 2-D oral/facial photographic image obtained intra-orally or No Cost extra-orally - image capture only D2332 Resin-based composite - three surfaces, anterior $80.00 D0704 3-D photographic image - image capture only No Cost D2335 Resin-based composite - four or more surfaces or involving $80.00 incisal angle (anterior) D0705 Extra-oral posterior dental radiographic image - image capture No Cost only D2390 Resin-based composite crown, anterior $60.00 5, 12 D0706 Intraoral - occlusal radiographic image - image capture only No Cost D2391 Resin-based composite - one surface, posterior Optional 5, 12 D0707 Intraoral - periapical radiographic image - image capture only No Cost D2392 Resin-based composite - two surfaces, posterior Optional 5, 12 D0708 Intraoral - bitewing radiographic image - image capture only No Cost D2393 Resin-based composite - three surfaces, posterior Optional 5, 12 D0709 Intraoral - complete series of radiographic images - image No Cost D2394 Resin-based composite - four or more surfaces, posterior Optional capture only D2510 Inlay - metallic - one surface 5, 11 Optional D0999 Unspecified diagnostic procedure, by report- includes office $10.00 D2520 Inlay - metallic - two surfaces 5, 11 Optional visit, per visit (in addition to other services) D2530 Inlay - metallic - three or more surfaces 5, 11 Optional

Procedures not listed above are not covered; however, may be available at the Contract Dentist’s “filed fees.” “Filed fees” means the Contract Dentist’s fees on file with Delta Dental. Questions regarding these fees should be directed to Delta Dental’s Customer Care at 800‑422‑4234. The above CDT codes and nomenclature are copyright of the American Dental Association. Note: Some nomenclature has been abbreviated. This Schedule A represents codes and nomenclature excerpted from the version of Current Dental Terminology (CDT) in effect on the date that the Policy or Amendment was issued. CDT coding and nomenclature are the copyright of the American Dental Association, and have been accepted as the standard for data transmission purposes under federal Administrative Simplification regulations. For the purposes of this Schedule, Delta Dental’s administration of Benefits, Limitations and Exclusions under this plan will at all times be based on the current version of CDT whether or not a revised Schedule B is provided. Notes in brackets { } type have been added by Delta Dental for clarification.

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Code Description Enrollee pays Code Description Enrollee pays

D2542 Onlay - metallic - two surfaces 5, 11 Optional D3221 Pulpal debridement, primary and permanent teeth $45.00 D2543 Onlay - metallic - three surfaces 5, 11 Optional D3222 Partial pulpotomy for apexogenesis - permanent tooth with $45.00 D2544 Onlay - metallic - four or more surfaces 5, 11 Optional incomplete root development D2610 Inlay - porcelain/ceramic - one surface 5, 11 Optional D3230 Pulpal therapy (resorbable filling) - anterior, primary tooth $45.00 D2620 Inlay - porcelain/ceramic - two surfaces 5, 11 Optional (excluding final restoration) D2630 Inlay - porcelain/ceramic - three or more surfaces 5, 11 Optional D3240 Pulpal therapy (resorbable filling) - posterior, primary tooth $45.00 D2642 Onlay - porcelain/ceramic - two surfaces 5, 11 Optional (excluding final restoration) D2643 Onlay - porcelain/ceramic - three surfaces 5, 11 Optional D3310 Root canal - endodontic therapy, anterior tooth (excluding final $150.00 restoration) 3 D2644 Onlay - porcelain/ceramic - four or more surfaces 5, 11 Optional 5, 11 D3320 Root canal - endodontic therapy, premolar tooth (excluding final $200.00 D2650 Inlay - resin-based composite - one surface Optional restoration) 3 5, 11 D2651 Inlay - resin-based composite - two surfaces Optional D3330 Root canal - endodontic therapy, molar tooth (excluding final $250.00 D2652 Inlay - resin-based composite - three or more surfaces 5, 11 Optional restoration) 3 D2662 Onlay - resin-based composite - two surfaces 5, 11 Optional D3346 Retreatment of previous root canal therapy - anterior 3 $200.00 5, 11 D2663 Onlay - resin-based composite - three surfaces Optional D3347 Retreatment of previous root canal therapy - premolar 3 $250.00 D2664 Onlay - resin-based composite - four or more surfaces 5, 11 Optional D3348 Retreatment of previous root canal therapy - molar 3 $300.00 D2710 Crown - resin-based composite (indirect) 6, 11 $125.00 D2712 Crown - 3/4 resin-based composite (indirect) 6, 11 $125.00 D3351 Apexification/recalcification- initial visit (apical closure/calcific $40.00 repair of perforations, root resorption, etc.) D2720 Crown - resin with high noble metal 2, 6, 11 $180.00 D3410 Apicoectomy - anterior 3 $200.00 D2721 Crown - resin with predominantly base metal 6, 11 $180.00 3 D2722 Crown - resin with noble metal 6, 11 $180.00 D3421 Apicoectomy - premolar (first root) $200.00 D2740 Crown - porcelain/ceramic 6, 11 $275.00 D3425 Apicoectomy - molar (first root) 3 $200.00 D2750 Crown - porcelain fused to high noble metal 2, 6, 11 $275.00 D3426 Apicoectomy (each additional root) 3 $50.00 D2751 Crown - porcelain fused to predominantly base metal 6, 11 $275.00 D3430 Retrograde filling- per root 3 $50.00 D2752 Crown - porcelain fused to noble metal 6, 11 $275.00 D3450 Root amputation, per root - not covered in conjunction with a $50.00 D2753 Crown - porcelain fused to titanium and titanium alloys $275.00 hemisection 3 D2780 Crown - 3/4 cast high noble metal 2, 11 $250.00 D3471 Surgical repair of root resorption – anterior $200.00 D2781 Crown - 3/4 cast predominantly base metal 11 $250.00 D3472 Surgical repair of root resorption – premolar $200.00 11 D2782 Crown - 3/4 cast noble metal $250.00 D3473 Surgical repair of root resorption – molar $200.00 D2790 Crown - full cast high noble metal 2, 11 $250.00 11 D3501 Surgical exposure of root surface without apicoectomy or repair $200.00 D2791 Crown - full cast predominantly base metal $250.00 of root resorption - anterior 11 D2792 Crown - full cast noble metal $250.00 D3502 Surgical exposure of root surface without apicoectomy or repair $200.00 D2794 Crown - titanium and titanium alloys 2, 11 $275.00 of root resorption – premolar D2910 Re-cement or re-bond inlay, onlay, veneer or partial coverage $20.00 D3503 Surgical exposure of root surface without apicoectomy or repair $200.00 restoration of root resorption – molar D2915 Re-cement or re-bond indirectly fabricated or prefabricated post $20.00 and core D2920 Re-cement or re-bond crown $20.00 D4000-D4999 Periodontics D2921 Reattachment of tooth fragment, incisal edge or cusp (anterior) $80.00 {Includes preoperative and postoperative evaluations and treatment under a local anesthetic.} D2928 Prefabricated porcelain/ceramic crown - permanent tooth $60.00 D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth $200.00 D2929 Prefabricated porcelain/ceramic crown - primary tooth - anterior $60.00 or tooth bounded spaces per quadrant D2930 Prefabricated stainless steel crown - primary tooth $60.00 D4211 Gingivectomy or gingivoplasty - one to three contiguous teeth or $50.00 D2931 Prefabricated stainless steel crown - permanent tooth $60.00 tooth bounded spaces per quadrant D2932 Prefabricated resin crown - anterior primary tooth $60.00 D4212 Gingivectomy or gingivoplasty to allow access for restorative $50.00 D2933 Prefabricated stainless steel crown with resin window - anterior $60.00 procedure, per tooth primary tooth D4240 Gingival flap procedure, including root planing - four or more $250.00 D2940 Protective restoration $15.00 contiguous teeth or tooth bounded spaces per quadrant D2941 Interim therapeutic restoration - primary dentition $15.00 D4241 Gingival flap procedure, including root planing - one to three $250.00 D2949 Restorative foundation for an indirect restoration $25.00 contiguous teeth or tooth bounded spaces per quadrant D2950 Core buildup, including any pins when required $25.00 D4260 Osseous surgery (including elevation of a full thickness flap $400.00 D2951 Pin retention - per tooth, in addition to restoration $25.00 and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant D2952 Post and core in addition to crown, indirectly fabricated - $90.00 D4261 Osseous surgery (including elevation of a full thickness flap $400.00 includes canal preparation 2 and closure) - one to three contiguous teeth or tooth bounded D2953 Each additional indirectly fabricated post - same tooth - includes $90.00 spaces per quadrant canal preparation 2 D4341 Periodontal scaling and root planing - four or more teeth per $50.00 D2954 Prefabricated post and core in addition to crown - base metal $50.00 quadrant - limited to 5 quadrants during any 12 consecutive post; includes canal preparation months D2957 Each additional prefabricated post - same tooth- base metal $50.00 D4342 Periodontal scaling and root planing - one to three teeth per $50.00 post; includes canal preparation quadrant - limited to 5 quadrants during any 12 consecutive D2980 Crown repair necessitated by restorative material failure $45.00 months D2981 Inlay repair necessitated by restorative material failure $45.00 D4346 Scaling in presence of generalized moderate or severe gingival No Cost inflammation- full mouth, after oral evaluation - 2 D1110, D1120 or D2982 Onlay repair necessitated by restorative material failure $45.00 D4346 per 12 month period D2983 Veneer repair necessitated by restorative material failure $45.00 D4355 Full mouth debridement to enable a comprehensive oral $15.00 D2990 Resin infiltration of incipient smooth surface lesions- limited to $15.00 evaluation and diagnosis on a subsequent visit - limited to 1 permanent molars through age 15 treatment in any 12 consecutive months D4910 Periodontal maintenance - limited to 2 treatments each12 month $15.00 period D3000-D3999 Endodontics D4921 Gingival irrigation - per quadrant No Cost D3110 Pulp cap - direct (excluding final restoration) $12.00 D3120 Pulp cap - indirect (excluding final restoration) $12.00 D5000-D5899 Prothodontics (removable) D3220 Therapeutic pulpotomy (excluding final restoration)- removal of $45.00 pulp coronal to the dentinocemental junction and application of D5110 Complete denture - maxillary 4, 8 $350.00 medicament D5120 Complete denture - mandibular 4, 8 $350.00

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Code Description Enrollee pays Code Description Enrollee pays

D5130 Immediate denture - maxillary 4, 8 $450.00 D6200-D6999 Prosthodontics, fixed D5140 Immediate denture - mandibular 4, 8 $450.00 {each retainer and each pontic constitutes a unit in a fixed partial denture [bridge]} D5211 Maxillary partial denture - resin base (including retentive/ $300.00 D6210 Pontic - cast high noble metal 2, 9 $240.00 clasping materials, rests, and teeth) 4, 8 D6211 Pontic - cast predominantly base metal 9 $240.00 D5212 Mandibular partial denture - resin base (including retentive/ $300.00 9 clasping materials, rests, and teeth) 4, 8 D6212 Pontic - cast noble metal $240.00 2, 6, 9 D5213 Maxillary partial denture - cast metal framework with resin $375.00 D6240 Pontic - porcelain fused to high noble metal $275.00 denture bases (including retentive/clasping materials, rests and D6241 Pontic - porcelain fused to predominantly base metal 6, 9 $275.00 teeth) 4, 8 D6242 Pontic - porcelain fused to noble metal 6, 9 $275.00 D5214 Mandibular partial denture - cast metal framework with resin $375.00 D6243 Pontic - porcelain fused to titanium and titanium alloys $275.00 denture bases (including retentive/clasping materials, rests and D6245 Pontic - porcelain/ceramic 5, 9 Optional 4, 8 teeth) D6250 Pontic - resin with high noble metal 2, 6, 9 $180.00 D5221 Immediate maxillary partial denture - resin base (including $300.00 D6251 Pontic - resin with predominantly base metal 6, 9 $180.00 retentive/clasping materials, rests and teeth) D6252 Pontic - resin with noble metal 6, 9 $180.00 D5222 Immediate mandibular partial denture - resin base (including $300.00 6, 9 retentive/clasping materials, rests and teeth) D6545 Retainer - cast metal for resin bonded fixed prosthesis $150.00 D5223 Immediate maxillary partial denture - cast metal framework with $375.00 D6549 Retainer - for resin bonded fixed prosthesis $150.00 resin denture bases (including retentive/clasping materials, rests D6600 Retainer inlay - porcelain/ceramic, two surfaces 5, 9 Optional and teeth) D6601 Retainer inlay - porcelain/ceramic, three or more surfaces 5, 9 Optional D5224 Immediate mandibular partial denture - cast metal framework $375.00 D6602 Retainer inlay - cast high noble metal, two surfaces 5, 9 Optional with resin denture bases (including retentive/clasping materials, rests and teeth) D6603 Retainer inlay - cast high noble metal, three or more surfaces 5, 9 Optional D5282 Removable unilateral partial denture - one piece cast metal $150.00 D6604 Retainer inlay - cast predominantly base metal, two surfaces 5, 9 Optional (including retentive/clasping materials, rests, and teeth), D6605 Retainer inlay - cast predominantly base metal, three or more Optional maxillary surfaces 5, 9 D5283 Removable unilateral partial denture - one piece cast $150.00 D6606 Retainer inlay - cast noble metal, two surfaces 5, 9 Optional metal (including retentive/clasping materials, rests, and D6607 Retainer inlay - cast noble metal, three or more surfaces 5, 9 Optional teeth),mandibular D6608 Retainer onlay - porcelain/ceramic, two surfaces 5, 9 Optional D5284 Removable unilateral partial denture - one piece flexible base $150.00 D6609 Retainer onlay - porcelain/ceramic, three or more surfaces 5, 9 Optional (including retentive/clasping materials, rests, and teeth)- per quadrant D6610 Retainer onlay - cast high noble metal, two surfaces 5, 9 Optional D5286 Removable unilateral partial denture - one piece resin (including $150.00 D6611 Retainer onlay - cast high noble metal, three or more surfaces 5, 9 Optional retentive/clasping materials, rests, and teeth) - per quadrant D6612 Retainer onlay - cast predominantly base metal, two surfaces 5, 9 Optional D5410 Adjust complete denture - maxillary 4 $20.00 D6613 Retainer onlay - cast predominantly base metal, three or more Optional 5, 9 D5411 Adjust complete denture - mandibular 4 $20.00 surfaces D6614 Retainer onlay - cast noble metal, two surfaces 5, 9 Optional D5421 Adjust partial denture - maxillary 4 $20.00 D6615 Retainer onlay - cast noble metal, three or more surfaces 5, 9 Optional D5422 Adjust partial denture - mandibular 4 $20.00 D6720 Retainer crown - resin with high noble metal 2, 6, 9 $180.00 D5511 Repair broken complete denture base, mandibular $45.00 D6721 Retainer crown - resin with predominantly base metal 6, 9 $180.00 D5512 Repair broken complete denture base, maxillary $45.00 D6722 Retainer crown - resin with noble metal 6, 9 $180.00 D5520 Replace missing or broken teeth - complete denture (each tooth) $15.00 D6740 Retainer crown - porcelain/ceramic 5, 9 Optional D5611 Repair resin partial denture base, mandibular $40.00 D6750 Retainer crown - porcelain fused to high noble metal 2, 6, 9 $275.00 D5612 Repair resin partial denture base, maxillary $40.00 D6751 Retainer crown - porcelain fused to predominantly base metal 6, 9 $275.00 D5621 Repair cast partial framework, mandibular $60.00 D6752 Retainer crown - porcelain fused to noble metal 6, 9 $275.00 D5622 Repair cast partial framework, maxillary $60.00 D6753 Retainer crown - porcelain fused to titanium and titanium alloys $275.00 D5630 Repair or replace broken retentive/clasping materials - per tooth $20.00 D6780 Retainer crown - 3/4 cast high noble metal 2, 9 $240.00 D5640 Replace broken teeth - per tooth $15.00 D6781 Retainer crown - 3/4 cast predominantly base metal 9 $240.00 D5650 Add tooth to existing partial denture $15.00 D6782 Retainer crown - 3/4 cast noble metal 9 $240.00 D5660 Add clasp to existing partial denture - per tooth $20.00 D6784 Retainer crown 3/4 - titanium and titanium alloys $240.00 D5710 Rebase complete maxillary denture 13 $150.00 D6790 Retainer crown - full cast high noble metal 2, 9 $240.00 D5711 Rebase complete mandibular denture 13 $150.00 D6791 Retainer crown - full cast predominantly base metal 9 $240.00 D5720 Rebase maxillary partial denture 13 $150.00 D6792 Retainer crown - full cast noble metal 9 $240.00 D5721 Rebase mandibular partial denture 13 $150.00 D6930 Re-cement or re-bond fixed partial denture $45.00 D5730 Reline complete maxillary denture (chairside) 13 $40.00 D6940 Stress breaker 9 $60.00 D5731 Reline complete mandibular denture (chairside) 13 $40.00 D6980 Fixed partial denture repair necessitated by restorative material $45.00 D5740 Reline maxillary partial denture (chairside) 13 $40.00 failure D5741 Reline mandibular partial denture (chairside) 13 $40.00 D7000-D7999 Oral and Maxillofacial Surgery D5750 Reline complete maxillary denture (laboratory) 13 $150.00 {Includes preoperative and postoperative evaluations and treatment under a local D5751 Reline complete mandibular denture (laboratory) 13 $150.00 anesthetic.} D5760 Reline maxillary partial denture (laboratory) 13 $150.00 D7111 Extraction, coronal remnants - primary tooth $35.00 D5761 Reline mandibular partial denture (laboratory) 13 $150.00 D7140 Extraction, erupted tooth or exposed root (elevation and/or $35.00 forceps removal) D5820 Interim partial denture (including retentive/clasping materials, $180.00 rests, and teeth), maxillary - limited to initial placement of interim D7210 Extraction, erupted tooth requiring removal of bone and/or $45.00 partial denture /stayplate to replace extracted anterior teeth sectioning of tooth, and including elevation of mucoperiosteal during healing 4 flap if indicated D5821 Interim partial denture (including retentive/claspingmaterials, $180.00 D7220 Removal of impacted tooth - soft tissue $75.00 rests, and teeth), mandibular - limited to initial placement of D7230 Removal of impacted tooth - partially bony $100.00 interim partial denture /stayplate to replace extracted anterior D7240 Removal of impacted tooth - completely bony $150.00 teeth during healing 4 D5850 Tissue conditioning, maxillary 4, 13 $30.00 D7241 Removal of impacted tooth - completely bony, with unusual $150.00 surgical complications D5851 Tissue conditioning, mandibular 4, 13 $30.00 D7250 Removal of residual tooth roots (cutting procedure) $100.00

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Code Description Enrollee pays FOOTNOTES 1 Listed Copayment covers up to 24 months of active orthodontic treatment D7251 Coronectomy - intentional partial tooth removal $150.00 excluding the services listed for D8999 (Start-up fee). Beyond 24 months of active D7286 Incisional biopsy of oral tissue - soft - does not include $10.00 treatment, an additional monthly fee of $75.00 applies. histopathologic examination or other pathology laboratory 2 Base or noble metal is the benefit. High noble metal (precious), if used, will be procedures charged to the Enrollee at the additional maximum cost to the Enrollee of $100.00 D7310 Alveoloplasty in conjunction with extractions - four or more $50.00 per tooth. If an indirectly fabricated post and core is made of high noble metal, teeth or tooth spaces, per quadrant an additional fee up to $100.00 per tooth will be charged for the upgrade. This D7311 Alveoloplasty in conjunction with extractions - one to three teeth $50.00 charge also applies to a titanium crown. or tooth spaces, per quadrant 3 A Benefit for permanent teeth only. D7320 Alveoloplasty not in conjunction with extractions - four or more $75.00 4 Includes after delivery adjustments and tissue conditioning, if needed, for the first teeth or tooth spaces, per quadrant six months after placement, if the Enrollee continues to be eligible and the service D7321 Alveoloplasty not in conjunction with extractions - one to three $75.00 teeth or tooth spaces, per quadrant is provided at the Contract Dentist’s facility where the denture was originally D7471 Removal of lateral exostosis (maxilla or mandible) - per site $50.00 delivered. 5 Optional is defined as any alternative procedure presented by the Contract D7510 Incision and drainage of abscess - intraoral soft tissue $50.00 Dentist that satisfies the same dental need as a covered procedure, is chosen D7922 Placement of intra-socket biological dressing to aid in No Cost by the Enrollee, and is subject to the Limitations and Exclusions of the program. hemostasis or clot stabilization, per site The applicable charge to the Enrollee is the difference between the Contract D7961 Buccal/labial frenectomy (frenulectomy) $25.00 Dentist’s “filed fee” for the Optional procedure and the “filed fee” for the covered D7962 Lingual frenectomy (frenulectomy) $25.00 procedure, plus any applicable Copayment. “Filed fees” means the Contract Dentist’s fees on file with Delta Dental. Questions regarding the DHMO program should be directed to Delta Dental’s Customer Service department at 800-422- D9000-D9999 Adjunctive General Services 4234. Unclassified treatment 6 Porcelain and other tooth-colored materials on molars are considered a material D9110 Palliative (emergency) treatment of dental pain - minor $35.00 upgrade with a maximum additional charge to the Enrollee of $150.00. procedure 7 Includes adjustments and/or office visits up to4 2 months. After 24 months, a D9211 Regional block anesthesia No Cost monthly fee of $75.00 applies. D9212 Trigeminal division block anesthesia No Cost 8 Replacement is subject to a limitation requiring the existing denture to be 5+ years D9215 Local anesthesia in conjunction with operative or surgical No Cost old. procedures 9 Replacement is subject to a limitation requiring the existing bridge to be 5+ years D9219 Evaluation for moderate sedation, deep sedation or general No Cost old. anesthesia 10 In the event comprehensive orthodontic treatment is not required or is declined D9310 Consultation - diagnostic service provided by dentist or No Cost physician other than requesting dentist or physician by the Enrollee, a fee of $25.00 will apply. The Enrollee is also responsible for any D9311 Consultation with a medical health care professional No Cost incurred orthodontic diagnostic record fees. 11 Replacement is subject to a limitation requiring the existing restoration to be 5+ D9430 Office visit for observation (during regularly scheduled hours)- No Cost years old. no other services performed D9440 Office visit - after regularly scheduled hours $50.00 12 An amalgam is the Benefit. 13 Limited to 1 per denture during any 12 consecutive months. D9932 Cleaning and inspection of removable complete denture, No Cost maxillary D9933 Cleaning and inspection of removable complete denture, No Cost mandibular D9934 Cleaning and inspection of removable partial denture, maxillary No Cost Comprehensive orthodontic treatment of the adult dentition - $1,800.00 adults, including dependent adult children age 19 and older 1 D9935 Cleaning and inspection of removable partial denture, No Cost mandibular D9990 Certified translation or sign-language services - per visit No Cost D9991 Dental case management - addressing appointment compliance No Cost barriers D9992 Dental case management - care coordination No Cost D9995 Teledentistry - synchronous; real-time encounter No Cost D9996 Teledentistry - asynchronous; information stored and forwarded No Cost to dentist for subsequent review D9997 Dental case management - Patients with special Health Care No Cost Needs

20 DeltaCare® USA

Schedule B 11. If a porcelain margin is also chosen by the Enrollee for a Limitation of benefits covered porcelain-fused-to-metal crown, the maximum additional cost for this laboratory upgrade is $75.00. 1. Full mouth x-rays are limited to one set every 24 consecutive months and include any combination of 12. The replacement of an existing inlay, onlay, crown, fixed periapicals, bitewings and/or panoramic film. partial denture (bridge) or a removable full or partial denture is covered when: 2. Bitewing x-rays are limited to not more than one series of four films in any six month period. a. The existing restoration/bridge/denture is no longer functional and cannot be made functional by repair 3. Diagnostic casts are limited to aid in diagnosis by the or adjustment, and Contract Dentist for covered benefits. b. Either of the following: - The existing non-functional restoration/bridge/ 4. If a biopsy is preauthorized by Delta Dental for an denture was placed five or more years prior to its oral surgeon, then examination of the resulting biopsy replacement, or specimen is covered under codes D0472, D0473 or - If an existing partial denture is less than five years D0474 and available at no additional cost. old, but must be replaced by a new partial denture 5. Prophylaxis or periodontal maintenance is limited to due to the loss of a natural tooth, which cannot be two procedures each 12 month period. replaced by adding another tooth to the existing partial denture. 6. Benefits for sealants include the application of sealants 13. A direct or indirect pulp cap is a benefit only on a vital only to permanent first and second molars with no permanent tooth with an open apex or a vital primary decay, with no restorations and with the occlusal tooth. surface intact, for first molars and second molars through age 15. Benefits for sealants do not include the 14. With the exception of pulp caps and pulpotomies, repair or replacement of a sealant on any tooth within endodontic procedures (e.g. root canal therapy, three years of its application. apicoectomy, retrofill, etc.) are only a benefit on a permanent tooth. 7. A filling is a benefit for the removal of decay, for minor repairs of tooth structure or to replace a lost filling. 15. A therapeutic pulpotomy on a permanent tooth is limited to palliative treatment when the Contract 8. A crown is a benefit when there is insufficient tooth Dentist is not performing root canal therapy. structure to support a filling or to replace an existing crown that is non-functional or non-restorable and 16. Periodontal scaling and root planing are limited to five meets the five year limitation (see Limitation #12). quadrants during any 12 month period.

9. A covered metallic inlay, onlay, crown or fixed partial 17. Full mouth debridement (gross scale) is limited to one denture (bridge) using base or noble metal is available treatment in any 12 month period. for listed Copayment(s). If the Enrollee elects to have high noble metal used instead, the maximum additional 18. The benefit for the replacement of a missing posterior cost of this material upgrade is $100.00 per tooth or tooth (or teeth) is a removable partial denture. pontic. For an indirectly fabricated post and core, the Coverage for the placement of a fixed partial denture benefit is for base or noble metal. If the Enrollee elects (bridge) is optional except in the following cases: to have a high noble metal indirectly fabricated post - The sole tooth to be replaced in the arch is a and core instead, the maximum additional cost of this permanent anterior tooth, provided it is not in material upgrade is $100.00 per tooth. connection with a partial denture on the same arch; or 10. For molars, a covered crown or unit of a fixed partial - The new bridge would replace an existing, non- denture (bridge) is a full cast metal restoration without functional bridge utilizing the same abutment porcelain or other tooth-colored material. If the Enrollee teeth, with no additional abutments or pontics with elects to have porcelain, porcelain-fused-to-metal, the exception of posterior cantilever bridges (see resin or resin-with-metal used instead, the maximum Limitation #12); or additional cost for this tooth-colored material upgrade - The abutment teeth are not being crowned is $150.00 per molar. solely for the purpose of supporting a pontic (each abutment tooth to be crowned must meet Limitation #8).

21 DeltaCare® USA

19. Relines, tissue conditioning and rebases are limited to 27. An Optional procedure is defined as any alternative one per denture during any 12 consecutive months. procedure presented by the Contract Dentist that satisfies the same dental need as a covered 20. Interim partial dentures (stayplates), in conjunction with procedure, is chosen by the Enrollee, and is subject fixed or removable appliances, are limited to: to the limitations and exclusions of the program. The - The replacement of extracted anterior teeth for applicable charge to the Enrollee is the difference adults during a healing period when the teeth between the Contract Dentist’s “filed fees” for the cannot be added to an existing partial denture or Optional procedure and the “filed fees” for the covered - The replacement of permanent tooth/teeth for procedure, plus any applicable Copayment for the children under 16 years of age. covered procedure. Optional treatment does not 21. Retained primary teeth shall be covered as primary apply when alternative choices are benefits. Optional teeth. procedures include: - The use of a tooth-colored material when restoring 22. Excision of the frenum is a benefit only when it a posterior tooth with a filling, inlay or onlay; and results in limited mobility of the tongue, it causes a - Units in a fixed partial denture (bridge) made large diastema between teeth or it interferes with a of porcelain/ceramic, which is not fused to and prosthetic appliance. supported by underlying cast metal.

23. Benefits provided by a pediatric Dentist are limited to 28. Porcelain crowns, porcelain fused to metal or resin with children through age seven following an attempt by the metal type crowns are not a benefit for children under assigned Contract Dentist to treat the child and upon 16 years of age. An allowance will be made for a resin prior authorization by Delta Dental, less applicable crown. (See Limitation #27). Copayments. Exceptions for medical conditions, “Filed fees” means the Contract Dentist’s fees on file with regardless of age limitation, will be considered on an Delta Dental. Questions regarding these fees should be individual basis. directed to Delta Dental’s Customer Service department at 24. In cases of accidental injury, benefits available are 800-422-4234. described in Schedule B, Accident Injury Benefit. Exclusions of benefits Damages to the hard and soft tissues of the oral 1. Any procedure that is not specifically listed under cavity from normal masticatory (chewing) function, Schedule A, Description of Benefits and Copayments. exclusive attrition and normal wear, will be covered as described in Schedules A, Description of Benefits 2. Dental conditions arising out of and due to Enrollee’s and Copayments; and B, Limitations and Exclusions of employment for which Workers’ Compensation is paid. Benefits. Services which are provided to the Enrollee by state government or agency thereof, or are provided without 25. Benefits for a soft tissue management program are cost to the Enrollee by any municipality, county or limited to those parts, which are listed covered services other subdivision, except as provided in Section 1373(a) listed on Schedule A. If an Enrollee declines non- of the California Health and Safety Code. covered services within a soft tissue management program, it does not eliminate or alter other covered 3. All related fees for admission, use, or stays in a hospital, benefits. out-patient surgery center, extended care facility, or other similar care facility. 26. A new removable partial, complete or immediate denture includes after delivery adjustments and tissue 4. Loss or theft of full or partial dentures, space conditioning at no additional cost for the first six maintainers, crowns and fixed partial dentures months after placement if the Enrollee continues to (bridges). be eligible and the service is provided at the Contract Dentist’s facility where the denture was originally 5. Dental expenses incurred in connection with any dental delivered. procedures started after termination of eligibility for coverage.

6. Dental expenses incurred in connection with any dental procedure started before the Enrollee’s eligibility with the DHMO program. Examples include: teeth prepared for crowns, root canals in progress, orthodontics.

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7. Congenital malformations (e.g. congenitally missing 17. Precious metal for removable appliances, metallic or teeth, supernumerary teeth, enamel and dentinal permanent soft bases for complete dentures, porcelain dysplasias, etc.), except for the treatment of newborn denture teeth, precision abutments for removable children with congenital defects or birth abnormalities. partials or fixed partial dentures (overlays, implants, and appliances associated therewith) and personalization 8. Dispensing of drugs not normally utilized in the delivery and characterization of complete and partial dentures. of dental services. 18. Extraction of teeth, when teeth are asymptomatic/ 9. Any procedure that in the professional opinion of the non-pathologic (no signs or symptoms of pathology or Contract Dentist: infection), including but not limited to the removal of a. has poor prognosis for a successful result and third molars and orthodontic extractions. reasonable longevity based on the condition of the tooth or teeth and/or surrounding structures, or 19. Treatment or extraction of primary teeth when b. is inconsistent with generally accepted standards for exfoliation (normal shedding and loss) is imminent. dentistry. 20. Orthodontic treatment must be provided by a licensed 10. Dental services received from any dental facility dentist. Self-administered orthodontics are not covered. other than the assigned Contract Dentist including 21. The removal of fixed orthodontic appliances for reasons the services of a dental specialist, unless expressly other than completion of treatment is not a covered authorized in writing by Delta Dental or as cited under benefit. Emergency Services. To obtain written authorization, the Enrollee should call Delta Dental’s Customer Service Orthodontic limitations department at 800-422-4234. The DHMO program provides coverage for orthodontic treatment plans provided through Contract Orthodontists. 11. Consultations for non-covered benefits. The start-up fees and the cost to the Enrollee for the 12. Implant placement or removal, appliances placed on treatment plan are listed in Schedule A, Description of or services associated with implants, including but not Benefits and Copayments and subject to the following: limited to prophylaxis and periodontal treatment. 1. Orthodontic treatment must be provided by a Contract 13. Fixed partial dentures (bridges) for children under 16 Orthodontist. years of age. 2. Benefits cover 24 months of active comprehensive 14. Restorations placed solely due to cosmetics, abrasions, orthodontic treatment. Included is the initial attrition, erosion, restoring or altering vertical examination, diagnosis, consultation, initial banding, dimension, congenital or developmental malformation 24 months of active treatment, de-banding and the of teeth. retention phase of treatment. The retention phase includes the initial construction, placement and 15. Appliances or restorations necessary to increase vertical adjustment to retainers and office visits for a maximum dimension, replace or stabilize tooth structure loss by of two years. attrition, realignment of teeth, periodontal splinting, gnathologic recordings, equilibration or treatment of 3. Treatment plans extending beyond 24 months of active disturbances of the temporomandibular joint (TMJ). treatment, or 24 months of the retention phase of treatment will be subject to a monthly office visit fee to 16. An initial treatment plan which involves the removal the Enrollee not to exceed $75.00 per month. and reestablishment of the occlusal contacts of 10 or more teeth with crowns, onlays, fixed partial dentures 4. Should an Enrollee’s coverage be cancelled or (bridges), or any combination of these is considered to terminated for any reason, and at the time of be full mouth reconstruction under the DHMO program. cancellation or termination be receiving any orthodontic Crowns, onlays and fixed partial dentures associated treatment, the Enrollee and not Delta Dental will with such a treatment plan are not covered Benefits. be responsible for payment of any balance due for This exclusion does not eliminate the benefit for other treatment provided after cancellation or termination. covered services. In such a case the Enrollee’s payment shall be based on a maximum of $2,300.00 for covered dependent children to age 19 and $2,500.00 for covered adults and dependent adult children age 19 and older. The amount will be prorated over the number of months to

23 DeltaCare® USA

completion of the treatment and, will be payable by the 7. Surgical procedures related to cleft palate, micrognathia Enrollee on such terms and conditions as are arranged or macrognathia. between the Enrollee and the Contract Orthodontist. 8. Treatment related to temporomandibular joint 5. If treatment is not required or the Enrollee chooses not disturbances. to start treatment after the diagnosis and consultation have been completed by the Contract Orthodontist, the 9. Supplemental appliances not routinely used in typical Enrollee will be charged a consultation fee of $25.00 in comprehensive orthodontics. addition to diagnostic record fees. 10. Restorative work caused by orthodontic treatment. 6. Three recementations or replacements of a bracket/ 11. Phase I orthodontics, as well as activator appliances band on the same tooth or a total of five rebracketings/ and minor treatment for tooth guidance and/or arch rebandings on different teeth during the covered expansion. Phase I orthodontics is defined as early course of treatment are benefits. If any additional treatment including interceptive orthodontia prior to recementations or replacements of brackets/bands are the development of late mixed dentition. performed, the Enrollee is responsible for the cost at the Contract Orthodontist’s “filed fees.” 12. Extractions solely for the purpose of orthodontics.

7. Comprehensive orthodontic treatment (Phase II) 13. Transfer after banding has been initiated. consists of repositioning all or nearly all of the permanent teeth in an effort to make the Enrollee’s 14. Composite bands, lingual adaptation of orthodontic occlusion as ideal as possible. This treatment usually bands and other specialized or cosmetic alternatives to requires complete fixed appliances; however, when the standard fixed and removable orthodontic appliances. Contract Orthodontist deems it suitable, a European or Accident injury benefits removable appliance therapy may be substituted at the An accidental injury is damage to the hard and soft tissue same Copayment amounts as for fixed appliances. of the mouth caused directly and independently of all 8. Orthodontic treatment in progress is limited to new other causes by external forces. Damage to the hard and DHMO Enrollees who, at the time of their original soft tissue of the mouth from normal chewing function effective date, are in active treatment started under is covered under Schedule A, Description of Benefits and their previous employer sponsored dental plan, as Copayments. long as they continue to be eligible under the DHMO Delta Dental will pay up to 100 percent of the Contract Program. Active treatment means tooth movement has Dentist’s “filed fees,” for expenses an Enrollee incurs for an begun. Enrollees are responsible for all Copayments accident injury, less any applicable Copayment(s), up to a and fees subject to the provisions of their prior dental Maximum of $1,600.00 in any 12 month period. plan. Delta Dental is financially responsible only for amounts unpaid by the prior dental plan for qualifying Accident injury benefits include the following procedure orthodontic cases. in addition to those listed in Schedule A, Description of Orthodontic exclusions Benefits and Copayments. 1. Pre-, mid- and post-treatment records which include CODE cephalometric x-rays, tracings, photographs and study models. D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth and/or alveolus - 2. Lost, stolen or broken orthodontic appliances. includes splinting and/or stabilization.

3. Retreatment of orthodontic cases. Payment of accident injury benefits is subject to Schedule B, Limitations and Exclusions of Benefits, in addition to the 4. Changes in treatment necessitated by accident of any following provisions: kind, and/or lack of Enrollee cooperation. MAXIMUM 5. Surgical procedures incidental to orthodontic treatment. Accident injury benefits will be provided for each Enrollee up to a maximum of $1,600.00 in any 12 month period. 6. Myofunctional therapy.

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LIMITATION

Accident injury benefits are limited to services provided as a result of an accident which occurred (a) while the Enrollee was covered under the DHMO program, or (b) while the Enrollee was covered under another DHMO program, and if the benefits for the expenses incurred would have been paid if the Enrollee had remained covered under that program.

EXCLUSIONS

In addition to Schedule B, limitations #13, #15, #20, #21, #24 and #28 and exclusions #1-9, #11-15, #18 and #19, the following exclusions apply:

1. Prophylaxis.

2. Extra-oral grafts (grafting of tissues from outside the mouth to oral tissue).

3. Replacement of existing restorations due to decay.

4. Orthodontic services (treatment of malalignment of teeth and/or jaws).

5. Replacement of existing restorations, crowns, bridges, dentures and other dental or orthodontic appliances damaged by accident injury.

“Filed fees” means the Contract Dentist’s fees on file with Delta Dental. Questions regarding these fees should be directed to Delta Dental’s Customer Service department at 800-422-4234.

25 DeltaCare® USA

Notes

26 DeltaCare® USA

Enrollment form

Delta Dental of California c/o Delta Dental Insurance Company P.O. Box 660138 Dallas, TX 75266‑0138

Kaiser Permanente Federal Member dental program enrollment

DeltaCare USA This is a dental HMO program. You and your family must receive all treatment from the DeltaCare USA dental office you select. Please indicate the number of the DeltaCare USA office you have chosen: # If you do not select an office, we will select one for you.

Please print

Full name Social security number or 10‑digit Kaiser Permanente medical record number Mailing address City, state, zip Phone number Male Female Date of birth Marital status: Single Married

Rates for calendar year 2021

Type Monthly Quarterly automatic deduction payment by check 1 person $14.26 $42.77 2 persons $23.87 $71.60 3 or more persons $36.18 $108.53

Type of enrollment: 1 person 2 persons Three or more persons Please list eligible dependents to be covered in addition to yourself: Spouse Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth Child Male Female Date of birth

27 DeltaCare® USA

Payment

Payment option: Monthly (automatic) Quarterly (payment by check)

Automatic Payment Authorization I (we) hereby authorize Delta Dental to charge the applicable monthly dues for dental coverage to my account designated below. I understand that coverage will only become and remain effective if there are sufficient funds at the time of the deduction. I understand eligibility begins the first of the month following my initial deduction. This authority to deduct funds from my account is to remain in full force and effect until I notify Delta Dental in writing 30 Days prior to termination. I also understand there cannot be any lapse of coverage in a 12‑month period from the time of my enrollment. I agree to comply with the terms as outlined in the Combined Policy and Disclosure Form. (My bank is authorized to make corrections if any should be necessary.)

Banking information: Checking account Savings account (Please enclose a voided check or preprinted deposit slip from the account checked.) Routing transit number (RTN) (The first two numbers of the RTN must be 01 through 12 or 21) Account number (Verify this number with your bank) Bank or savings and loan name Branch name City, state, zip Branch phone number

Signature of enrollee Date

Signature of spouse Date

In accordance with the disclosure requirements of California Health & Safety Code Section 1363(h), this is to advise you that Delta Dental of California’s ratio of health care expense to premiums received for the last calendar year, with respect to the DeltaCare USA Individual Program, was [70.6]%. Note: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information may be guilty of a felony of the third degree.

James Smith 00-0000/0000 123 122 Main St. Anyplace, NY 10000 Date

Attach PAY TO THE ORDER OF $ voided check DOLLARS or ANYPLACE BANK deposit Anyplace, NY 10000 slip here For . ı: 12000000 5 ı: 123456789 0 || 12 3

Routing transit Account number number

(rev. 08/16)

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DeltaCare USA Participating Dental Offices/ Consultorios dentales de la red DeltaCare USA — California

Please indicate the number of the office you have selected on the dental setting, Delta Dental will arrange for professional services through DeltaCare USA enrollment form. a certified interpretation vendor at no cost to the enrollee. Additional dental offices will be added as required. If any office is closed Atención en otros idiomas: Las habilidades en idiomas son informadas to further enrollment, Delta Dental reserves the right to assign you por las instalaciones dentales individuales y no son verificadas another dental office as close to your home as possible. All members of independientemente por Delta Dental. Si un afiliado requiere ayuda en your family must be treated at the same facility. otro idioma para poder comunicarse durante la cita dental, Delta Dental Language assistance: Language capabilities are self‑reported by the coordinará los servicios profesionales mediante un proveedor certificado individual dental facilities and not independently verified by Delta Dental. de interpretación sin costo para el afiliado. If an enrollee requires language assistance to enable communication in a

Code Language Code Language Code Language Code Language Code Language Code Language AF Afrikaans CL Creole GR Greek IN Indonesian 14 Mien SM Samoan AM Armenian HR Croatian HE Hebrew IT Italian PE Persian SP Spanish/Español AR Arabic CS Czech HI Hindi JA Japanese PL Polish TA Tagalog KM Cambodian EI East Indian 4 Hmong KO Korean PT Portuguese TH Thai CA Cantonese FR French HU Hungarian LO Lao RO Romanian TR Turkish CH Chinese GE German 13 Ilacano 12 Mandarin RU Russian VI Vietnamese

Code Description Code Description FT Number of full‑time dentists PT Number of part‑time dentists

Code Description WH Indicates functional accessibility for individuals with limited mobility. Information regarding dental office accessibility for patients with mobility impairments is available by calling Customer Care at 800‑422‑4234.

Please call 800‑422‑4234 for updates to this list or check the DeltaCare USA Network online Dentist Directory at: deltadentalins.com.

Northern California Antelope #008248  #060735  offices (open) #016236  Salam Ghannam DDS Smile Time Dental Walegra Dental Group 2225 Buchanan Rd Ste A, 94509 500 Auburn Folsom Rd Ste 8008 Walerga Rd Ste 100, 925-779-1112 330B, 95603 (SP) 916-984-4224 Alameda 95843 916-725-4530 #055237  #022462  Belmont Alameda Landing Dentistry (HI SP) Samuel S Leung DDS #061179  Dental Group 5117 Lone Tree Way, 94531 Belmont Plaza Dental Care 2660 5th St Ste C, 94501 Antioch 925-777-9898 390 El Camino Real Ste D, 510-384-4000 #049760 (CA 12) 94002 (SP) Bay View Dental 2225 Buchanan Rd Ste G, 94509 650-631-2893 #036321  925-237-3738 (SP RU) #042191  Western Dental Services Bright Now! Dental-Alameda (SP TA) 2590 Sycamore Dr, 94509 #045495 2140 S Shore Ctr, 94501 925-776-1140 Maria Lourdes Yeo DDS 510-214-0253 #052413  (SP) 2130 Ralston Ave Ste 1D, 94002 (SP) Bright Now! Dental 5867 Lone Tree Way Ste F, 650-591-4704 #041082  94531 Alamo Western Dental Services 925-732-4628 Berkeley #048222  4518 Lone Tree Way, 94531 (HI SP TA) #035983  Alamo Smiles Dental Group 925-529-8300 Berkeley Dental 3000 Danville Blvd Ste A, 94507 (SP)  909 University Ave, 94710 925-820-2688 #135501 Crossings Dental Care 510-665-6058 Auburn (KM CH HI) Albany 3379 Deer Valley Rd, 94531 925-706-0775 #062004  #164401 (SP TA) Modern Dentistry Of Auburn #028055  Shadan Jabali DDS 185 Palm Ave, 95603 Berkeley Hills Dental Group 1113 Garfield Ave, 94706 #019985  530-885-6559 2320 Woolsey St Ste 312, 94705 510-525-6100 East Bay Dental 510-848-8624 (SP) 5157 Lone Tree Way, 94531 #029835  925-777-1719 Sierra Smiles Dental Group #037063  (SP) 2503 Bell Rd, 95603 Refresh Dental 530-823-3803 3031 Telegraph Ave Ste 136, (SP) 94705 510-845-2240 (CA 12 SP)

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#036288 #064437  #011118  #058899  Western Dental Services Star Dental Practice Citrus Dental Group Galvan Dental Corporation 115 Berkeley Sq, 94704 2447 Mission Ave Ste B, 95608 5925 Birdcage Centre Ln Ste 4375 Clayton Rd Ste D, 94521 510-540-8400 916-333-1875 D105, 95610 925-676-6363 (SP) (AR HI SP) 916-246-1502 (SP TA) (SP) Brentwood #063244 #062463  #041585  Western Dental Services Inc #137501  Golden State Smiles Brentwood Smiles Dental Group 7141 Fair Oaks Blvd, 95608 Citrus Heights Dental Office 1851 Sutter St, 94520 6660 Lone Tree Way Ste 7, 94513 916-488-9700 6994 Sunrise Blvd, 95610 925-827-2798 925-513-8363 916-723-8900 (HI SP) Castro Valley (HU RO RU SP) #010383 #064291  Lester Yamashita DDS #055082  Bright Now! Dental-Castro Valley #378601  2969 Salvio St, 94519 Lone Tree Dental Group 20923 Redwood Rd Ste C, Madison Square Dental Care 925-685-5296 5421 Lone Tree Way Ste 110, 94546 6024 San Juan Ave Ste C, 95610 (JA SP) 94513 510-550-5056 916-728-2888 925-605-9393 (CA 12 TA VI) #036323  (SP) #046614  Western Dental Services Castro Valley Smiles Dentistry #062418  1821 Concord Ave, 94520 #013865  3779 E Castro Valley Blvd, 94552 Smile Time Dental 925-825-8900 Valora Legaspi DDS 510-581-0500 6406 Sunrise Blvd Ste C, 95610 (SP) 2400 Balfour Rd Ste 301, 94513 (HI KO SP) 916-984-4224 925-240-5808 (CA SP TA VI) #030033  (CH VI) Chico Willow Pass Dental Care 1255 Willow Pass Rd, 94520 #039473  Clovis 925-680-4444 Calistoga Ampla Health #064217 (SP VI) #035102  236 W East Ave Ste H, 95926 Aspen Dental Sister Ann Dental Clinic 530-342-6065 1315 Shaw Ave Ste 102, 93612 911 Washington St, 94515 559-321-0886 Corcoran 707-709-2300 #041931  #063109  (SP) Chico Dental Group #023187  United Health Centers Of The 955 East Ave, 95926 Bright Now! Dental San Joaquin Valley Cameron Park 530-893-5334 1420 Shaw Ave Ste 101, 93611 1209 Whitley Ave, 93212 559-299-9008 559-992-5020 #053964  (SP TA) (4 SP) (SP) Country Club Dental 3222 Royal Dr Ste A, 95682 #064433  #051123  530-677-4457 Chico Modern Dentistry Cupertino Clovis Crossing Dental Group (SP) 241 W East Ave Ste 1, 95926 #026176 530-332-8972 1095 Herndon Ave Ste 102, I Pro Dental Campbell 93612 19705 Stevens Creek Blvd, 95014 #007289  559-326-5272 408-996-7987 #040128  Lakeview Dental Office (12 SP) Brite Dental 2571 California Park Dr Ste 120, #146501  281 E Hamilton Ave Ste 2, 95008 95928 Clovis Gentle Dental Daly City 408-871-9734 3151 Willow Ave, 93612 530-345-6888 #026261  559-299-9556 (12) Bella Lim DDS #061579  (SP VI) Signature Dental Practice 7455 El Camino Real Ste C, #005531  2505 S Bascom Ave, 95008 94014 Smile Makers #062514  408-377-8910 650-994-4561 2647 Forest Ave, 95928 Golden Valley Smiles (SP) (SP TA) 530-879-1888 1010 Shaw Ave Ste B, 93612 559-323-1776 Carmichael (CA 12 TA) #045497  Maria Lourdes Yeo DDS #030583  #054707  #036359  2055 Gellert Blvd Ste 4, 94015 Angel E Soto DDS Inc Ocean Dental Group Western Dental Services 650-754-1300 6227 Fair Oaks Blvd, 95608 1330 Shaw Ave Ste 103, 93612 2471 Cohasset Rd Ste 170, 95926 (TA) 916-979-7122 530-894-9040 559-325-6161 (SP) (SP) #136201  #036316  Mouhannad Al-Majdalani DDS #058923  Western Dental Services #063325 320 Washington St Apt 105, Fonda Webber DDS Inc 751 W Shaw Ave, 93612 Western Dental Services Inc 94015 8329 Fair Oaks Blvd Ste D, 559-323-5500 1010 Mangrove Ave Ste AB, 650-994-1111 95608 95926 (SP) 916-571-2781 530-342-7500 #142601  (RU) Concord Rodolfo Villasin DMD Chowchilla #022752  341 Westlake Ctr Ste 237, 94015 #043852  #039526  Concord Dental Arts 650-756-6211 Modern Dental Health n M Camarena Health Center 2222 East St Ste 270, 94520 (TA) 5723 Marconi Ave Ste A, 95608 300 Prosperity Blvd Bldg B, 925-689-3500 916-489-9990 93610 (SP) #062695  (FR HI RU SP) 559-664-4000 Serramonte Ridge Dental (SP) #050448  901 Campus Dr Ste 304, 94015 #016770  Downtown Concord Dental 650-756-1900 Sacramento Dental Group Citrus Heights 2151 Salvio St Ste A1, 94520 (SP TA) 6611 Coyle Ave, 95608 925-566-8738 #041173  916-965-6250 (SP) (AM RO RU) Aura Dental Care 6024 San Juan Ave Ste A, 95610 916-729-5849 (RU)

30 DeltaCare® USA

Danville El Cerrito Elk Grove #043019  #065001  #029882  #016238  Liberty Family Dental Chris M Vitakes DDS Art Dental Alpha Dental 9401 E Stockton Blvd Ste 215, 909 San Ramon Valley Blvd Ste 10586 San Pablo Ave, 94530 9045 Bruceville Rd Ste 170, 95624 218, 94526 510-559-8598 95758 916-686-9627 925-553-7761 (SP VI) 916-683-9080 (CH) (GR SP) (RU VI) #064284  #064185  #062029  Bright Now! Dental-El Cerrito #038827  Luc Dental Care Galvan Dental Care 11430 San Pablo Ave Ste 200, Case Dental Group 8101 Laguna Blvd Ste 2, 95758 917 San Ramon Valley Blvd Ste 94530 9381 E Stockton Blvd Ste 116, 916-684-1922 290, 94526 510-253-0049 95624 925-837-9172 916-683-2000 #058599  (TA 12 SP) #061473  (CH PE SP TA) Ora Dentistry Dentists Of El Cerrito Plaza 2733 Elk Grove Blvd Ste 180, #052988  Dental #017469  95758 Ivory Smiles 170 El Cerrito Plz, 94530 Cozy Dental 916-975-1000 185 Front St Ste 105, 94526 925-294-0665 2370 Maritime Dr, 95758 (HI) 925-588-4444 (SP) 916-683-2272 (HI) (SP) #060194  #052788 Prestige Dental #043944  Lavassani Firoozeh #038208  8450 Elk Grove Blvd Ste 300, Kai Ming Cai DDS Inc 411 Kearney St, 94530 Design Dental 95758 4018 Blackhawk Plaza Cir, 94506 510-527-1742 5700 Whitelock Pkwy Ste 120, 916-478-0343 925-736-9860 (AR TA) 95757 (CA 12) 916-714-3344 #062417  #085001  (PT SP) Smile Time Dental #057823  Rodney Kim DDS 9184 E Stockton Blvd Ste B, Sycamore Valley Dental Group 11100 San Pablo Ave Ste 107, #022838  95624 103 Sycamore Valley Rd W, 94530 Elk Grove Dental Group 916-984-4224 94526 510-233-9022 9640 Bruceville Rd Ste 101, (CA TA VI) 925-362-1800 (SP VI) 95757 (AR HI SP TA) 916-686-9030 Fair Oaks #036291  (HI SP) #056770  Davis Western Dental Services Fair Oaks Quality Dental #048144  11299 San Pablo Ave Ste A, #025678  11622 Fair Oaks Blvd Ste 103, Davis Smiles Dentistry Dental 94530 Elk Grove Landing Family Dental 95628 Group 510-231-0147 8351 Elk Grove Blvd Ste 300, 916-903-7644 4515 Fermi Pl Ste 106, 95618 (SP) 95758 (SP) 530-750-1955 916-691-6997 (SP) El Dorado Hills (HI SP) #061791  #020322  Madison Oaks Dental #015572  Green Valley Dental Group & #055278  6600 Mercy Ct Ste 200, 95628 Twin Pines Dental Orthodontics Family Smile Center 916-966-6060 1109 Kennedy Pl Ste 4, 95616 2205 Francisco Dr Ste 150, 9381 E Stockton Blvd Ste 120, (HI RU) 530-753-9900 95762 95624 (GR SP) 916-934-0207 916-686-4212 #007282  (12 SP) (KO) River City Dental Group Dublin 8908 Madison Ave Ste A, 95628 #058597  916-536-5151 #050466  #064384 Fernandez Dental Office (SP) Fallon Dental Group Orchard Dental Care 9320 Elk Grove Blvd Ste 170, 3746 Fallon Rd, 94568 4962 Robert J Mathews Pkwy 95624 Fairfield 925-803-0100 Ste 200, 95762 916-714-5422 (HI) 916-542-7316 #056229  (SP VI) Community Health Clinic Ole #063465  #059903  470 Chadbourne Rd Ste A, #054675 Pannu Dental Group Smile Time Dental 94534 Grove Dental Group 7137 Dublin Blvd Ste A, 94568 3840 El Dorado Hills Blvd Ste 707-419-8988 9727 Elk Grv Florin Rd Ste 155, 925-828-6739 203B, 95762 95624 (CH HI SP TA) 916-984-4224 #021421  916-714-7771 Dr Richard Ramos DMD Inc Earlimart #056563  (SP) 3075 Travis Blvd, 94534 Town Center Dental 707-435-9004 #063123  4355 Town Center Blvd Ste 211, #063844 (SP TA) United Health Centers Of The 95762 Laguna Park Dentistry San Joaquin Valley 916-939-6777 4827 Laguna Park Dr Ste 1, #048576  476 E Washington Ave, 93219 (HI RU SP) 95758 Fairfield Dentists Dental Group 661-849-2781 916-376-7106 3332 N Texas St Ste C, 94533 (SP) #023580  (PE SP VI) 707-399-9082 (SP) East Palo Alto Younes Jonah Tabrizi DDS Dental Corp #044629  #035084  993 Governor Dr Ste 104, 95762 Laguna Star Family Dental #058727  Ravenswood Family Dentistry 916-941-1515 5105 Laguna Blvd Ste 4, 95758 Galvan Dental Corporation 1807 Bay Rd, 94303 (GE) 916-478-0222 1500 Oliver Rd Ste F, 94534 650-289-7700 (HI SP) 707-434-8777 (HI SP) (SP TA)

31 DeltaCare® USA

#137401  Fremont #021389  #055773  Julius Mosley II DDS #026181  Star Dental Geny Ana Reyes Chan DDS Inc 1261 Travis Blvd Ste 300, 94533 Advanced Smile Design 5021 Mowry Ave, 94538 3636 N 1st St Ste 126, 93726 707-421-2161 39560 Stevenson Pl Ste 117, 510-797-4900 559-243-1115 (CH SP VI) 94539 (HI SP) 510-797-8100 #062516  #038816  (HI TA) #046655  Golden Valley Smiles Marlon C Taasan DMD Western Dental Services Inc 2745 W Shaw Ave Ste 103, 93711 1545 N Texas St Ste 309, 94533 #028713  3055 Mowry Ave, 94538 559-227-2900 707-422-6651 American Dental Group 510-494-9010 (SP TA) 39624 Mission Blvd, 94539 (SP) #062517  510-573-4743 Golden Valley Smiles #060721  (CH) #061680  5657 E Kings Canyon Rd Ste 107, Smile Time Dental Western Dental Services Inc 93727 1955 W Texas St Ste 2B, 94533 #055350  36416 Fremont Blvd, 94536 559-454-7900 916-984-4224 Brookevale Family Dentistry 510-739-3889 39236 Argonaut Way, 94538 (SP) #056381  #062408  510-739-0701 Hossam El-Zuhery DDS Valle Smiles (SP TA) Fresno 5646 N Palm Ave Ste 101, 93704 1955 W Texas St Ste 12, 94533 #064808  559-431-6626 707-428-5400 #1C3701  Adeniyi Olayinka Akande DDS (AR) Dental Care Center 2841 Tulare St, 93721 #036317  39470 Fremont Blvd, 94538 559-222-2238 #054234  Western Dental Services 510-745-9222 Market Place Smiles Dentistry 2440 N Texas St, 94533 (American Sign Lanugage 12 #2C6601  Dental Group 707-422-4600 SP) Angels Family Dental 6623 N Riverside Dr Ste 101, (HI SP) 3664 W Shaw Ave, 93711 93722 #055079  559-277-5800 559-547-3120 #063322 Dr Meenu Giri Family Dentistry (AR SP) (SP) Western Dental Services Inc 37259 Fremont Blvd, 94536 1600 Travis Blvd, 94533 510-790-0700 #056905 #059942  707-429-4000 Bright Now! Dental Noel T Paredes DDS #025567  3244 W Shaw Ave Ste A, 93711 6167 N Fresno St Ste 103, 93710 Folsom Duc Nguyen DDS 559-490-0597 559-824-9524 #063019  39411 Fremont Blvd, 94538 (CH SP) (TA) BSC Dental Smiles 510-438-9201 2700 E Bidwell St Ste 300, (CH SP VI) #020942  #062203 95630 Bright Now! Dental Pearl Dentistry 916-299-9487 #044899  6680 N Blackstone Ave, 93710 1265 E Shaw Ave Ste 100, 93710 Fremont Dental Excellence 559-431-9111 559-224-0103 #040940  1895 Mowry Ave Ste 120, 94538 (SP) Folsom Hills Dentistry Dental 510-494-8181 #026525  Group (GE SP TA) Bullard Dental Group #014155  2465 Iron Point Rd Ste 120, 323 E Bullard Ave Ste 104, 93710 Sam Akande DDS 95630 #003718 559-439-9990 1902 E Ashlan Ave, 93726 916-984-9600 Fremont Hills Dental Office 559-228-3000 (SP) 698 Mowry Ave, 94536 #054240  (SP) 510-608-6097 Champlain Dentist Dental Group #050579  (TA) 1193 E Champlain Dr, 93720 #127101  Renaissance Family And 559-433-6427 Sami Youssef DDS Cosmetic Dentistry #038174  (SP VI) 4755 E Gettysburg Ave Ste 101, 2180 E Bidwell St Ste 100, 95630 Gentle Dental 93726 916-983-9800 39340 Fremont Blvd, 94538 #064360  559-292-4444 (HI) 510-651-7700 Downtown Dental (AR SP) (HI SP TA) 2948 Fresno St, 93721 #054465  559-264-0004 #183701  Smile Time Dental #228101  (SP) St George Quality Dental 2260 E Bidwell St Ste 110, 95630 Hillview Dental Group 1515 W Shaw Ave #101, 93711 916-984-4224 40739 Grimmer Blvd, 94538 #056329  559-227-1700 (RU SP TA) 510-651-1440 Erbe Palafox DDS Inc (AR AM RU SP) (KM PT SP) 4848 N 1st St Ste 106, 93726 #036292 559-227-6200 #056018  Western Dental Services #010706  Tower Dental Care 1016 Riley St Ste 1, 95630 Rosalie S Geronimo DMD Inc #052655  1215 N Del Mar Ave, 93728 916-984-4127 1956 Driscoll Rd, 94539 Fig Garden Dental Group 559-233-5625 510-440-1406 1008 West Shaw Ave Ste 105, (SP) Fowler (TA) 93711 #036320  #063135  559-227-0027 Western Dental Services United Health Centers Of The #033018  (SP) 1255 W Shields Ave, 93705 San Joaquin Valley Shine Dental 559-227-4000 106 E Main St, 93625 39055 Hastings St Ste 203, #142101  (SP) 559-834-3973 94538 First Family Dental (SP) 510-791-3144 6115 N 1st St Ste 102, 93710 (HI SP) 559-229-8200 #045242  (AR SP) Western Dental Services 1255 W Shields Ave, 93705 #056509  559-227-4000 Gentle Dental Fresno (HI) 5690 N Fresno St Ste 101, 93710 559-436-3470 (SP)

32 DeltaCare® USA

#036325  #036586  Kerman #063128  Western Dental Services Western Dental Services #063189  Foothill Dental Care 3077 W Shaw Ave, 93711 210 N 11th Ave Ste 101, 93230 United Health Centers Of The 1984 Railroad Ave Ste B, 94550 559-244-5501 559-585-2170 San Joaquin Valley 925-456-7800 (SP) 517 S Madera Ave, 93630 (SP TA) Hayward 559-846-6330 #036301  #041409  (SP TA) #043734  Western Dental Services Bright Now! Dental Livermore Smiles Dentistry 4195 E Shields Ave, 93726 20483 Hesperian Blvd, 94541 Kingsburg 4375 1st St, 94551 559-243-8960 925-294-9288 510-731-0124 #046249  (SP) (SP) (HI SP TA) H S Mann DDS Inc 1518 Draper St, 93631 #036319  #044239  #155001  559-897-4111 Western Dental Services Mint Dental Dental Solutions/Dr Shtulman (SP) 4901 E Kings Canyon Rd, 93727 19682 Hesperian Blvd Ste 101, 87 Fenton St Ste 105, 94550 559-456-1785 925-292-5231 94541 Lathrop (AR CH SP) 510-782-9942 (SP VI) #060184  (RU SP) #063218  Plume Dental #039163  15366 S Harlan Rd, 95330 Western Dental Services Inc #003967  Smile Line Dentistry 209-645-0032 5776 N Blackstone Ave Ste 104, Fairway Park Dental Office 1046 Murrieta Blvd, 94550 93710 31111 Mission Blvd, 94544 925-456-7600 Lemoore 559-650-1457 510-477-6887 (HI SP) (SP) (SP TA) #063122  United Health Centers Of The #057460  #024652 #040736  San Joaquin Valley Western Dental Center White & Bright Family Dental Gentle Dental Hayward 250 E Hanford Armona Rd, 2177 Las Positas Ct, 94551 6073 N Fresno St Ste 103, 93710 24239 Hesperian Blvd, 94545 93245 925-273-6000 559-432-6384 510-926-6460 559-997-6140 (SP) (TA VI SP) (SP) #042111  Lodi Woodward Dental Care #062416  Lincoln #064958  7475 N 1st St Ste 103, 93720 Golden State Smiles #062365  Bright Now! Dental-lodi 559-431-7645 22755 Foothill Blvd, 94541 Bella Vista Dental 2309 W Kettleman Ln Ste 104, (SP VI) 510-782-4161 825 Twelve Bridges Dr Ste 55, 95242 95648 209-371-6911 Galt #062026  916-543-4400 #048648  K3 Dental (HI SP) #062563  Galt Dental Group 1320 Apple Ave Ste 202, 94541 Dentists Of Lodi Dental Group 1067 C St Ste 125, 95632 510-888-9110 #023474  2610 Reynolds Ranch Pkwy Ste 209-744-0463 (HI SP) Citadel Dental 100, 95240 (KO SP VI) 941 Sterling Pkwy Ste 100, 95648 707-302-0805 #009022  916-408-8585 (SP) #027139  South Hayward Dental (GE TR) Sirak Workneh DDS 1689 Industrial Pkwy W, 94544 #062955  430 Pine St, 95632 510-264-9074 #015202  Lodi Family Dentistry 209-744-9917 (CA PT SP) Lincoln Hills Family Dental 525 S Fairmont Ave Ste F, 95240 (4 RU SP) 2295 Fieldstone Dr Ste 100, 209-369-1051 #039643  95648 (HI SP) Gilroy Western Dental Services 916-543-0222 #057456  123 W Jackson St, 94544 (HI SP) #037720  Accu Dental 510-887-5700 Modern Dental And Implants 6955 Camino Arroyo Ste 50, (SP) #016173  601 W Kettleman Ln, 95240 95020 Parkway Dental Group 209-366-1850 408-847-4938 Hercules 781 Sterling Pkwy, 95648 (SP) (FR HI PE SP) #046985  916-543-7880 A Noble Smile Los Altos #047040  500 Alfred Nobel Dr Ste 285, #056748  #0C0401  City Dental Center 94547 Smile Time Dental Samson Fu-Keung Lee DDS 7671 Monterey St Ste C, 95020 510-741-7041 731 Sterling Pkwy Ste 100B, 763 Altos Oaks Dr Ste 3, 94024 408-842-5000 (SP VI) 95648 650-948-6075 (SP) 916-984-4224 (CA 12 SP) Hollister (CA RU SP) #061846  #065072 Los Banos #056768  Gilroy Plaza Dental Aspen Dental #064733  Tooth Spa Dentistry 6974 Automall Pkwy, 95020 1210 East Park St Ste 106, 95023 Western Dental Services Inc 831 Sterling Pkwy Ste 130, 95648 408-847-4111 831-902-2829 1153 W Pacheco Blvd, 93635 916-209-3708 (HI SP) 209-383-2207 (TA VI) #064960  (SP) #053122  Bright Now! Dental - Hollister Livermore Western Dental Services 1760 Airline Hwy Ste K, 95023 Los Gatos 780 1st St, 95020 #044891  831-902-2810 #059614  408-337-3620 Alta Vista Dental Harsono Dental Corp (SP) 3183 Independence Dr, 94551 Huron 431 Monterey Ave Ste 6, 95030 925-292-1459 #063113  408-354-1717 (RU) Hanford United Health Centers Of The (IN) #036358  San Joaquin Valley Western Dental Services 16928 11th St, 93234 1560 Lacey Blvd #107, 93230 559-945-2541 559-589-6302 (SP)

33 DeltaCare® USA

#024894  Mendota #049583 #039645  Los Gatos Dental Care #063155  Afshin Bidgol DMD Western Dental Services 555 Knowles Dr Ste 112, 95032 United Health Centers Of The 2020 Coffee Rd Ste F3, 95355 2045 W Briggsmore Ave Ste E, 408-370-7733 San Joaquin Valley 209-526-0676 95350 (AR FR SP) 121 Barboza St, 93640 209-527-3000 559-655-5000 #064124 (PE SP) #047160  (SP) Aspen Dental One Smile Dental 3900 Sisk Rd Ste O, 95356 #063220  15075 Los Gatos Blvd Ste 100, Menlo Park 209-857-3910 Western Dental Services Inc 95032 1440 E Hatch Rd Ste 102, 95351 #012522  408-356-2049 #043358  209-531-2000 Joseph K Sarkosh DDS (HI SP TA) Coffee Dental Group (SP) 888 Oak Grove Ave Ste 6, 94025 1130 Coffee Rd Ste 1A, 95355 650-327-8081 Madera 209-523-5991 #046673 (SP) #055448  (KO SP) Western Dental Services Inc 1705 Prescott Rd, 95350 Idental Family Dentistry Merced 620 W Yosemite Ave, 93637 #046710  209-572-6045 #055242 559-673-7700 Gill Family Dentistry Dr Chang Family Dentistry 1518 Coffee Rd Ste B, 95355 #063219  2448 M St, 95340 #054667  209-549-1721 Western Dental Services Inc 209-383-0811 Sams Dental Office (HI SP) 2605 Coffee Rd Ste 200, 95355 (12 SP) 2413 W Cleveland Ave, 93637 209-521-0100 559-395-4808 #063060  (SP) #059501  (SP) Great Smiles Dental Merced Dental Group 3219 Mchenry Ave Ste E, 95350 #061682  1120 Olivewood Dr, 95348 #036342  209-409-8987 Western Dental Services Inc 209-325-4395 Western Dental Services (AR HI SP TA) 2900 Standiford Ave Ste 2, (SP) 1100 N Gateway Dr, 93637 95350 559-661-5120 #020517  209-577-5008 #036356  (SP) Modesto Dental (SP) Western Dental Services 2225 Plaza Pkwy Ste P1, 95350 1124 W Olive Ave, 95348 #050209  209-576-8181 Monterey 209-383-5000 Western Dental Services Inc (SP) #053668  (SP) 1100 N Gateway Dr, 93637 Monterey Dental Center 559-661-5120 #056239  656 Munras Ave, 93940 #063326 Modesto Modern Dentistry 831-920-2127 Western Dental Services Inc Manteca Dental Group (AR SP) 12 W 20th St, 95340 2103 Mchenry Ave Ste C, 95350 #065077 209-388-1000 209-435-9550 Ivory Dental Morgan Hill 1148 S Main St, 95337 #1C9301  Milpitas #062721  209-249-0123 Condit Dental #391301  Modesto Smiles Dentistry Dental (HI SP) 17020 Condit Rd Ste 180, 95037 Alexander Galang DDS Group 408-778-4548 830 Hillview Ct Ste 150, 95035 3601 Pelandale Ave Ste D1, #022750  (SP) 408-934-7676 95356 Stadium Dental Group 209-245-0014 2288 Daniels St, 95337 #017147  #049648  (SP) 209-456-5610 Morgan Hill Dental Care Milpitas Dental Practice (SP) 18455 Technology Dr, 95037 76 Ranch Dr Bldg C1, 95035 #037885  408-778-4838 408-935-8336 R Mesbah DDS #036831  (SP) (TA) 1101 Standiford Ave Ste D3, Western Dental Services 95350 1160 W Yosemite Ave, 95337 #020283  #065294  209-571-5429 209-624-5160 South Valley Dental Montague Hills Dentistry (SP) (SP) 15870 Monterey St, 95037 991 Montague Expy Ste 211, 408-778-6684 95035 #045056 #036347 (SP VI) 408-262-9999 Raymond Nepomuleno DDS Inc Western Dental Services 2020 Coffee Rd Ste B4, 95355 1332 E Yosemite Ave, 95336 Mountain View #019240  209-529-5886 209-823-0219 Nisha Dharmani DDS (SP) #352801  (SP) 430 E Calaveras Blvd, 95035 Ahmad Abdollahi DDS 285 South Dr Ste 2, 94040 Mariposa 408-263-9714 #060936  (SP) Suave Dental 650-988-0787 #062196  3025 Mchenry Ave Ste N, 95350 (SP TA) Mact Dental Mariposa #048832 209-527-3990 5192 Hospital Rd, 95338 Yoo J Kim (RU AR SP) #060508  209-966-0573 40 N Park Victoria Dr Ste D, Apple Dental (SP) 95035 #059508  1040 Grant Rd Ste 103, 94040 408-263-0371 Wellspring Dental Group 650-336-1313 Martinez (KO SP) 1801 Tully Rd Ste C1, 95350 #042527  209-526-3370 #018575  Alhambra Dental Group Modesto (KO SP) Palo Alto Dental Care 327 Moffett Blvd Ste A, 94043 4040 Alhambra Ave, 94553 #054210  650-858-2028 925-313-9700 Aesthetic Dental Designs #038597  (CA 12 SP VI) (AR CH SP TA) 1006 H St, 95354 Western Dental Services 209-338-3388 1720 Hatch Rd, 95351 #0C8401  #021489  (SP TA) 209-538-9550 Bright Now! Dental (SP) San Antonio Dental 1160 Arnold Dr Ste G, 94553 530 Showers Dr Ste 3, 94040 925-372-7100 650-917-8348 (SP) (CA 12 SP VI)

34 DeltaCare® USA

Napa North Highlands #177701  #055281  #061990  #062684  Timothy Han DDS Petaluma Valley Dental Alora Dentistry Highland Dental Group 320 13th St Ste 301, 94612 701 Sonoma Mountain Pkwy Ste 917 Trancas St, 94558 3901 Madison Ave Ste 5, 95660 510-839-2045 E1, 94954 707-226-5533 916-999-0183 (SP) 707-782-0789 (HI) (AR KO SP) (AR SP) #062677  #024881 Novato Uptown Dental Group #020354  1708 Franklin St Ste B, 94612 Surya Manga Achyuta DDS Childrens Mobil Dental Clinic #055009  510-465-7777 1372 N Mcdowell Blvd Ste B1, 3448 Villa Ln Ste 102, 94558 Marin Community Clinics (SP) 94954 707-251-2000 6090 Redwood Blvd Ste D, 707-778-9993 (SP) 94945 #036287  (HI SP) 415-448-1500 Western Dental Services #064254  (SP) Ez Smile Family Dental Group 1530 Broadway, 94612 Pinole 510-251-1000 1544 Jefferson St Ste A, 94559 #053682  #026081  (SP TA VI) 707-255-7711 Novato Smiles Dentistry Dental Bright Now! Dental (SP) 948 Diablo Ave, 94947 1477 Fitzgerald Dr Ste 106, #056412  415-897-8020 94564 Western Dental Services Inc #063179  (SP) 510-669-0350 Napa Valley Dental Group 3405 International Blvd, 94601 (HI SP TA) 510-469-2012 2119 Jefferson St, 94559 #064649  (SP) 707-257-2400 Union Dental #056471  (HI SP) Pinole Modern Dentistry Dental 5404 Nave Dr, 94949 Orange Cove 415-234-6261 Group #063676  (SP VI) #063120  1208 Fitzgerald Dr, 94564 Ole Health United Health Centers Of The 510-210-8907 300 Hartle Ct, 94559 Oakland San Joaquin Valley (SP) 707-254-1775 445 11th St, 93646 #017481  (SP) 559-626-4031 Pittsburg Bay Area Dental (SP TA) 3300 Webster St Ste 907, #011404  #017107  94609 Sky Dental Sister Ann Community Dental Palo Alto 510-350-8187 2230 Gladstone Dr Ste 100, 1141 Pear Tree Ln Ste 120, 94558 (RU) #063695  94565 707-258-6128 Lora Costa DDS Inc 925-432-2444 (SP) #017551 824 Bryant St, 94301 (SP TA) Bright Now! Dental 650-327-1787 #062464  8105 Edgewater Dr Ste 250, (RU SP TA VI) #036289  Smile Country Dental 94621 Western Dental Services 2016 Jefferson St, 94559 510-568-6272 Parlier 2120 Railroad Rd Ste 105, 94565 707-603-4955 #064359  925-439-4774 #055347  Parlier Dental Studio (SP) #014096  East Bay Family Dentistry 545 E Manning Ave Ste 108, Trancas Dental Group 3040 E 9th St Ste D, 94601 93648 Placerville 935 Trancas St Ste 4E, 94558 510-534-0706 559-646-3844 #014629 707-257-6277 (SP) Brookside Dental (12 RO SP TA) #055353 4330 Golden Center Dr Ste B, Elegant Smile Dental Center #063158  95667 #039925  3301 E 12th St Ste 165, 94601 United Health Centers Of The 530-622-1987 Western Dental Services 510-533-5500 San Joaquin Valley 1260 Trancas St, 94558 (SP) 650 S Zediker Ave, 93648 #053988  707-501-5101 559-646-3561 Missouri Flat Dental Group (SP) #057917 (SP) 3967 Missouri Flat Rd Ste 120, Franklin Dental Care 95667 Newark 1624 Franklin St Ste 1220, 94612 Petaluma 530-642-2876 #031197  510-893-4041 #052705  All Smile Dental Center (CA SP) Design Dental Smiles #060767  37070 Newark Blvd Ste E, 1456 Professional Dr Ste 401, Placerville Dentistry Group 94560 #043497  94954 699 Main St Ste B, 95667 510-790-8268 Oakland Smile Center 707-763-3203 530-295-8000 (CA 12) 300 Frank H Ogawa Plz Ste 100, (AR FR SP) 94612 Pleasant Hill #056424  510-893-1923 #065341 #065271  Kamini Patel DDS Inc (CH) Petaluma General Dentistry Perfect Smiles Dental Of 7200 Jarvis Ave, 94560 135 Keller St Ste F, 94952 Pleasant Hill 510-744-9744 #038288  707-778-6006 1952 Contra Costa Blvd, 94523 (HI) Oakland Smile Dental (RU SP) 925-825-9663 8105 Edgewater Dr Ste 124, #050190  94621 #049283  #037931  PBS A Dental Corporation 510-924-7310 Petaluma Modern Dentistry Pleasant Hill Smiles Dental Group 5910 Thornton Ave Ste B, 94560 (PE SP) 401 Kenilworth Dr Ste 960, 2380 Monument Blvd Ste F, 510-792-4525 94952 94523 (SP TA) #004653 707-789-9600 925-363-4455 Timothy Han DDS (RU SP) (SP) #039588  2710 Telegraph Ave Ste 250, Rosemont Family Dental Care 94612 #053909  35124 Newark Blvd, 94560 510-839-4106 Pleasant Hill Wellness Dental 510-796-3441 (SP) 30 Golf Club Rd Ste C, 94523 (PT SP TA) 925-685-8633 (KO SP)

35 DeltaCare® USA

#062811  #013771  Redwood City #057826  Richard Ramos DMD Inc. Tri Valley Dental #031550 Gentle Care Family Dentistry At 764 Grayson Rd Ste A, 94523 5820 Stoneridge Mall Rd Ste 118, Birch Dental Group Stanford Ranch 925-448-2345 94588 155 Birch St Ste 5, 94062 6741 Five Star Blvd Ste A, 95677 (TA) 925-225-1555 650-366-0552 916-435-2864 (KO SP) (SP) (TA) Pleasanton #2C5101  Porterville #012387  #056469  Alisal Dental Care #043191  Eugene Espiritu Gentle Dental North Rocklin 5933 Coronado Ln Ste 205, Neilesh Patel DDS Inc 705 Veterans Blvd Ste 1, 94063 5494 Crossing Dr Ste 103, 95677 94588 365 Pearson Dr Ste 2, 93257 650-298-8818 916-778-3539 925-846-6308 559-788-2532 (CA 12 SP TA) (SP) (CA VI) (SP) #059008  #021692  #042699  #057381  Randhawa Dental Practice Healthy Smiles Family Dentistry Bernal Dental Care Rene Herrera DDS Inc 570 El Camino Real Ste 130, 2160 Sunset Blvd Ste 503, 95765 3283 Bernal Ave Ste 108, 94566 141 E Putnam Ave, 93257 94063 916-771-0757 925-249-9242 559-781-2729 650-361-9880 (CA) (CH SP) (SP) (HI SP TA) #016849  #164201  #036350  #039731  Highland Dental Group Bernal Dental Group Western Dental Services Siva Cherukuri DDS 3291 Stanford Ranch Rd Ste 102, 4466 Black Ave Ste K, 94566 1213 W Henderson Ave, 93257 194 Arch St Ste B-c, 94062 95765 925-485-1172 559-306-3100 650-369-4616 916-435-1665 (HI SP TA) (SP) (HI SP TA VI) #059896 #055123  Portola #031062  Rocklin Dental Whispers 6011 Stanford Ranch Rd Ste 112, Eternal Dental Care #063711  United Dental 95765 1491 Cedarwood Ln Ste C, 94566 Portola Dental Clinic 647 Veterans Blvd, 94063 916-663-5675 925-202-2332 480 1st Ave, 96122 650-367-4300 (AR HI SP) 530-832-6602 (SP) #061196  (SP) Gokani Dental Corporation #036284 #054648  1024 Serpentine Ln Ste 114, Rancho Cordova Western Dental Services Rocklin Modern Dentistry 94566 5182 Commons Dr Ste 101, 95677 #047008  975 Veterans Blvd, 94063 925-462-1464 916-660-9487 Procare Dental 650-365-8900 (HI) (SP TA) 11050 Coloma Rd Ste 17, 95670 #054236  916-635-9800 #009032  Richmond Rocklin Modern Dentistry Dental (AR HI 4 SP) Group Leida P Stine DDS Inc #050866 1400 Santa Rita Rd Ste I, 94566 5182 Commons Dr Ste 101, 95677 #037990  Bay Dental 925-828-9993 916-660-9487 Rancho Cordova Dental Group 6200 Huntington Ave, 94804 (SP TA) 510-527-5300 10910 Olson Dr Ste 100, 95670 #041806  916-638-3780 (SP) #044444  Serenity Dental (SP) 6661 Stanford Ranch Rd Ste D, Mojab General & Specialist #057185  Dental 95677 #059892  Winning Smile Dental Group 1439 Cedarwood Ln Ste D, 916-630-1084 Rancho Cordova Smile Dentistry 12732 San Pablo Ave, 94805 94566 (JA) Dental Group 510-233-3100 925-484-1202 (KO SP) 4022 Sunrise Blvd Ste 160, #054456  95742 #044370 Smile Time Dental 916-246-1108 Riverbank Pattanayak Dental Corporation 2241 Sunset Blvd Ste E, 95765 #064283  1400 Santa Rita Rd Ste C, 94566 916-984-4224 #021048  Bright Now! Dental-Riverbank 925-485-9595 (RU SP) RC Dental Group 2441 Claribel Rd Ste A, 95367 (HI SP) 11180 Sun Center Dr, 95670 209-502-4555 Rohnert Park 916-368-0440 #043338  #025253 (AR RU SP KO) #063873  Pleasanton Ridge Dental Group Bright Now! Dental Riverbank Smiles Dental 6766 Bernal Ave Ste 560, 94566 5755 Redwood Dr Ste 200, #057833  2119 Patterson Rd Ste 9, 95367 925-461-3100 94928 Western Dental Services Inc 209-502-7770 (HI) 707-584-1000 10321 Folsom Blvd Ste A, 95670 (HI SP) (SP) 916-362-5201 #055774  #042877  Pleasanton Valley Dental Care #053921  Redding Suave Dental 5460 Sunol Blvd Ste 5, 94566 Rhonert Park Smiles Dentistry 3309 Sierra St, 95367 925-600-0065 #046993  6315 Commerce Blvd, 94928 209-872-3399 (SP) Western Dental Services Inc 707-584-7401 1350 Churn Creek Rd Ste F1, (AR RU SP) #062453  96003 Roseville 530-224-9700 Rocklin Sharda Patel DMD Inc #028281  #056520  1488 Cedarwood Ln Ste D, Aesthetic Dentistry #063328 Agape Dental 94566 8445 Sierra College Blvd Ste B, Western Dental Services Inc 5752 Lonetree Blvd, 95765 925-846-4491 95661 1667 Hilltop Dr Ste E, 96002 916-824-8711 (HI) 916-773-0505 530-223-5500 (TA) (AM RU) #057461  #046713  Sunflower Dental #060724  Destiny Dental Implant Center 1400 Santa Rita Rd Ste D, 94566 Apple Dental 6950 Destiny Dr, 95677 925-398-8403 9600 Fairway Dr Ste 150, 95678 916-672-6377 (HI) 916-788-8252 36 DeltaCare® USA

#054709  #024565  #054686  #242901  Aria Family Dental Pleasant Grove Dental Group Arden Modern Dentistry Dental Madison Dental Care 4014 Foothills Blvd Ste 103, 10357 Fairway Dr Ste 100, 95678 Group 5149 Madison Ave, 95841 95747 916-782-4500 2654 Marconi Ave Ste 100, 95821 916-338-3880 916-780-9990 (RU) 916-437-0157 (RU SP) #016569  #011889  #165601  Market West Dental Group #064820  Rocky Ridge Family Dental Brent Varshawsky DMD 3290 Arena Blvd Ste 610, 95834 August Dentistry 1700 Rocky Ridge Dr Ste 100, 1901 Watt Ave Ste 2, 95825 916-574-9400 1701 Santa Clara Dr Ste 100, 95661 916-483-5677 (SP) 95661 916-782-6001 916-670-1006 (RU SP) #023542  #058643  (TA) Bright Now! Dental Midtown Modern Dental Group #062778  591 Watt Ave Ste 100, 95864 1804 19th St Ste 100, 95811 #017161  Roseville Family Dental Care 916-481-5057 916-246-0889 Bright Now! Dental 3981 Foothills Blvd Ste 160, (CA LO 12 SP TH) (RU SP) 960 Sunrise Ave Ste 115, 95661 95747 916-772-9300 916-773-4343 #060074  #018046  (HI) Capitol Dental Group Miracle Smile Dezham Dental #042339  87 Scripps Dr Ste 102, 95825 Group Confidental Care #056525  916-565-1300 3009 K St Ste 255, 95816 927 Reserve Dr Ste A, 95678 Roseville Star Dental (SP) 916-441-3311 916-742-5424 1950 Douglas Blvd Ste B1, 95661 (CA SP TA VI) 916-783-7105 #387001  #064759  (HI SP) Charles Tran DDS #032105  Dr Alan C Pan DDS 6175 Stockton Blvd Ste 260, More Smiles Dental 1700 Eureka Rd Ste 120, 95661 #1C2301  95824 2020 Hurley Way Ste 135, 95825 916-781-6688 Said Shaari DDS 916-427-6263 916-641-7700 (JA 12) 406 Sunrise Ave Ste 270, 95661 (CH HI SP VI) (RU SP) 916-789-4568 #063100  (RU SP) #061490  #040404  Esthetic Dentistry And Implants Delta Shores Dentistry Dental Natomas Dental Care 140 Folsom Rd, 95678 #054680  Group 2321 Northgate Blvd, 95833 916-784-2129 Sentinel Dental 8204 Delta Shores Cir S Ste 140, 916-564-8088 6756 Stanford Ranch Rd Ste 2, 95832 (4 TA) #049096  95678 916-277-9069 Eureka Ridge Dentistry 916-774-0600 (SP) #064021 1490 Eureka Rd Ste 130, 95661 Orchard Dental Care 916-409-3979 #029990  #064044  925 Secret River Dr Ste B, 95831 Shailesh Jawale DDS Dentists Of Arden Dental Group 916-422-8332 #065130  928 Pleasant Grove Blvd Ste 3521 Arden Way Ste 101, 95864 Galleria Dental Center 100, 95678 916-241-0873 #000669  790 Atlantic St, 95678 916-772-1367 (SP) Pacific Plaza Family Dental 916-780-5678 (HI SP) 6930 65th St Ste 107B, 95823 (HI SP) #039592  916-422-5697 #042818  Elder Creek Dental Group (CH VI) #007284  Smile Designs Of Roseville 3811 Florin Rd Ste 8, 95823 Granite Bay Smiles Dentistry 1158 Cirby Way Ste B, 95661 916-392-7020 #010387  8630 Sierra College Blvd Ste 110, 916-771-0330 (KO SP VI) Park Place Dental Group 95661 4690 Natomas Blvd Ste 100, 916-783-0244 #023652  #056440  95835 (SP) Star Dental Florin Dental Center 916-515-4500 2030 Douglas Blvd Ste 37, 95661 6624 Valley Hi Dr Ste 1, 95823 (HI RU SP) #060181  916-773-6222 916-421-1421 Gurkamal Sandhu DDS Inc (RU SP) (SP) #026025  1895 E Roseville Pkwy Ste 100, Paul Shieh DDS 95661 #055416  #277101  5659 Stockton Blvd, 95824 916-789-8766 Teresa Deguzman DDS Greenhaven Dental Group 916-456-8625 (HI) Corporation 925 Secret River Dr Ste A, 95831 2436 Professional Dr Ste 200, 916-421-3815 #322101  #012754  95661 (HI SP TA) Pioneer Family Dental Interdental Care 916-774-9920 7850 Stockton Blvd Ste 160, 106 N Sunrise Ave Ste B10, 95661 (RU SP TA) #064780  95823 916-787-0631 Greenhaven Modern Dentistry 916-689-3310 (RU TA) #064118  992 Florin Rd, 95831 (12 SP TA VI) Tooth By Sunny Badyal 916-221-9970 #016175  258 Gibson Dr Ste 110, 95678 (SP) #050165  Pavilions Dental 916-630-7633 Pocket Dental 1259 Pleasant Grove Blvd Ste (HI SP HI) #063008 905 Secret River Dr Ste A, 95831 100, 95678 Ivy Dental Group 916-428-5318 916-782-2010 #036335 9701 Business Park Dr Ste 400a, (RU SP) Western Dental Services 95827 #062671  9450 Fairway Dr Ste 110, 95678 916-400-3552 Premier Dental Group #010386  916-771-8464 (HI SP) 3517 Marconi Ave Ste 105, 95821 Pleasant Grove Dental Group 916-481-1111 10357 Fairway Dr Ste 100, 95678 Sacramento #063988  (AR HI KO SP) 916-782-4500 #064170  Land Park Modern Dentistry Albert S Lee DDS Inc Dental Group 1355 Florin Rd Ste 15, 95822 3640 Crocker Ave Ste 130, 95818 916-393-9968 916-550-9429 (CA CH FR 12 12) (SP)

37 DeltaCare® USA

#027422  #055280  #063242  Pro Dental Group Smile Time Dental Western Dental Services Inc #052840  1111 24th St Ste 201, 95816 7227 29th St Ste B, 95822 5200 Stockton Blvd, 95820 San Bruno Smile 916-442-5228 916-984-4224 916-455-6600 797 Jenevein Ave, 94066 (SP) (RU SP) (SP) 650-873-8299 (SP TA) #023836  #060096  #057831  Promenade Dental Group Star Dental Practice Western Dental Services Inc San Carlos 3635 N Freeway Blvd Ste 110, 1824 Avondale Ave, 95825 5247 Elkhorn Blvd Ste C, 95842 #059467  95834 916-900-8521 916-344-1500 Laurel Dental San Carlos 916-285-6691 (HI KO SP VI) 1267 Laurel St, 94070 (SP) #046697  650-381-4811 #040356  Western Dental Services Inc (12 SP) #058994  Strawberry Creek Dental Group 5261 Elkhorn Blvd, 95842 Redford Smiles 8211 Bruceville Rd Ste 155, 95823 916-344-2362 San Francisco 79 Scripps Dr Ste 204, 95825 916-525-7635 #082801  916-565-2570 (SP) #057830  Bernardo Gonzalez DDS (CA KO SP) Western Dental Services Inc 2720 24th St, 94110 #1C9201  5501 Stockton Blvd, 95820 415-282-4566 #062448  Unique Dental 916-739-6100 (SP) Reliance Dental Care 7300 Franklin Blvd Ste 104, 8876 Vintage Park Dr Ste 105, 95823 #024691  #014142  95828 916-428-4325 Yolanda Gonzales DMD Center Of Cosemtic Dentistry 916-681-2751 (4 RU SP) 2378 Fruitridge Rd, 95822 1550 Lombard St, 94123 (CH HI SP VI) 916-421-1010 415-921-5555 #037655  (4 TA) (AR SP TA) #031026  Vineyard Dental Sacramento Dentistry Group 8940 Vintage Park Dr Ste 100, Salida #057598  1105 E St, 95814 95829 #037923  Cosmo Dental 916-538-6900 916-525-3200 Salida Dental Group 490 Post St Ste 1022, 94102 (4 SP VI) 5708 Pirrone Rd, 95368 415-800-7594 #019048  209-543-3888 (RU) #064089  VP Dental Care (SP) Sacramento Family And Implant 3337 El Camino Ave, 95821 #059169  Dentistry 916-486-8240 Salinas Dental Arts Practice Dr Albina 1 Scripps Dr Ste 302, 95825 (SP VI) #037257  Batchaeva 916-999-4337 Accu Dental 450 Sutter St Rm 1925, 94108 (GE) #046700 929 N Main St, 93906 415-757-0604 Western Dental Services 831-783-1336 (PT RU SP) #062215  1355 Florin Rd Ste 3, 95822 (FR HI PE SP VI) Sacramento Kids Dentistry 916-424-1400 #065391 2821 Eastern Ave Ste 2, 95821 #033434  Ez Smile Family Dental Group 916-850-9999 #046698  Diamond Dental Of Salinas 3100 19th Ave, 94132 (AR HI RU SP) Western Dental Services 1209 N Davis Rd, 93907 415-584-2537 1701 Watt Ave, 95825 831-424-4111 (RO SP TA) #064020  916-973-1200 (SP TA) Sacramento Wellness Dentistry (SP) #058401  8759 Center Pkwy, 95823 #043371  Gentle Dental 916-382-8900 #046699  Image Dental 2494 Mission St, 94110 (RO RU SP) Western Dental Services 1184 Monroe St Ste 9, 93906 415-821-1200 3645 Northgate Blvd Ste A, 831-512-7515 (SP) #014095  95834 (VI) Said Shaari DDS 916-286-7750 #132801 77 Cadillac Dr Ste 270, 95825 (SP) #275801  Grand Mission Dental Group 916-649-8200 Steinbeck Country Dental 4749 Mission St, 94112 (RU SP) #058670  Practice 650-583-8822 Western Dental Services 535 E Romie Ln Ste 10, 93901 (SP TA) #114901  4401 Florin Rd, 95823 831-758-5836 Serena Pugeda DMD 916-428-4000 (SP) #121801 2518 L St Ste A, 95816 J T Dental 916-446-7768 #044851  #036336  2415 Noriega St, 94122 (SP TA TA) Western Dental Services Western Dental Services 415-682-2415 8324 Elk Grove Florin Rd, 95829 1229 N Main St, 93906 (CH SP) #061800  916-509-3334 831-442-8000 Simply Smiles Dental Care (SP) #022751  9655 Folsom Blvd, 95827 #063265  Kayvan Kafayi DDS 916-857-0620 Western Dental Services Inc #036344  450 Sutter St Rm 1433, 94108 (HI SP) 2693 Florin Rd, 95822 Western Dental Services 415-398-2360 916-424-5500 921 S Main St #A, 93901 (CH RU) #022867  (SP) 831-783-3160 Smile Makers (SP) #033063 1906 Del Paso Rd, 95834 #063247 Michael Cole DDS 916-263-9888 Western Dental Services Inc San Bruno 2595 Mission St Ste 308, 94110 (CA 12 TA) 3945 Marysville Blvd Ste 1-2, 415-647-9191 95838 #336601  (SP) #054870  916-646-4100 Eugene Espritu Smile Time Dental (SP) 1230 El Camino Real Ste K, #134701  3433 Arden Way Ste B, 95825 94066 Mikhail Berdichevsky DDS 916-984-4224 650-875-6808 4444 Geary Blvd Ste 303, 94118 (RU SP TA) (SP TA) 415-386-5590 (RU) 38 DeltaCare® USA

#184601  #060306  #036198  #058650  Noriega Dental Almaden Dental Care Dental Solutions John Vu DMD 3749 Noriega St, 94122 5595 Winfield Blvd Ste 102, 2680 S White Rd Ste 100, 95148 583 Willow St, 95125 415-661-8851 95123 408-531-9501 408-642-1144 (CA) 408-224-5200 (HI SP) (SP VI)

#064558  #057452 #063064  #030822  Open Wide San Francisco Almaden Valley Smile Design Evergreen Family Dental Group Josephine Clemente DDS 1196 Valencia St, 94110 6472 Camden Ave Ste 100, 1620 E Capitol Expy Ste C, 95121 2211 Moorpark Ave Ste 150, 415-400-3854 95120 408-223-6017 95128 (CS FR PL SP) 408-997-9027 (HI SP) 408-216-9037 (SP) (13 SP TA) #136501 #011864  Richmond Dental Care #064253  Evergreen Valley Dental #019242  4312 Geary Blvd, 94118 AZ Dental 4868 San Felipe Rd Ste 120, Kini Dental Care 415-752-5605 1095 E Brokaw Rd Ste 40, 95131 95135 100 Oconnor Dr Ste 23, 95128 (RU) 408-437-1111 408-528-8303 408-998-8383 (AR CA CH FR GR HI 12 (HI SP VI) (HI) #023138 SP VI) Roberto Calabio DMD Inc #064113  #026187  3184 22nd St, 94110 #064249  Ez Dental Kini Gentle Dental Care 415-642-2050 AZ Dental 5730 Cottle Rd Ste 240, 95123 827 Blossom Hill Rd Ste W5, (TA) 2195 Monterey Hwy Ste 30, 408-227-6000 95123 95125 (SP) 408-226-1060 #150101 408-295-1100 (HI SP) San Bruno Ave Dental Clinic (AR CA CH FR GR HI KO 12 #064705  2817 San Bruno Ave, 94134 SP VI) Family Dental Care #042562  415-656-2868 750 N Capitol Ave Ste C4, 95133 Lexann Smile Dental (CH SP) #059921  408-993-8491 1569 Lexann Ave Ste 108, 95121 AZ Dental Corporation (SP TA) 408-270-4211 #213501  405 Saratoga Ave Ste 60, 95129 (SP VI) South Van Ness Dental Group 408-247-5500 #059310  240 Shotwell St Ste 230, 94110 (AR HI SP VI) Guadalupe Dental Care #064260  415-431-9797 2593 S King Rd Ste 9, 95122 Marcy Kazeminy DDS Inc (CA SP) #036417  408-238-4824 1676 Story Rd, 95122 Berna Sanayei DDS (SP) 408-755-0797 #053861  2929 The Villages Pkwy, 95135 (SP) The Santos Dental Group Corp 408-274-9554 #033735  450 Sutter St Rm 1114, 94108 Gurdip Narula DDS #009015  415-362-9893 #013295  2850 Quimby Rd Ste 145, 95148 Maxsmile Dentistry & (TA) Big Smiles Dental Care 408-274-5000 Orthodontics 1547 Saratoga Ave, 95129 (AM HI SP TA) 266 N Jackson Ave Ste 3, 95116 #212701 408-725-3740 408-272-2644 Van Ness Dental Group (SP VI) #045738  (13 SP TA) 2243 Van Ness Ave Ste 201, Hana Family Dental 94109 #042504  374 S Redwood Ave, 95128 #047275  415-441-2098 Blossom Hill Dental Center 408-386-1383 Meridian Dental Associates (CA 12) 704 Blossom Hill Rd Ste 100, 1241 Meridian Ave, 95125 95123 #013287 408-266-6144 #061674  408-363-8700 Image Dental (KO SP VI) Western Dental Services Inc (HI SP) 250 Montclair Ave Ste B, 95116 2626 Mission St, 94110 408-223-0988 #033366 415-285-7500 #039738 One Stop Dental (SP) Bright Now! Dental #002706  1155 S King Rd, 95122 171 Curtner Ave Ste 80, 95125 Irma Francisco DDS Inc 408-928-5678 San Jose 408-572-8411 4750 Almaden Expy Ste 152, (SP VI) #037258  95118 Accu Dental #045499  408-264-5880 #060139  730 Story Rd Ste 5, 95122 Cao Tu Nguyen DDS (SP TA) Pannu Dental Group 408-998-1088 2114 Senter Rd Ste 3, 95112 1569 Lexann Ave Ste 212, 95121 (HI PE SP TA) 408-993-8624 #186401  408-270-2847 (FR VI) Jackson Family Dental (HI SP TA) #060524  2324 Montpelier Dr Ste 3, 95116 Accu Dental & Orthodontics #047568  408-937-5950 #050214  1180 Blossom Hill Rd Ste 4, 95118 City Dental Center PBS A Dental Corporation 408-978-2500 5460 Dellwood Way Ste 30, #014877  750 N Capitol Ave Ste C8, 95133 95118 Jasna Galeb DDS 408-926-2221 #021635  408-723-4000 1547 Saratoga Ave, 95129 (SP TA) Adrienne Van DDS (SP) 408-725-8331 2114 Senter Rd Ste 14, 95112 (RU SP) #024850  408-298-8187 #061217  Portia Dela Vega Oblea DMD David Jou Dental Corporation #134901  2356 Senter Rd, 95112 #143301  91 N Bascom Ave, 95128 Joel Santos DDS 408-993-9939 Afshin Abdollahi DDS 408-926-2331 200 N Jackson Ave Ste D, 95116 (SP TA) 2100 Curtner Ave Ste A, 95124 (KO) 408-254-7491 408-979-0808 (TA) #025083  (SP) #142401  Pro-Tech Dental Care Dental Concepts Eastridge 2664 Berryessa Rd Ste 210, 2200 Eastridge Loop Ste 1060, 95132 95122 408-258-8903 408-238-6684 (VI)

39 DeltaCare® USA

#057599 #064600 #059653  San Ramon Refresh Dental Group Valley Fair Family And Cosmetic Sl Dental Specialty Group #056476  266 N Jackson Ave Ste 1, 95116 Dentistry 1436 Clarke St, 94577 Camino Ramon Dental 408-272-1999 373 S Monroe St Ste 102, 95128 510-939-7246 2301 Camino Ramon Ste 240, (CA 12 VI) 408-260-8844 94583 (HI) #060518  925-830-0888 #041552  Sudha Chinta DDS (CA KO) Rio Dental Clinic #163301  433 Estudillo Ave Ste 302, 94577 1060 S White Rd Ste C, 95127 Valley Family Dental Care 510-351-0930 #000594  408-929-4321 88 Tully Rd Ste 104, 95111 Country Fair Dental (SP VI) 408-490-4178 #036315  12111 Alcosta Blvd, 94583 (VI) Western Dental Services 925-829-3111 #055676  14895 E 14th St Ste 100, 94578 (HI SP) Rose Garden Dental #057368 510-618-1230 2081 Forest Ave Ste 3, 95128 Western Dental Services (SP) #022858  408-288-5470 1110 S King Rd Ste 60, 95122 San Ramon Family Dental (HI SP) 408-273-7251 San Mateo 3160 Crow Canyon Rd Ste 100, (SP) #037686  94583 #042546  A + Dental Center 925-866-8422 S J Dental #036353 400 N San Mateo Dr Ste 2, (HI) 1876 Curtner Ave Ste 100, 95124 Western Dental Services 94401 408-371-7391 1871 Camden Ave, 95124 650-343-0895 #063473  (CA 12 SP) 408-377-5700 (CH SP TA) Smile Time Dental 9130 Alcosta Blvd Ste A2, 94583 #054328  #036318  #062619 916-984-4224 Sikka Dental Corporation Western Dental Services Andrei Roschkowsky DDS (CA SP TA VI) 150 N Jackson Ave Ste 203, 48 E Santa Clara St, 95113 351 N San Mateo Dr, 94401 95116 408-293-7000 650-344-7635 Sanger 408-259-1280 (SP VI) (RU SP) #057352  (HI SP TA) H S Mann DDS Inc #064962 #2C0001  2514 Jensen Ave Ste 101, 93657 #017363  Western Dental Services Inc Peninsula Dental 559-875-7980 Silicon Dental 1153 S King Rd B, 95122 401a N San Mateo Dr, 94401 (SP) 2060 Aborn Rd Ste 210, 95121 408-240-0250 650-344-7626 408-238-5500 (SP) (CA TA) #042109  (HI SP) Kim Hoang Tran DDS Inc #062152  #042548 263 Academy Ave, 93657 #058336  Western Dental Services Inc Western Dental Services 559-876-1031 Smile Design 451 Blossom Hill Rd, 95123 4100 S El Camino Real, 94403 (SP VI) 1206 N Capitol Ave Ste 201, 408-337-3622 650-235-1460 95132 (HI SP) (SP) #063190  669-235-5589 United Health Centers Of The (GR HI SP TA) #018511  San Pablo San Joaquin Valley Willow Dental Care #015680  1570 7th St, 93657 #003503  1675 Willow St, 95125 Reach Dental Care 559-875-0557 Story Dental Health Center Inc 408-264-8700 4200a Klose Way, 94806 (SP) 2454 Story Rd, 95122 (SP TA) 510-223-8228 408-272-0888 (CH HI TA) Santa Clara (HI PT SP) #059308  #064261  Winchester Dental Place San Rafael #020995  1399 S Winchester Blvd Ste 120, Devmay Dental Tuyen Nguyen DDS 95128 #060070  545 Saratoga Ave Ste B, 95050 634 E Santa Clara St, 95112 408-370-7767 Ez Smile Family Dental Group 408-247-5442 408-286-6156 (SP VI) 361 3rd St Ste H, 94901 (HI SP) (FR SP VI) 415-456-3273 #062018  (KO SP) #060337  #021004  Young Dental Corporation 1705 Northern Dental Uni Dental Branham Ln Ste B4, 95118 #055011  122 Saratoga Ave # 200, 95051 175 S Capitol Ave Ste E, 95127 408-264-7630 Marin Community Clinics 408-556-1333 408-923-3073 (SP KO VI) 3110 Kerner Blvd, 94901 (SP VI) 415-448-1500 #019966  San Leandro (SP) Silicon Valley Dental 2727 Walsh Ave Ste 102, 95051 #009619  #019633  #3C1301 408-987-0530 Unident Andy Q V Le DDS Pacific Dental Group (FR HI SP) 2390 Senter Rd, 95112 1600 150th Ave, 94578 1523 5th Ave, 94901 408-298-6420 510-276-5533 415-453-6277 #010498  (SP VI) (CH SP VI) (CA 12 SP) Star Dental 980 El Camino Real Ste 250, #057588 #062414  #000898  95050 Union Dental Golden State Smiles San Rafael Dentistry 408-247-3740 175 Bernal Rd Ste 260, 95119 15301 Washington Ave, 94579 905 Lincoln Ave, 94901 (HR RU) 408-365-9791 510-351-6820 (KO SP VI) 415-453-1241 (SP) #041754  #060414 Western Dental Services #037313  San Leandro Dental Studio #062976  2825 El Camino Real, 95051 Unismile 425 Estudillo Ave Ste B, 94577 Select Dental 408-343-4170 6134 Camino Verde Dr Ste G, 510-969-8510 95119 1050 Northgate Dr Ste 505, (SP) 408-226-1600 94903 (HI KO SP) 415-499-9300 (SP)

40 DeltaCare® USA

Santa Cruz #055778 #041047  #061704  #062694  Sepideh Pejham Gotta Smile Western Dental Services Inc Randall Medefesser DDS 12948 Village Dr Ste D, 95070 1035 W Robinhood Dr Ste 200, 5756 Pacific Ave Ste 75, 95207 550 Water St Ste J1, 95060 408-255-9057 95207 209-472-1765 831-425-5515 (TA) 209-952-3687 (SP) (SP) (SP) Selma #063323 #036338  #063112  #031827  Western Dental Services Inc Western Dental Services United Health Centers Of The Kevin Thang Pham DDS PC 902 E Hammer Ln, 95210 1107 Ocean St, 95060 San Joaquin Valley 7746 Lorraine Ave Ste 204, 209-957-9500 831-600-3260 2705 Highland Ave, 93662 95210 (SP) 559-891-9003 209-475-0869 Sunnyvale (SP) (SP) #008454  Santa Rosa Gentle Dental Sunnyvale #064296  #021793  South San Francisco 1639 Hollenbeck Ave, 94087 Lake Front Smiles Essential Dental Care #040747  408-732-6931 4707 Quail Lakes Dr Ste 200B, 55 Mission Cir Ste 103, 95409 Cecilia R H Avenido DMD Inc (HI RU SP VI) 95207 707-568-0480 2400 Westborough Blvd Ste 209-337-4500 (SP) 200, 94080 #052058 (HI SP) 650-989-8502 Gordon G Gong DMD #046867  (TA) 877 W Fremont Ave Ste K4, #024855  Ez Smile Family Dental Group 94087 Maria Theresa Oronce DMD 4757 Hoen Ave, 95405 #039469  408-736-7744 1701 N El Dorado St, 95204 707-575-9595 Epitacio N Sison Jr DDS (CA) 209-292-8737 (PE SP) 100 Arroyo Dr Ste C, 94080 (TA) 650-878-3171 #178501 #065111  (TA) Joon Ku Lee DMD #057612  Norcal Family Dental Group 500 E Remington Dr Ste 26, Pacific Dental Group 1144 Sonoma Ave Ste 107, 95405 #115101  94087 7743 West Ln Ste C5, 95210 707-691-5251 Grand Mission Dental Group 408-774-2828 209-474-1101 (RO) 1486 Huntington Ave Ste 302, (KO) (KM KO SP VI) 94080 #037617 650-583-8822 #025246  #014339  Office Of Dr Rostami Inc (SP TA) Lora Costa DDS Park West Dental Group 479 Stony Point Rd, 95401 1286 Kifer Rd Ste 110, 94086 10928 Trinity Pkwy, 95219 707-523-3700 #024022  408-774-1200 209-474-8000 (SP) Jeanette Estipona DDS (JA RU SP TA VI) (SP) 2400 Westborough Blvd Ste 103, #062465  94080 #016204 #026860  Smile Country Dental 650-296-6952 Olive Tree Dental Southern California Dental 140 Stony Point Rd Ste A, 95401 (TA) 990 W Fremont Ave Ste U3, Practice 707-578-3118 94087 20 S California St, 95202 #039468  408-773-8870 209-941-0814 #045242  Noel S Miranda DMD (SP TA) (CH HI 4 SP) Western Dental Services 1486 Huntington Ave Ste 302, 1240 Farmers Ln, 95405 94080 #064009  #028413  707-542-5200 650-583-8822 Pannu Dental Group Star Dental Practice (HI) (SP TA) 1117 Tasman Dr, 94089 8626 Lower Sacramento Rd Ste 408-752-0684 37B, 95210 #036327  #2C2301  (HI SP) 209-951-8088 Western Dental Services Northwood Dental Care (KM HI) 4100 Montgomery Dr Ste B, 125 Northwood Dr Ste A, 94080 #010499  95405 650-827-9746 Smilesavers Dental #062032 707-537-2021 (13 TA) 1214 Apollo Way Ste 402, 94085 Stockton Creative Dental (SP) 408-737-0101 2043 E Fremont St Ste 8, 95205 #057585  (HI SP) 209-466-5000 #063201  Union Dental (HI SP) Western Dental Services Inc 215 Miller Ave, 94080 #398201  1144 Sonoma Ave Ste 108, 95405 650-763-1223 Sunnyvale Family Dtl Care #036326 707-523-2399 (CH SP VI) 990 W Fremont Ave Ste O, Western Dental Services (SP) 94087 Stockton 1407 W March Ln, 95207 408-739-8999 209-473-4000 (TA VI) #036813  #040719 Yunfei Fan DDS Bright Now! Dental-Stockton #042096 1420 Guerneville Rd Ste 5, #063241 6323 Pacific Ave, 95207 Western Dental Services 95403 Western Dental Services Inc 209-242-0470 678 N Wilson Way, 95205 707-623-9471 787 E El Camino Real, 94087 209-937-9000 408-990-8644 (12 SP) #037719  (SP) Dental Group Of Stockton #042098 Saratoga 1036 W Robinhood Dr Ste 104, Western Dental Services Tracy #009540  95207 7860 West Ln Ste B, 95210 #050886  Prospect Dental Care 209-956-9650 209-954-1727 1480 Saratoga Ave, 95070 (IT SP) Arch Dental 1920 W Grant Line Rd, 95376 408-866-3000 #064125  209-820-0789 (FR SP) #036906 Western Dental Services Inc (HI SP) Eduardo H Roa DDS 434 E Dr Martin Luther King Jr 1341 W Robinhood Dr Ste C3, Blvd, 95206 95207 209-643-6170 209-957-0765 (SP) (SP)

41 DeltaCare® USA

#023268  #048644  #057251  #027639  Bright Now! Dental Turlock Smiles Dentistry And Vacaville Dentistry And Bright Now! Dental 2663 Naglee Rd, 95304 Orthodontics Orthodontics Dental Group 5344 W Cypress Ave Ste 101, 209-836-4950 2808 W Monte Vista Ave, 95380 671 Elmira Rd Ste 130, 95687 93277 (KO SP) 209-667-2879 707-215-5259 559-635-4391 (4 SP) #023693  #038595  #036322  Grantline Dental Western Dental Services Western Dental Services #023227  2242 W Grant Line Rd Ste 102, 703 N Golden State Blvd, 95380 791 E Monte Vista Ave, 95688 Cosmetic Touch Dental Group 95377 209-634-4053 707-359-2211 2634 W Walnut Ave, 93277 209-832-2525 (SP) (SP) 559-732-7224 (HI SP) (AM SP) Ukiah Vallejo #054453  #052167  #044947  #054368  Kamini Patel DDS Inc Ukiah Dental Bayside Dental Practice Packwood Creek Dental Group 530 W Eaton Ave Ste L, 95376 307 Luce Ave, 95482 2121 Redwood St Ste A, 94590 4129 S Mooney Blvd Ste B, 209-839-8810 707-462-1881 707-644-7600 93277 (HI) (SP) (SP) 559-732-1953

#062772  Union City #062078  #055580  Naglee Dental Group Visalia Modern Dentistry Dental #039548  Galvan Dental Care 2682 Naglee Rd Ste 110, 95304 Group BV Family Cosmetic Dentistry 2809 Redwood Pkwy, 94591 209-425-4505 3206 N Dinuba Blvd Ste F, 93291 2 Union Sq Ste 230, 94587 707-643-0888 (SP) 559-334-2013 510-489-5000 (12 SP TA) (HI SP) #033811  #137201  #036329  Tracy Smiles Dental Group Western Dental Services #060147  Julius Mosley II DDS 2600 S Tracy Blvd Ste 170, 1230 S Mooney Blvd, 93277 E P Reyes Dental Inc 2121 Redwood St Ste E, 94590 95376 559-624-0503 32138 Alvarado Blvd, 94587 707-558-1660 209-836-5441 510-487-6265 (SP) (SP) #036331  (TA) #056752  Western Dental Services #036333 828 S Mooney Blvd, 93277 #039162  Mak Dental Western Dental Services 559-636-6000 Noble Dental Care 480 Redwood St Ste 13, 94590 2313 N Corral Hollow Rd, 95376 34603 Alvarado Niles Rd, 94587 707-554-2600 209-832-9680 510-493-2130 (SP) Walnut Creek (HI SP) #027824  #063566  #000798  Dental Care Of Walnut Creek Western Dental Services Inc Vacaville Northbay Dental Group 1111 Civic Dr Ste 145, 94596 2990 W Grant Line Rd, 95304 475 Redwood St Ste 30, 94590 925-937-9017 #021426  209-830-7797 707-643-1714 (SP) (SP TA) Alamo Dental 3057 Alamo Dr, 95687 #022896  #062554  707-448-8881 Tulare Tri-City Dental Vallejo Dr Ahmad Hakimjavadi DDS #036310  3630 Sonoma Blvd, 94590 1804 San Miguel Dr, 94596 #010095  Western Dental Services 707-643-1987 925-262-1162 Alamo Family Dental Care 1111 E Tulare Ave, 93274 (SP TA) (SP) 2501 Nut Tree Rd, 95687 559-688-3313 707-454-3888 (SP) #036357 #034527  (CH RO) Western Dental Services Horizons Dental 3587 Sonoma Blvd, 94590 100 N Wiget Ln Ste 209, 94598 Turlock #004927  707-557-8000 925-945-7977 #014891  Alamo Plaza Dental Office (SP) (SP TA) Healthy Smile Dental 810 Alamo Dr, 95688 795 E Olive Ave Ste B, 95380 707-469-8188 #063565  #1C9701  209-668-9300 (SP TA) (HI SP) Western Dental Services Inc Mikhail Berdichevsky DDS 133 Plaza Dr Ste R, 94591 120 La Casa Via Ste 105, 94598 #029121  707-557-6245 925-933-9820 #050212  All Smiles Dental (SP) (HE RU) Lulette A Mercado DDS Family 1241 Alamo Dr Ste 11, 95687 Dentistry 707-447-8289 #063329 #008907  1065 Colorado Ave Ste 6, 95380 (12 SP) 209-250-2300 Western Dental Services Inc San Miguel Dental 3400 Sonoma Blvd, 94590 1844 San Miguel Dr Ste 206, (SP TA) #039351  707-554-4000 94596 Bayside Dental 925-279-3326 #054237 72 Peabody Rd, 95687 (12 RO SP TA) Palm Dental Group 707-450-0732 Valley Springs 241 N Palm St, 95380 #056441  #002987  209-667-2245 #039771  Valley Springs Dental Tim Patel DDS (KO SP) Nut Tree Smiles Dentistry 313 Vista Del Lago Dr, 95252 1818 San Miguel Dr, 94596 110 Nut Tree Pkwy, 95687 209-772-7200 925-945-7366 #061824  707-451-8390 (HI SP) (HI SP) Smile Bright Family Dentistry (SP) 981 E Tuolumne Rd Ste 110, Visalia 95382 #050775  #064325 Watsonville 209-667-5405 Vacaville Dental Center Aspen Dental #037259  (SP) 141 Parker St Ste B, 95688 3221 S Mooney Blvd Ste A, Accu Dental 707-450-1003 93277 40 Penny Ln Ste 2, 95076 (HI SP) 559-754-3953 831-724-0245 (AR FR HI KO 12 PE SP VI)

42 DeltaCare® USA

#036309  #021422  Northern California Fremont Western Dental Services Melissa Lee DDS offices (closed) #052427  1895 Main St, 95076 1215 Plumas St Ste 1901, 95991 Anil Chowdhary 831-763-4743 530-751-7671 3200 Mowry Ave Ste A, 94538 (SP) (SP) Antioch 510-648-2487 #0C1001  (HI SP TA) West Sacramento #064197  Dental Care Of Antioch Tooth By Sunny Badyal #018264  3432 Hillcrest Ave Ste 250, #039894  1215 Plumas St Ste 52, 95991 Acme Dental 94531 Mission Dental 530-671-1244 820 Westacre Rd, 95691 925-754-2145 39560 Stevenson Pl Ste 218, (SP) 916-371-1500 (SP) 94539 (SP) 510-494-8856 #046520 Auburn #014630  Western Dental Services Inc #025710  Fresno Dentistry Today 727 Colusa Ave, 95991 Sierra Family Dental #008872  1001 Jefferson Blvd Ste 500, 530-751-0115 1300 Lincoln Way Ste D, 95603 Northside Dental Practice 95691 1440 E Champlain Dr Ste 101, #063327 530-885-1931 916-372-7022 93720 Western Dental Services Inc (TA) (KO VI) 559-446-1350 940 Colusa Ave Ste A, 95991 Berkeley (SP VI) #064174  530-755-9900 #042286  Luc Dental Care #161501  #055101  Berkeley Family Dental 1050 Jefferson Blvd, 95691 Sidney Jackson DDS Yuba City Dentistry Group 3000 Colby St Ste 302, 94705 916-371-9051 7433 N 1st St Ste 101, 93720 1052 Live Oak Blvd, 95991 510-843-4450 559-447-3003 530-671-4784 (SP) #061676  (SP) Sacramento West Dental Office (HI SP) Citrus Heights 821 Jefferson Blvd, 95691 Lodi 916-372-3368 #007823  #036343  (HI) Everlast Professional Dental 7400 Sunrise Blvd Ste A, 95610 Western Dental Services 320 S Cherokee Ln, 95240 #035874  916-726-1819 209-366-7970 South River Dental Group (SP VI) 2455 Jefferson Blvd Ste 130, Madera 95691 Clovis 916-372-8062 #152901  #039512  (SP) Michael Ward DDS n M Camarena Health Center 375 Bullard Ave Ste 3, 93612 344 E 6th St, 93638 Woodland 559-298-7424 559-664-4000 #021391  (SP) Mountain View Cottonwood Dental Group 520 Cottonwood St Ste 4, 95695 Daly City #012033  530-669-6688 #043355  California Family Dental (12 SP) Marivic Agoncillo DDS Inc 2425 California St Ste D, 94040 343 Gellert Blvd Ste G, 94015 650-967-1389 #019690  650-731-0625 (HI SP) Lincoln Dental (SP TA) 520 Cottonwood St Ste 11, 95695 #042851 530-661-9276 Dublin Camino Family Dentistry 451 W El Camino Real Ste B, (SP) #032852  94040 Restore Smiles Dental 650-938-9002 #062616  6990 Village Pkwy Ste 210, (HI SP) Woodland Family Dental 94568 58 W Court St, 95695 925-556-9074 #170301  530-668-5500 (HI SP) (SP) Parktown Dental Care 990 Bay St, 94040 Folsom #040062  650-968-4000 #042360  Woodland Smiles (SP TA) Whingming Lee DDS 2041 Bronze Star Dr Ste 100, 1671 Creekside Dr Ste 101, 95630 95776 #023615  916-983-9909 530-662-7592 Smile By Design Inc (CA) (SP) 105 South Dr Ste 140, 94040 650-938-1868 Foster City #025080  (CH JA SP TA) Yolo Dental Practice #013159 520 Cottonwood St Ste 9, 95695 Jing-Jing Qian DDS Oakland 530-662-8100 1289 E Hillsdale Blvd Ste 3, #024221  (CA 12 SP TA) 94404 Oakland Dental Care 650-572-8518 315 14th St, 94612 Yuba City (12) 510-444-6300 #063304  (SP) Freedom All Dental And Orthodontics 1222 Colusa Ave Ste H, 95991 #155701 #138201  530-673-3684 Family Dental Center Wayne Fong DDS (SP) 122 Thicket Ln, 95019 1624 Franklin St Ste 410, 94612 831-724-6000 510-444-1083 (HI SP) (SP)

43 DeltaCare® USA

Petaluma #053731  #025490  #031122  Happy Smile Dental Care Gentle Dental Santa Rosa Petaluma Dental Care 2664 Berryessa Rd Ste 213, 1421 Guerneville Rd Ste 102, 1436 Professional Dr Ste 302, 95132 95403 94954 408-259-7000 707-528-7000 707-763-2828 (SP TA) (SP) (SP) #033686  South San Francisco Redding Healthy Smiles Family Dental #052919  2664 Berryessa Rd Ste 107, #021046 Maria Luisa B Santos 95132 Eric R Waits DMD 125 Northwood Dr Ste A, 94080 408-258-1323 2115 Eureka Way, 96001 650-873-4740 (SP TA) 530-246-1142 (SP TA) (TA) #349601 #013447  John Tanaka DDS Roseville Winston Manor Dental Office 2034 Forest Ave Ste 1A, 95128 101 Hickey Blvd Ste C, 94080 #001704  408-279-8080 650-991-4848 American Family Dentistry (JA KO SP) (SP TA VI) 1160 Cirby Way Ste 100, 95661 916-789-8530 #143601  Sunnyvale (SP) Tianna Dao DDS #028978  2344 Mckee Rd Ste 10, 95116 Sai Dental #000667  408-926-9300 Sierra College Dental Practice 1050 E El Camino Real, 94087 408-423-9197 9290 Sierra College Blvd Ste San Leandro 300, 95661 (HI) #176001  916-788-8450 Margaret Yap DDS (HI SP TA VI) #0C9501  13770 Doolittle Dr, 94577 Stephen Fong DDS 510-352-3918 Sacramento 990 W Fremont Ave Ste S, (CH SP TA) 94087 #057818  408-736-4101 Arden Oaks Dental Care #046440  1741 Professional Dr, 95825 Select Dental Turlock 916-485-5539 145 E 14th St Ste 100, 94577 #023627  (HI RU TA) 510-587-9400 Delbon Dental (SP) #167201 2101 Geer Rd Ste 105, 95382 209-667-2977 Eugene Spencer Jr DDS San Mateo 2322 Butano Dr Ste 212, 95825 (SP) #001652  916-486-2838 Deepak Sachdev DDS Windsor 1415 S El Camino Real, 94402 #036898  #191601  650-573-6500 New Essence Dentistry Charles Aikawa DDS (HI SP) 4000 Truxel Road Ste 2, 95834 8741 Brooks Rd S Ste 201, 95492 707-579-1201 916-515-1000 San Pablo (SP) (SP) #030705  San Francisco Contra Costa Dental 14330 San Pablo Ave Ste B, #051951  94806 Alexander Kogan DDS Inc 510-234-1414 255 King St Ste A, 94107 (SP TA) 415-644-0644 (CA 12 RU SP) San Ramon #048127  #049550  Mission Dental Perfect Smiles Family Dentistry 2482 Mission St, 94110 9260 Alcosta Blvd Ste B10, 415-285-9900 94583 (SP) 925-833-8702 (PT TA) San Jose #049635  #162401  Perfect Smiles Family Dentistry Blossom Hill Family Dental 9260 Alcosta Blvd Ste B10, 5058 Union Ave Ste A, 95124 94583 408-559-8668 925-833-8702 (SP VI) (TA)

#398301 Santa Rosa Comfort Dental Group 2881 Hemlock Ave Ste A, 95128 #013132  408-249-8888 Bright Care Dental (SP) 1420 Guerneville Rd Ste 2, 95403 707-578-3776 #049647  Gordon K Kanagaki DDS Inc #054681  7176 Santa Teresa Blvd Ste B4, Elite Dental 95139 1331 Guerneville Rd Ste G, 95403 408-226-7760 707-526-3900 (AR SP)

44 DeltaCare® USA

Southern California DC013174  DC047149  DC062030  BRITE DENTAL GROUP YOUR DENTIST Impladent Implant and Cosmetic offices (open) 1221 N Harbor Blvd, 92801-2421 3174 W Lincoln Ave Ste 102, Dentistry 714-224-4999 92801-6085 1520 E Lincoln Ave Ste 2, 92805- Agoura Hills 0/1 (SP) 714-826-5000 2261 1/0 (SP TA VI) 714-774-6330 DC022091  DC013770  1/0 (AM PE SP) AGOURA DENTAL 7 DAY DENTAL DC048191 5809 Kanan Rd, 91301-1651 2265 W Lincoln Ave, 92801- HILLSVIEW DENTAL DC062140  818-735-3800 6503 414 S Anaheim Hills Rd, 92807- Welcome Dentistry 1/0 (GE SP) 714-491-8600 4241 1201 N Euclid St, 92801-1954 0/5 (CH FR JA KO PE SP TA VI) 714-974-5223 714-817-8345 DC044928  1/0 2/0 (KO SP VI) SEA BREEZE DENTAL CARE DC014097  5029 Kanan Rd, 91301-2515 SUNKIST DENTAL OFFICE DC052114  DC062499  818-991-9852 2500 E Ball Rd Ste 150, 92806- NA DENTAL Apple Tree Dental 9/1 (RU SP) 5000 1830 W Lincoln Ave Ste G-F, 2170 W Lincoln Ave, 92801-5601 714-533-9670 92801-6746 714-907-0606 Alhambra 0/1 (HI) 714-491-0082 1/0 (KO SP) DC025939  1/0 (KO SP) JIN ZHANG DDS DC021442 DC063041 1711 W Main St, 91801-1827 EXCEL DENTAL DC057984  Ace Dental Group 626-308-1711 1602 N Lemon St, 92801-1205 Crescent Family Dental 1007 W La Palma Ave Ste 3, 1/0 (CA CH JA SP) 714-525-5558 522 N Magnolia Ave, 92801-4937 92801-3620 1/0 (SP VI) 714-828-1415 714-778-6160 DC0C0201  1/0 (CH SP) 2/0 (KO SP) ALHAMBRA GARFIELD DENTAL DC025173  INC DENTAL HEALTH ANAHEIM DC058562  DC063273  747 S Garfield Ave, 91801-4438 HILLS Smiles for Orange Country Anaheim Smiles Dental 626-289-6815 8101 E Kaiser Blvd Ste 150, 9672 Ball Rd, 92804-5309 5475 E La Palma Ave Ste 200, 2/0 (SP) 92808-2661 714-772-0102 92807-2075 714-921-9252 2/0 (HI SP) 657-341-3700 Aliso Viejo 0/1 (HI SP) 2/0 (FinnishGE KO 12 SP TA) DC044625  DC058791  GUITTA HARB DMD INC DC026769  Radiance Dental DC063415  26731 Aliso Creek Rd Ste 210, NOEMI TAGUINOD DENTAL 5675 E La Palma Ave Ste 197, Dental Wellness of Anaheim 92656-4811 408 S Beach Blvd Ste 113, 92807-2107 250 W Lincoln Ave, 92805-2903 949-360-0225 92804-1876 714-695-0593 714-535-3254 1/0 (AR FR SP) 714-816-0954 1/0 (AR) 1/0 1/0 (SP TA) DC056971  DC059496  DC063952  ALISO VIEJO DENTAL DC030551  Neeta Somani DDS Inc Anaheim Hills Dental Arts 26921 Aliso Creek Rd Ste B, DENTAL AESTHETICS 1842 W Lincoln Ave Ste B, 100 S Chaparral Ct Ste 150, 92656-3395 PROFESSIONALS 92801-5489 92808-2284 949-425-1447 1751 W Romneya Dr Ste D, 714-533-4321 714-637-4200 1/0 (SP) 92801-1815 1/0 (HI SP) 1/0 (HI SP) 714-772-3538 Alta Loma 0/1 (SP TA) DC060588  DC188001  DC061193  California Dental Group of North DANNY THOMAS DDS Smile360 Family Dentistry DC034491  Anaheim 601 S Euclid St, 92802-1233 9778 19th St, 91737-3538 CALIFORNIA DENTAL GROUP 1221 N Euclid St, 92801-1954 714-778-0700 909-980-4878 2300 S Harbor Blvd, 92802-3518 714-491-2732 0/1 (SP) 2/0 (AR HI SP) 714-750-3030 1/0 (PL SP) 0/1 (SP VI) DC256501  Anaheim DC060680  DR. JOHN M DELANEY DENTAL  DC003047  DC035597 San Angel Dental CORPORATION STATE COLLEGE DENTAL BEACH DENTAL CARE 1637 S Euclid St, 92802-2406 1161 N Euclid St, 92801-1938 GROUP 2940 W Lincoln Ave Ste L, 714-998-1222 714-999-5050 330 N State College Blvd Ste 92801-6200 1/0 (SP) 2/0 (SP) 105, 92806-2943 714-995-4000   714-772-5005 0/1 (KO SP) DC061124 DC258301 0/3 (PE SP) Patriot Dental DENTAL CARE OF ANAHEIM DC038727  922 S Euclid St, 92802-1523 815 N Euclid St, 92801-4128 DC004784  ROSETTA VERGEL DE DIOS 714-776-7015 714-758-0791 BRIGHT NOW DENTAL DMD 1/0 (SP VI) 0/1 (HI SP) 150 N State College Blvd, 92806- 1691 S Euclid St, 92802-2406   2909 714-991-7572 DC061165 DC274701 714-780-0856 1/0 (SP TA) Dentists of Anaheim Hills Dental ANAHEIM OPEN 7 DAYS 17/0 (SP) Group DENTAL DC042526 8162 E Santa Ana Canyon Rd Ste 637 N Euclid St, 92801-4621 DC013160  WESTERN DENTAL SERVICES 104, 92808-1112 714-772-2893 MAYSOON SAEED DDS INC INC 714-202-0765 0/5 (KM CA CH LO 12 SP TA TA 710 S Brookhurst St Ste K, 1696 W Katella Ave, 92802-3015 2/0 (SP) VI) 92804-4321 714-635-6000   714-758-0778 43/2 DC061389 DC3C2201 1/0 (AR) Westport Dental ANAHEIM HILLS DENTAL DC044688  420 S State College Blvd, GROUP YOUROCDENTISTCOM 92806-4119 5731 E Santa Ana Canyon Rd Ste 1116 N Euclid St, 92801-1955 714-772-0770 A, 92807-3234 714-635-0855 1/0 (SP VI) 714-998-2956 1/0 (AR AM FR SP) 10/2 (SP)

45 DeltaCare® USA

Apple Valley DC028125 DC112201  DC033092 DC008689  ARCADIA DENTAL GROUP SIOE HWA ONG DDS INC MILLENNIUM DENTAL CENTER GENTLE DENTAL APPLE 111 E Live Oak Ave, 91006-5240 17906 Pioneer Blvd Ste 100, 1830 28th St, 93301-1904 VALLEY 626-445-1181 90701-4417 661-326-8536 18245 US Highway 18 Ste 3, 1/2 (CA 12 SP) 562-860-9612 0/2 (AR SP) 92307-2217 1/1 (IN) 760-242-2977 DC029181  DC042486  2/0 JASON GEE DDS INC Azusa WESTERN DENTAL SERVICES 638 W Duarte Rd Ste 9, 91007- DC012598  4401 Ming Ave, 93309-4817 DC022889  9203 JAMES AHN DDS INC 661-397-7400 APPLE VALLEY SMILES 626-447-7877 315 E Gladstone St, 91702-4928 38/3 (SP) 12218 Apple Valley Rd Bldg 1 Ste 1/0 (CH 12 SP) 626-969-6728 1, 92308-1704 1/0 (SP) DC042487  760-300-3678 DC040824  WESTERN DENTAL SERVICES 5/2 (SP) OMID FARAHMAND DMD DC033796  1201 24th St # A, 93301-2300 289 W Huntington Dr Ste 313, BRIGHT NOW DENTAL-AZUSA 661-431-1120 DC023235  91007 810 E Alosta Ave, 91702-2706 31/4 (SP) PARKWAY DENTAL GROUP 626-254-1948 626-804-2144 20258 US Highway 18 Ste 400, 0/1 (AR FR JA PE SP) 3/1 DC042519  92307-6197 WESTERN DENTAL SERVICES 760-646-8839 DC196501  DC045234  3401 Coffee Rd Ste A, 93308- 3/1 (SP) ARCADIA DENTAL CENTER ST JOHN DENTAL 5080 440 E Huntington Dr Ste 101, 910 E Gladstone St, 91702-4747 661-587-3512 DC024165  91006-3750 626-332-3000 35/2 (SP) DEXTER DENTAL GROUP INC 626-447-5126 1/0 (AR SP) 19195 US Highway 18 Ste 201, 3/1 (AM SP) DC043525  92307-2562 DC053831 GOSFORD VILLAGE DNTL 760-242-0796 Arleta Canyon City Dental GROUP 5/0 (SP TA) DC000223  706 N Azusa Ave, 91702-2507 5353 Gosford Rd Ste 103, 93313- SIMA BOOSTANFAR DMD 626-334-7310 4969 DC036527  9069 1/2 Woodman Ave, 91331- 2/0 661-588-2065 SUNBURST DENTAL 6463 4/2 (SP) 17995 US Highway 18 Ste 2, 818-893-8799 DC063268  92307-2190 1/0 (SP) Hesam Shahoveisi DMD Inc DC045321  760-946-5200 483 S Citrus Ave, 91702-4734 STOCKDALE SMILES DENT & 1/0 (SP) DC054264  626-966-3400 ORTH Planet Dental 1/0 (SP) 11120 Stockdale Hwy Ste 103, DC047378  9700 Woodman Ave Ste A29, 93311-3656 WESTERN DENTAL SERVICES 91331-6459 Bakersfield 661-665-0080 8/0 (SP) INC 818-897-1999 DC012136  19071 Bear Valley Rd Ste 1, 1/0 (HI KO SP TA VI) BAKERSFIELD DENTAL GROUP DC061146  92308-2718 5120 Stockdale Hwy Ste D, Guy W. Mendivil DDD 760-810-4066 DC059712  93309-2673 Professional Dental Corp 56/0 (SP) Woodman Dental Care 661-324-5442 515 W Columbus St Ste A & B, 8725 Woodman Ave Ste B, 3/0 (SP) DC051120 91331-6562 93301-5847 661-323-5910 JESS RANCH DENTAL 818-891-6670 DC012986  1/0 (SP) 18805 Bear Valley Rd Ste 4, 1/0 (SP TA) RIVER LAKES DENTAL GROUP 92308-2728 9510 Hageman Rd Ste B, 93312- DC062469  760-961-7001 Arroyo Grande 3953 Ocean Dental Group 1/0 (SP) DC050262  661-829-2700 2750 Ming Ave, 93304-4431 R & R DENTAL CARE 9/1 (FR SP VI) 661-396-1701 DC055387  236 S Halcyon Rd, 93420-3118 2/0 (AR SP) Apple Valley Dental Associates 805-489-1495 DC013335  20162 US Highway 18 Ste L, 8/0 (SP) ROBERT REDELSPERGER DDS DC062689  92307-2935 2106 20th St, 93301-3711 San Dimas Dental Practice 760-946-1466 Artesia 661-324-6053 3809 San Dimas St Ste A, 93301- 1/0 (KO SP) 1/0 (SP) DC000733  5727 SARAH CUPINO DMD 661-322-7696 DC062277 DC013485  12146 South St Ste E, 90701- 1/0 (SP TA) Valley Desert Dentist 6844 BHASKAR JOSHI DDS INC 21580 Bear Valley Rd Ste B2-2, 2519 River Blvd, 93305-2651 562-924-1007 DC062703  92308-7200 661-873-9632 1/0 (SP TA) Dentists of Bakersfield of Dental 760-503-9233 1/0 (HI SP) 2/0 Group DC042287  1403 Allen Rd Ste 1000, 93314 DC020014  AARTI SHAH DDS INC 661-368-0919 Arcadia HOME CARE DENTAL 17613 Pioneer Blvd, 90701-4008 2/0 (SP) DC011037  562-809-8482 5917 Niles St Ste 3, 93306-4695 661-366-6527 KAI WU DDS INC 0/1 (AR HI KO SP VI) Baldwin Park 906 S Baldwin Ave, 91007-6703 1/1 (AR SP) DC000313  626-462-9890 DC055230  PRAKASH PATEL DDS 1/0 (CH JA 12 SP) LEE AND KIM DENTAL CORP DC020863  4138 Maine Ave Ste N3, 91706- 17334 Pioneer Blvd, 90701-2708 MERCY PLAZA DENTAL GROUP 3302 DC018884  562-924-3334 500 Old River Rd Ste 225, 93311- 626-960-6395 SANTA ANITA DENTAL GROUP 1/0 (KO SP) 9508 721 W Huntington Dr Ste B, 661-663-0109 0/1 (SP) 91007-6734 2/0 (GE SP) 626-574-1766 7/1 (SP)

46 DeltaCare® USA

DC029898  Bell Gardens DC062285  DC039541  BALDWIN PARK FAMILY DC055522 Alondra Dental Associates CATHERINE NGUYEN DDS INC DENTAL BRIGHT NOW DENTAL-BELL 8800 Alondra Blvd Ste A, 552 E Lambert Rd, 92821-4116 13020 Francisquito Ave Ste 7, GARDENS 90706-4302 714-990-3344 91706-3753 6840 Eastern Ave Ste A, 90201 562-317-4917 0/1 (SP VI) 626-962-9474 323-513-0842 3/0 (SP) 1/0 (KO SP) 16/0 DC040105  DC329301  BREA DENTISTS & DC056766  DC328401  JOHN LIM DMD ORTHODONTISTS San Jose Yangon Dental MARKETPLACE DENTAL 10120 Alondra Blvd, 90706-3904 2500 E Imperial Hwy Ste 120, 14514 Ramona Blvd Ste 1, 91706- OFFICE 562-920-6644 92821-6116 3361 6815 Eastern Ave Ste A1, 90201- 1/0 (SP TA) 714-990-2299 626-337-4700 3919 4/0 (SP) 1/0 (CH SP) 323-560-2595 Beverly Hills 0/1 (SP) DC005483  DC040782  Banning GALLERY DENTAL ARTS COSMETIC & DENTAL IMPLANT DC036281  DC372001  9400 Brighton Way Ste 309, CENTER WESTERN DENTAL SERVICES JIN WEI CHU DDS 90210-4710 782 N Brea Blvd, 92821-3334 887 W Ramsey St, 92220-4437 6526 Eastern Ave, 90201-3004 310-273-7397 714-257-0330 951-849-3214 323-771-3949 1/0 (AM RU) 0/1 (KO SP VI) 55/11 (SP) 2/0 (CH 12 SP) DC026347  DC041994  DC048549  Bellflower SMILE ANGELS OF BEVERLY KAREN KOO DDS 936 E Imperial Hwy, 92821-5612 BANNING FAMILY CENTER DC003208  HILLS 714-990-4911 1070 E Ramsey St, 92220-5924 ROSECRANS DENTAL GROUP 8500 Wilshire Blvd Ste 709, 1/1 (SP) 951-846-2560 9222 Rosecrans Ave, 90706- 90211-3105 3/0 (GE 4 SP) 2140 310-201-9001 DC057441  562-272-0222 1/0 (FR GR SP) Brea Dental Care DC057219  0/4 (PE SP VI) Dental Works DC057362  330 N Brea Blvd Ste B, 92821- 4001 6350 W Ramsey St Ste A, DC010634  Montage Cosmetic Dental 562-356-0948 92220-3065 SMILE CENTER DENTAL 9400 Brighton Way Ste 210, 2/0 (AR FR JA PT SP VI) 951-769-0466 16542 Bellflower Blvd Ste 100, 90210-4709 1/0 (AR FR RO SP) 90706-5417 310-270-4222 DC058386  562-866-7073 1/0 (SP) Gental Dental Brea Barstow 0/1 (SP) 715 E Birch St Ste A, 92821-5704 DC023900  DC255201  714-332-1006 PROCARE DENTAL GRP DC019923  STEVEN GOLDY AND 3/0 (AR SP) 1232 E Main St, 92311-2409 BELLFLOWER DENTAL ASSOCIATES 760-256-1189 17615 Lakewood Blvd, 90706- 416 N Bedford Dr Ste 102, 90210- DC061821  1/0 (SP TA TA) 6409 4308 Brea Dental Group 562-408-1447 310-550-1511 503 E Imperial Hwy, 92821-5544 Beaumont 13/0 1/0 (AM HE RU SP) 714-672-9000 DC026912  DC305001  1/0 BEAUMONT SMILES DENTAL DC046702  WESTERN DENTAL SERVICES KAMBIZ KASHFIAN DDS GROUP DC1C4801  INC 50 N La Cienega Blvd Ste 206, 1620 E 2nd Street Market Place BERRY IMPERIAL DENTAL 9755 Alondra Blvd, 90706-3677 90211-2246 Ste A, 92223-3166 GROUP 562-925-4022 310-659-7949 951-769-9131 649 W Imperial Hwy Ste H, 66/0 (SP) 1/0 (AM FR SP) 6/1 (SP) 92821-3838 714-529-1232 DC059299  Bonita DC059832  1/0 (SP) DR LEE BEAUMONT DENTAL Western Dental Services Inc DC013283  17660 Lakewood Blvd, 90706- BONITA FAMILY DENTAL 930 Beaumont Ave, 92223-1831 DC3C1501  6410 4424 Bonita Rd, 91902-1423 951-845-2200 IMPERIAL DENTAL CARE 562-461-1180 619-479-8703 1/0 (KO SP) 200 E Imperial Hwy, 92821-4925 23/0 1/1 (HR RU SP TA) 714-671-9999 DC062788  2/1 (AR FR HE HI SP VI) The Dental Office of Beaumont DC059549  Brea 1620 E First St Ste 200, 92223- Bruce J Uy DMD Dental DC025689  Buena Park 3174 Corporation SHEENA BHATIA DDS DC012353  951-800-8095 16900 Lakewood Blvd Ste 306, 151 S Kraemer Blvd Ste C1, 92821- FOROUTAN DENTAL 2/0 (SP) 90706-5580 4672 CORPORATION 562-867-5191 714-257-9200 8951 Knott Ave Ste L, 90620- Bell 2/0 (SP TA TA) 1/0 (HI SP) 4108 DC012292  714-826-4181 DC060041  DC035011  KAMRAN HAKIM DDS 1/0 (SP TA) 6334 Atlantic Ave, 90201-1228 Alexander Santos Flores DMD BRIGHT NOW DENTAL-BREA Inc 101 W Imperial Hwy Ste E, 92821- 323-560-3646 DC023298  10454 Artesia Blvd Ste C, 7902 0/1 (SP) VALLEY VIEW DENTAL 90706-6838 714-988-1000 10102 Valley View St, 90620- DC013144  562-925-5899 10/0 1/0 (SP TA) 4344 DR DESAI-GAGE FAMILY 714-229-4898 DC036008  DENTAL 0/1 (SP) 4127 Gage Ave, 90201-1128 DC062191  FULLERTON DENTAL CARE 323-773-2931 Bellflower Smile Center 747 S Brea Blvd Ste 34, 92821- 2/0 (SP) 9202 Alondra Blvd, 90706-4210 5379 562-246-9989 714-870-2000 1/0 (RU SP) 1/1 (SP)

47 DeltaCare® USA

DC029969  DC011528  Calabasas DC037718  P DHOLAKIYA & ASSOCIATES EMPIRE DENTAL GROUP DC062035  101 DENTAL GROUP DDS 1635 N Victory Pl, 91502-1645 Armen Galustian DDS 7259 Owensmouth Ave, 91303- 7011 Orangethorpe Ave Ste 100, 818-565-0057 4764 Park Granada Ste 107, 1530 90621-3322 9/1 (SP) 91302-3322 818-999-9900 714-994-4482 818-224-2420 0/1 (GE SP) 0/2 (SP) DC012934  1/0 (AM HE RU SP) TOLUCA LAKE DENTAL DC058338  DC036324  3808 W Riverside Dr Ste 408, DC356501  St Mark Family Dental Group WESTERN DENTAL SERVICES 91505-5301 CALABASAS DENTAL GROUP 20913 Sherman Way, 91303-1743 5971 Lincoln Ave, 90620-3580 818-842-4019 26500 Agoura Rd Ste 114, 818-992-4600 714-995-9359 1/0 (SP) 91302-3558 1/0 (AR SP) 35/13 (SP) 818-871-0680 DC013523  1/0 (AR AM SP) DC061443  DC036557  BURBANK-GLENDALE DENTAL Western Dental Services Inc ALL SMILES DENTAL GROUP Calexico 21729 Vanowen St, 91303-2618 7938 Valley View St, 90620- 500 E Olive Ave Ste 430, 91501- 818-898-0858 DC039717  2354 2171 11/0 (SP) KAMRAN GHOREYSHI FAMILY 714-670-7657 818-567-4662 DENTISTRY 0/1 (SP) 1/0 (RU SP) Canyon Cntry 408 E 3rd St Ste C, 92231-2854 760-357-9000 DC060521  DC042829  DC015675  1/0 (SP) A New Smile Canyon Country PRIME DENTAL CARE CASTLE DENTAL CENTER 27209 Camp Plenty Rd, 91351- 7540 Orangethorpe Ave Ste C4, 140 N Victory Blvd Ste 101, Camarillo 2634 90621-3458 91502-1848 661-251-0480 DC003118  714-522-4445 818-841-1634 3/0 (FR SP) 1/0 (KO SP) 17/1 (SP) LAS POSAS DENTAL CARE 4000 Calle Tecate Ste 111, Canyon Country DC045697  DC022062 93012-5284 DC031240  BRITE DENTAL VIGEN ALIKHANIAN DDS 805-383-6745 SMILES DENTAL GROUP 5258 Beach Blvd Ste A, 90621- 3927 W Burbank Blvd, 91505- 1/0 (12 SP) 18520 Soledad Canyon Rd Ste G, 1276 2118 91351-3731 714-523-2828 818-845-0900 DC017291  661-252-2800 1/0 (KO) 1/0 (AM RU SP) MISSION OAKS DENTAL GROUP 4900 Verdugo Way Ste A, 0/1 (AM RU SP) 93012-8631 DC061497  DC024660  Carlsbad DENTISTS OF BUENA PARK BOYAJIAN & BARDAKJIAN DDS 805-484-7277 DENTAL GROUP 3808 W Riverside Dr Ste 307, 4/2 DC029516  7540 Orangethorpe Ave Ste A1, 91505-4339 GATEWAY DENTAL GROUP 90621-3458 818-861-7840 DC018205  2635 Gateway Rd Ste 101, 714-576-2540 1/0 (AR AM RU) R TRENT & GINA TORGERSEN 92009-1753 4/0 (SP) DDS 760-431-8112 DC035522  484 Mobil Ave Ste 31, 93010- 4/2 (SP) DC062777  BURBANK VILLAGE DENTISTRY 6363 Buena Park Dental Center 928 N San Fernando Blvd Ste E, 805-484-1221 DC030035  8402 Commonwealth Ave, 91504-4318 2/0 (SP) GENTLE DENTAL CARLSBAD 90621-2528 818-841-8607 2620 El Camino Real Ste A, 714-739-2051 1/0 (AM RU SP TA) DC041958  92008-1255 1/0 (SP) PALM DENTAL CARE 760-720-0966 DC058001  2177 Ventura Blvd, 93010-7934 5/0 (SP TA) DC063962 WESTERN DENTAL SERVICES 805-388-1048 Heungki Min DDS A Professional INC 0/1 (SP) DC038342  Corp 1107 N San Fernando Blvd, FORUM FAMILY DENTAL 5881 Beach Blvd, 90621-2021 91504-4331 DC057498 1905 Calle Barcelona Ste 229, 714-266-0378 818-295-2566 Raffi Chalian DDS Inc 92009-8453 1/0 (KO SP) 40/0 (PE SP) 2107 Pickwick Dr, 93010-6427 760-753-6786 805-445-1333 0/1 (SP VI) DC157001  DC063032 1/0 (AM RU SP) ST THERESE FAMILY Midtown Dental Group DC045527  DENTISTRY 4406 W Magnolia Blvd Ste A, DC198701  CARLSBAD FAMILY DENTISTRY 6891 La Palma Ave, 90620-2429 91505-2729 CAMARILLO DENTAL GROUP 2010 Cassia Rd Ste 110, 92009- 714-994-6911 818-260-0274 2380 Las Posas Rd Ste A, 4210 1/0 (TA) 1/0 93010-3445 760-930-8900 805-388-9110 1/0 (RU SP) Burbank DC0C4301  6/0 (SP) DC053894  DC000082  RENE GHOTANIAN DDS Canoga Park La Costa Dentistry and SAN GABRIEL SUMMIT DENTAL 500 E Olive Ave Ste 250, 91501- Orthodontics 255 E Orange Grove Ave Ste B, 2171 DC025572  7625 Via Campanile Ste 130, 91502-1240 818-846-2600 OMEGA DENTAL GROUP 92009-8489 818-557-0964 1/0 (AM SP) 21712 Sherman Way, 91303-1931 760-633-1653 1/0 (SP) 818-883-6634 DC236001  1/0 (HE SP) 7/0 (SP) DC011035  JOHN YEKIKIAN DDS DC057572 LOUIS MO DDS 2601 W Alameda Ave Ste 406, DC027937  CARLSBAD VILLAGE FAIRE 500 E Olive Ave Ste 460, 91501- 91505-4813 Z. GEORGES RHAYEM D.D.S. DENTISTS DENTAL GROUP 2171 818-843-7841 DENTAL CORP. 300 Carlsbad Village Dr Ste 203, 818-846-3181 1/0 (AM PE SP) 21123 Victory Blvd, 91303-2828 92008-2990 1/0 (SP) 818-888-2700 0/1 (AR AM FR SP) 760-487-0203 4/0

48 DeltaCare® USA

Carson Cerritos DC063040  585 Telegraph Canyon Rd, DC014861  DC013210  Delicate Smiles 91910-6436 HYACINTH EZEANI DDS PAUL KIM DMD 4531 Philadelphia St Ste B107, 619-421-7010 460 E Carson Plaza Dr Ste 114, 11900 South St Ste 122, 90703- 91710-2249 0/1 (SP TA) 90746-3282 6800 909-902-9100 310-719-1865 562-809-6177 3/0 (CA SP TA) DC034615  1/0 1/0 (KO PT SP) CHULA VISTA DENTAL CARE DC063786  1177 Broadway Ste 19, 91911-2771 DC016934  DC184301  Chino Aesthetic Dental 619-409-1400 ISLAND DENTAL BLOOMFIELD DENTAL CENTER 12555 Central Ave Ste B, 91710- 1/1 (SP) 301 W Carson St, 90745-2608 12657 166th St, 90703-2101 3569 310-787-7053 562-926-6502 909-627-0988 DC040221  1/0 (SP) 1/0 (AR SP TA VI) 1/0 (HI SP) SAMUEL HAYATT DMD 2260 Otay Lakes Rd Ste 110, DC053927  Chatsworth Chino Hills 91915-1007 619-482-5555 Omid Barkhordar Dental Group DC027864  DC003117  1/0 (SP) 101 W Carson St, 90745-2602 FUTURE DENTAL CARE CHINO HILLS DENTAL GROUP 310-513-0222 10242 Canoga Ave, 91311-3007 3410 Grand Ave Ste F, 91709- DC040892  2/0 (RU SP VI) 818-882-5252 1473 OTAY LAKES DENTAL GROUP 0/1 (AR AM FR SP) 909-364-0027 DC058396 11/1 2060 Otay Lakes Rd Ste 230, 91913-1364 THE DENTAL OFFICE OF DC061248  619-656-1865 CARSON Chatsworth Dentistry Dental DC029176  1/0 (CH 12 SP TA) 612 E Carson St Ste 101, 90745- Group PINE CENTER DENTAL GROUP 2896 10316 Mason Ave, 91311-3305 5771 Pine Ave Ste S, 91709-6529 DC044620  310-469-9355 818-493-1302 909-597-2477 CANYON VISTA DENTAL 3/0 3/0 (SP) 1/0 (KO SP VI) GROUP 700 Otay Lakes Rd, 91910-6912 DC059587  DC284101  DC031829  619-421-8474 Western Dental Services Inc DEVONSHIRE PLAZA DENTAL DENTAL CARE OF CHINO HILLS 3/0 (SP) 172 E Carson St, 90745-2702 GROUP 3280 Chino Hills Pkwy Ste 4, 310-618-1522 10230 Canoga Ave, 91311-3007 91709-5866 DC050209  20/0 (AM CA CH KO RU SP TA 818-341-8400 909-606-9907 WESTERN DENTAL SERVICES VI) 1/0 (AM FR SP) 0/1 (HI SP) INC 1101 Broadway, 91911-2706 DC063672  Chino DC062205  CESAR CARRASCO DDS Hillcrest Dental Studio 619-422-8891 DC026852  21847 S Avalon Blvd, 90745- 2130 Grand Ave Ste H, 91709- 38/0 (SP) CHINO SMILES DENTAL GROUP 3304 4867 6961 Schaefer Ave, 91710-9126 310-549-9710 909-927-5333 DC056451  909-590-0640 1/0 (SP) 1/0 (HI SP) Estrada Family Dental Group 7/2 355 K St Ste A, 91911-1209 DC363701  DC062598  619-934-5713 DC043660  FAMILY DENTAL CENTER The Dental Office on Soquel 2/0 (SP) PRIORITY DENTAL GROUP 22813 Figueroa St, 90745-4633 Canyon 4673 Riverside Dr Ste D, 91710- 310-549-3717 15850 Soquel Canyon Pkwy Ste DC057560  5905 1/0 (AR SP) A, 91709-7927 Bonita Smiles Dentistry 909-627-7977 909-375-0133 1558 E H St Ste B, 91913-2018 1/0 Castaic 1/0 (SP) 619-421-9070 1/0 (SP) DC012356  DC047223  HASLEY CANYON DENTAL Chula Vista BRIGHT NOW DENTAL-CHINO DC060971  GROUP DC009447  12027 Central Ave, 91710-1908 David Gonzalez DDS Dental 29655 The Old Rd, 91384-4570 TWIN OAKS FAMILY DENTISTRY 909-270-4291 Corp 661-702-8338 230 F St Ste D, 91910-2845 14/0 855 Third Ave Ste 3330, 91911- 3/1 (SP) 619-427-5262 1350 1/0 (FR GE SP) DC047376  619-208-2908 DC038027  WESTERN DENTAL SERVICES 1/0 (SP) CASTAIC DENTAL CENTER INC DC021040  31886 Castaic Rd, 91384-3946 VILLAGE DENTAL GROUP 12400 Central Ave, 91710-2603 DC063287  661-257-2300 878 Eastlake Pkwy Ste 1511, 909-613-0106 Eastlake Modern Dentistry 1/0 (HI PL SP) 91914-4550 63/0 (SP) Dental Group 619-739-4936 1690 Millenia Ave Ste 102, 91915- Cathedral City 6/1 (HI SP) DC055128  2889 DC050208  Valdez Family Dentistry 619-344-8164 DC026776  WESTERN DENTAL SERVICES 4129 Riverside Dr, 91710-3183 1/0 (SP) INC 909-591-9211 MEIGS FAMILY DENTAL 1040 Tierra Del Rey Ste 209, 69160 Ramon Rd Ste 100, 2/0 (SP TA) DC063477  91910-7865 92234-9140 San Ysidro Health Chula Vista 619-656-9713 760-969-5469 DC056744  678 Third Ave., 91910 1/0 (SP) 46/0 (SP) Chino Valley Smile Center 619-662-4100 12850 10th St Ste B1, 91710-4297 1/0 (SP TA) DC1C3501  909-613-0111 DC030417  CARMEN DENISE MAROON PURE DENTAL 1/0 (AR SP) DC0C1801  LOPEZ DDS 69420 Ramon Rd, 92234-3349 GENTLE DENTAL CHULA VISTA 2648 Main St Ste A, 91911-4664 760-202-1171 DC059048  520 Broadway Ste 1, 91910-5376 619-423-5200 2/0 (SP) Nguyen Tabari Dental 619-476-1001 1/0 (SP TA) Partnership 4/0 12604 Central Ave, 91710-3508 909-591-1745 DC031635  2/0 (AR CA FR JA 12 SP) SMILE SAN DIEGO

49 DeltaCare® USA

City Of Industry Corona DC052868 DC033581  DC005418  DC001604  Western Dental Services Inc BRIGHT NOW DENTAL COSTA VALLEY DENTAL CENTER JOSEPH RAJABI DDS 617 N Main St, 92880-1467 MESA 17595 Almahurst St Ste 101-2, 900 S Main St Ste 107, 92882- 951-273-3879 2300 Harbor Blvd Ste H5, 91748-9909 3401 69/0 (SP) 92626-6203 626-965-7445 951-734-4170 949-610-0146 1/0 (SP TA) 0/1 DC059719  10/2 (AR KO VI) Orchard Dental Group DC025605  DC002542  2150 California Ave Ste 107, DC036332 WALNUT SMILES DENTAL R US 92881-7271 WESTERN DENTAL SERVICES 21750 Valley Blvd Ste C, 91789- 1303 W 6th St Ste 103, 92882- 951-279-4333 534 W 19th St, 92627-2748 0939 3196 1/0 (SP) 949-645-1408 909-595-0807 951-898-2101 36/9 (SP) 3/1 2/0 (SP VI) DC060185  Mostafa Khattab DDS DC045295  DC043072  DC004224  807 W Grand Blvd Ste B, 92882- NEWPORT SMILES DENTAL UNIQUE FAMILY COSMETIC SOUTH CORONA DENTAL 3272 SPA DENTISTRY GROUP 951-737-8737 570 W 19th St, 92627-2749 18558 Gale Ave Ste 266, 91748- 1312 E Ontario Ave Ste 102, 1/0 (AR GE SP) 949-642-1033 1396 92881-6645 1/0 (PT SP) 626-581-3188 951-273-0370 DC062813  1/0 (CH SP) 5/2 (SP) West Corona Dentistry DC055690  4264 Green River Rd Ste 102, Smile Max Dental DC056511  DC009195  92880-1632 2969 Harbor Blvd, 92626-3912 Plaza Dental Group DENTAL ASSOCIATES OF 951-340-0200 714-437-1100 17515 Colima Rd Ste C, 91748- CORONA 1/0 (SP VI) 1/0 (SP TR) 1859 1380 El Sobrante Rd, 92879-5759 626-965-0971 951-273-9580 DC063546  DC057753  2/0 (KO SP TA) 2/0 (AR HI 4 KO SP TH) City Dental Centers SOCAL SMILES DENTISTRY 161 N McKinley St Ste 102, 230 E 17th St Ste 208, 92627- Claremont DC010322 92879-6530 3898 951-737-3746 949-645-0045 DC012593  BRIGHT NOW DENTAL 1/0 1/0 (KO SP TA VI) NEWPORT DENTAL 140 W Ontario Ave Ste 105, 406 Auto Center Dr, 91711-5458 92882-5272 Corona Del Mar DC061281  909-624-6199 951-735-4969 Brite Clean Smiles 7/0 (SP) 15/0 DC029287  CORONA DEL MAR DENTAL 488 E 17th St Ste A101, 92627- 3277 DC046717 DC011789  GROUP 949-777-1005 WESTERN DENTAL SERVICES MCKINLEY DENTAL 2345 E Coast Hwy Ste C, 92625- 1/0 (SP) INC 115 N McKinley St Ste 105, 92879- 2034 740 S Hill Blvd Ste B, 91711-5400 6562 949-675-3131 DC061405  909-625-6092 951-280-9300 0/1 17TH Street Modern Dentistry 61/0 (KO SP TA) 1/0 (HI SP) Coronado Dental Group 270 E 17th St Ste 15, 92627-3845 DC055822  DC013104  DC039394  714-224-0480 Claremont Modern Dentistry MAIN STREET DENTAL GROUP MARTHA MORETT DDS 2/0 (SP) 405 W Foothill Blvd Suite 104, 131 W Ontario Ave Ste 102, 1203 2nd St Ste A, 92118-1430 92882-5274 619-435-6840 91711-2786 Covina 909-626-1236 951-898-9700 1/0 (SP) 8/0 9/1 (SP) DC015597 Costa Mesa AHMED SAEED DDS INC 661 S 2nd Ave, 91723-3518 Colton DC015150  DC006360  LITA HERMANSJAH DDS 626-966-3571 DC063456  DAZZLING SMILE DENTAL 916 W 6th St, 92882-3239 0/1 (SP) Assure Dental GROUP 951-738-1749 1080 E Washington St, 92324 204 E 17th St Ste 201, 92627- 1/0 (IN SP) DC032182  909-783-9099 7300 COLLEGE STREET FAMILY 2/0 (SP) 949-515-8181 DENTAL GROUP DC024304  1/0 (SP) CORONA FAMILY DENTAL 153 W College St, 91723-2008 DC368501  GROUP 626-339-9085 ST PATRICK DENTAL CLINIC DC013168  1358 W 6th St Ste 101, 92882- 0/1 (KO SP) 1200 E Washington St Ste F2, PACIFIC HARBOR DENTAL 3167 92324-6499 GROUP 951-734-4620 DC039353  909-422-0885 3030 Harbor Blvd Ste G1, 0/2 (AR SP) COVINA DENTAL ARTS & 0/1 (SP TA TA) 92626-2562 ORTHODONTICS 714-546-6100 558 W Badillo St, 91722-3762 Compton DC029917 6/1 (SP) SOFT CARE DENTAL 626-331-0506 DC036307  910 Washburn Ave Ste D, 92882- 5/1 (AM FR KO SP TA TR VI) WESTERN DENTAL SERVICES DC013279  4383 BRIGHT DENTAL CARE 1821 N Long Beach Blvd, 90221- DC057366  951-734-7717 320 Bristol St Ste H, 92626- 1203 Your Covina Family Dentistry 0/1 (SP TH) 7946 310-639-4300 675 S 2nd Ave, 91723-3518 714-546-7595 46/7 (SP) 626-966-3108 DC032980  1/0 (SP VI) GENTLE DENTAL CORONA 1/0 (AR RU SP) Corcoran 1074 W 6th St Ste 104, 92882- DC022156  DC063109  DC058810  1639 NEWPORT DENTAL GROUP United Health Centers of the San Wong Dental Corporation 951-279-7650 1835 Newport Blvd Ste E267, Joaquin Valley 626 S 2nd Ave, 91723-3517 1/2 92627-5013 1209 Whitley Ave, 93212-2327 626-332-0013 949-574-0100 559-992-5020 1/0 (AR CA CH 12 PE RU SP TA 0/1 (IT RU SP TR) 2/0 (SP) VI)

50 DeltaCare® USA

DC058966  DC062221  Downey DC062476 Sylvia Salem DDS Inc Cypress Modern Smiles DC000646  All Kids Dental Care 650 S 1st Ave, 91723-3538 6897 Katella Ave, 90630-5107 PLANET DENTAL 9474 Firestone Blvd, 90241- 626-332-7311 714-952-3044 8843 Rosecrans Ave Ste A, 5504 1/0 (AR SP) 1/0 (SP VI) 90242-5286 562-803-4224 562-633-9300 10/0 (AR AM CA CH KO 12 RU DC061109 Dana Point 2/0 (KO SP TA) SP) Covina Family & Cosmetic DC019004  Dentistry Inc DANA POINT DENTAL GROUP DC023299  Duarte 4708 N Grand Ave, 91724-2005 34080 Golden Lantern St Ste MEHREGAN DENTAL DC039750  626-332-8608 201, 92629-2679 CORPORATION DUARTE FAMILY DENTAL 1/0 (SP TA) 949-661-5664 10558 Paramount Blvd, 90241- 1217 Buena Vista St Ste 202, 0/2 (KO SP) 2405 91010-2413 DC061703  562-869-2091 626-357-2254 Western Dental Services Inc Del Mar 2/0 (SP) 1/0 (PE SP) 1453 N Azusa Ave Ste F4, 91722- DC007272  1201 DEL MAR PROFESSIONAL DC033113  Earlimart 626-330-2894 DENTAL GROUP KENNETH W CHENG DDS DC063123  24/0 (SP) 13983 Mango Dr Ste 106, 92014- 8029 Imperial Hwy, 90242-3713 United Health Centers of the 3146 562-862-6979 San Joaquin Valley DC0C5901  858-792-6662 0/1 (KO 12 SP) 476 E Washington, 93219 COVINA DENTAL OFFICE 0/1 661-849-2781 1052 N Citrus Ave, 91722-2739 DC034386  2/0 (SP) 626-967-6767 DC036821 FARNAZ HAYAVI DDS 1/0 (AR SP) DELMAR DENTISTRY CENTER 8301 Imperial Hwy, 90242-3830 Eastvale 318 9th St Ste C, 92014-2805 562-862-5777 Cudahy DC011174  858-259-9129 1/0 (AM KO SP VI) GATEWAY DENTAL GROUP & DC025191  1/0 (TR) ORTHODONTICS ST JAMES DENTAL GROUP DC044946  12571 Limonite Ave Ste 230, 7607 Atlantic Ave, 90201-5019 DC059759  DR. ZAK DOWNEY DENTAL 91752-3677 323-771-7254 Promenade Dentistry Dental CARE 951-360-3444 1/0 (SP) Group 10501 Lakewood Blvd Ste A-B, 4/1 (SP) 2710 Via De La Valle Ste B250, 90241-2709 DC063205  92014-1931 562-862-2341 DC011787  Western Dental Services Inc 858-703-1012 10/2 (RO SP) BRIGHT NOW! DENTAL 7903 Atlantic Ave Ste G, 90201- 1/0 (SP) 12636 Limonite Ave Ste 1A and 5926 DC046676  1B, 92880-4200 323-773-2200 Delano WESTERN DENTAL SERVICES 951-808-4323 5/0 (SP) DC013857  INC 20/1 LETICIA TOLENTINO DMD INC 9906 Imperial Hwy, 90242-3207 Culver City 1625 Cecil Ave # A, 93215-1515 562-940-6463 DC060993  DC005952 661-725-9393 68/0 (CH HI 12 PE SP) Eastvale Smiles Dentistry ALL CARE DENTAL 1/0 (13 SP TA) 13334 Limonite Ave Ste 120, 4310 Overland Ave, 90230-4117 DC056608 92880 310-837-8087 DC049580  Downey Promenade Dental 951-228-9294 1/0 WESTERN DENTAL SERVICES Group 2/0 (SP) 730 Woollomes Ave Ste 101, 8998 Apollo Way, 90242-4030 DC013514  93215-9506 562-441-7212 El Cajon CULVER CITY FAMILY 7/0 866-415-1958 DC029203  DENTISTRY 31/0 (SP) EL CAJON FAMILY DENTAL 4909 Sepulveda Blvd, 90230- DC059037  2720 Fletcher Pkwy, 92020-2110 5264 Downey Dental Center Diamond Bar 619-466-1292 310-313-3100 8515 Florence Ave Ste 200, DC035451  1/0 (AR SP) 1/0 (SP) 90240-4043 DIAMOND BAR SMILES 562-869-4532 2841 S Diamond Bar Blvd Ste B, DC036104  DC053860  3/0 (CA CH SP) 91765-3473 RSD DENTAL GROUP AND Smile Comfort Dental 909-860-6232 ORTHODONTICS 9702 Venice Blvd Ste A, 90232- DC059057  5/1 (SP) 2907 Jamacha Rd Ste B, 92019- 2717 Bright Now! Dental-Downey 4342 310-895-9885 8612 Firestone Blvd, 90241-5243 DC042787  619-660-2424 1/0 (AR AM CH 12 RU SP TA) 562-382-1528 DIAMOND DENTAL GROUP 4/2 (SP) 11/0 (SP) DIAMOND BAR Cypress 20657 Golden Springs Dr Ste DC038229 DC059291  DC015308  207, 91789-3898 BRIGHT NOW! DENTAL Downey Dental Arts CYPRESS DENTAL GROUP 909-595-8288 RANCHO 8077 Florence Ave Ste 107, 9922 Walker St Ste C, 90630- 0/2 (AR CH SP) 2502 Jamacha Rd, 92019-4364 90240-3981 3097 619-212-7959 562-928-6900 714-220-0354 DC047663 11/0 1/0 (SP) 1/0 (HE SP) RITCHIE PARK DDS INC 1155 S Diamond Bar Blvd Ste B, DC043648  DC062393  DC044443  91765-2235 DENTAL ARTS GROUP The Downey Dentist FAMILY DENTISTRY GAMAL 909-396-4435 707 Arnele Ave, 92020-2501 7825 Florence Ave Ste B, 90240- TEWFIK 1/0 619-444-1001 3976 6334 Lincoln Avenue, 90630- 1/0 (JA RU SP TA) 562-746-0350 5811 DC198101  1/0 (SP) 714-527-1801 GRAND AVENUE DENTISTRY 0/1 (AR SP) 1111 Grand Ave Ste G, 91765-2227 909-860-5854 0/1 (HI KO SP)

51 DeltaCare® USA

DC046647 DC019551  DC054308  DC179901  WESTERN DENTAL SERVICES SUNSHINE DENTAL GROUP Encinitas Dental Wellness RENE GHOTANIAN DDS INC 4161 Tyler Ave, 91731-1966 285 N El Camino Real Ste 216, 5363 Balboa Blvd Ste 346, 91316- 583 N 2nd St, 92021-6449 626-579-4274 92024-5385 2836 619-440-6222 1/0 (SP) 760-753-1227 818-990-3551 37/0 (SP) 1/0 1/0 (AM SP) DC020419  DC050225  SWE DENTISTRY DC057607 DC184401  LIFE SMILES DENTAL CARE 10354 Garvey Ave Ste B, 91733- Encinitas Smiles Dentistry Dental ENCINO DENTAL CENTER 1530 Hilton Head Rd Ste 111, 2133 Group 17815 Ventura Blvd Ste 101, 91316- 92019-4655 626-350-8366 415 Santa Fe Dr, 92024-5134 3637 619-441-8000 0/1 (SP) 760-388-2161 818-708-1200 1/0 (AR SP) 4/0 1/0 (HE SP) DC022740  DC062403  DR BERI DENTAL OFFICE Encino Escondido Steele Canyon Smiles and 10496 Garvey Ave, 91733-2265 DC017619  DC005132  Orthodontics 626-442-5678 MOSHE ABRAMOVICI DDS GENTLE DENTAL-DEL LAGO 2990 Jamacha Rd Ste 132, 0/1 (HI SP) 16550 Ventura Blvd Ste 403, 3440 Del Lago Blvd Ste C, 92019-4320 91436-5025 92029-7430 619-670-1700 DC053109  818-986-0898 760-746-8777 5/0 Western Dental Services Inc 0/0 (HE RO RU) 1/0 (GE SP) 11450 Valley Blvd, 91731-3230 DC062738  626-532-1442 DC019961  DC007041  CitiDental Rancho 49/0 (SP) ENCINO DENTAL ESTHETICS ESCONDIDO DENTAL GROUP 2451 Jamacha Rd Ste 104, 17525 Ventura Blvd Ste 100, 403 W Felicita Ave, 92025-6517 92019-4324 DC059553  91316-5100 760-233-2260 619-444-0500 COMFORT DENTAL GROUP 818-784-7832 0/1 (SP) 2/0 (AR) 10012 Garvey Ave Ste 11, 91733- 1/0 (SP) 2086 DC034863  DC062882  626-433-1300 DC023865  BRIGHT NOW DENTAL SmilePlus Dentistry-El Cajon 2/0 (AM SP) ENCINO COSMETIC DENTAL ESCONDIDO 1242 East Main St., 92021 GROUP 1286B Auto Park Way, 92029- 619-444-6355 DC061600  16133 Ventura Blvd Ste 1100, 2232 3/0 (AR SP) 626 Dental Care 91436-2415 760-705-9464 4900 Peck Rd, 91732-1422 818-906-2222 19/0 DC063807  626-579-5158 1/0 (SP) Brenda Evans Louka DDS Inc 1/0 (CA CH 12 SP) DC036286  APC DC032956  WESTERN DENTAL SERVICES 1276 E Washington Ave, 92019- DC062051  DANIEL TEBBI DMD 1468 E Valley Pkwy, 92027-2314 3036 Atlantic Pacific Smile Group of 16661 Ventura Blvd Ste 620, 760-480-8700 619-440-9211 El Monte 91436-4812 37/9 (AR RU SP) 1/0 (AR SP) 11230 Garvey Ave Ste H, 91733- 818-789-2034 2475 1/0 (SP) DC036836  El Centro 626-401-1235 BRIGHT NOW DENTAL DC036308 2/0 (CH 12 SP) DC053505 501 W Felicita Ave Ste 101, WESTERN DENTAL SERVICES Encino Smile Care 92025-5639 1450 N Imperial Ave, 92243-1314 DC063264  15720 Ventura Blvd Ste 300, 760-705-3150 760-370-3950 Serenity Dental 91436-2922 16/0 22/9 (HI) 10811 Garvey Ave, 91733-2301 818-788-6684 626-442-6115 1/0 DC040743  DC063682 1/0 (SP TR) ESCONDIDO SMILES DENTAL El Centro Dental DC058024  GROUP 852 E Danenberg Dr, 92243-8511 El Segundo Encino Family Dental Group 860 W Valley Pkwy Ste 100, 760-344-9951 DC059937  15720 Ventura Blvd Ste 322, 92025-2534 2/0 (SP) El Segundo Modern Dentistry & 91436-2993 760-745-1585 Orthodontics 818-788-7060 3/1 (SP) El Monte 310 E Grand Ave Ste 102, 90245- 1/0 (FR RU SP) DC002096  3871 DC045918  EASTERN LOS ANGELES 424-277-1138 DC059728  MAPLE STREET DENTAL GROUP DENTAL 1/0 (SP) PARTOVY PROFESSIONAL 327 S Maple St, 92025-4122 12015 Garvey Ave Ste A, 91732- DENTAL GROUP 760-745-2550 3156 Encinitas 16055 Ventura Blvd Ste 400, 1/0 (SP) 626-454-1888 DC014605  91436-2608 1/0 (CH SP) CAMINO DENTAL GROUP 818-990-0400 DC055994  1340 Encinitas Blvd Ste 100, 1/0 (AM RU SP) NC Dental Specialties DC003785  92024-2844 1356 W Valley Pkwy Ste K, CENTRAL DENTAL GROUP 760-942-3900 DC061700  92029-2138 12072 Valley Blvd, 91732-3137 3/3 (SP) All About Smile Dental Group 760-233-5887 626-527-2200 16133 Ventura Blvd Ste 1120, 1/0 0/1 (CA CH 12 SP VI) DC034728  91436-2415 NCH DENTAL 818-788-0651 DC056975  DC012851  477 N El Camino Real Ste C210, 2/0 (FR SP TA VI) Leilani S Alarcon DDS Inc ALFONSO MARTINEZ DDS 92024-1355 925 E Pennsylvania Ave Ste D, 11733 Valley Blvd, 91732-3073 760-943-8880 DC164601  92025-3432 626-575-7565 1/0 (KO SP) DAN ROSEN DDS 760-747-3140 1/0 (SP) 16542 Ventura Blvd Ste 505, 1/0 (SP TA) 91436-4576 818-907-6736 1/0

52 DeltaCare® USA

DC060116  DC033532  DC061998 DC058520 NC Family Dental SIERRA PARKWAY DENTAL Medical Center Dental Group Western Dental-Fullerton 1018 W El Norte Pkwy, 92026- CARE 11160 Warner Ave Ste 303, 1620 S Harbor Blvd Ste A, 92832 3341 16953 Sierra Lakes Pkwy Ste 110, 92708-4055 714-294-7066 760-740-2595 92336-1272 714-557-8492 46/0 (SP) 1/0 (SP) 909-357-3900 1/0 0/1 (HI SP) DC063381  DC063170  Fountain Vly Selenite Dental Escondido Valley Braces DC058478  DC002516  508 S Harbor Blvd, 92832-2411 913 E Valley Pkwy, 92025-3428 Western Dental Center DAVID COHEN DDS 714-770-0455 760-233-2333 10144 Sierra Ave, 92335-6725 11180 Warner Ave Ste 451, 1/0 (AR SP) 1/0 (SP) 909-428-0500 92708-7505 78/0 (FR PE SP) 714-444-4428 DC183601  DC063960  1/0 (SP) NANDINI MURTHY DDS Escondido Dental Arts DC059020  607 E Chapman Ave, 92831-3803 202 S Juniper St, 92025-4221 Young Kwun Kim DDS Inc DC384201  714-774-2638 706-306-4466 8110 Mango Ave Ste 101, 92335- QUALITY DENTAL CARE 0/1 2/0 (PE RU SP) 3603 17150 Euclid St Ste 322, 92708- 909-829-9324 4092 Garden Grove DC154801  1/0 (KO SP) 714-444-4224 DC011701  EL NORTE FAMILY DENTAL 1/0 (AR SP) CENTURY DENTAL CARE 306 W El Norte Pkwy Ste D, DC062273 13011 Century Blvd, 92843-1209 92026-1960 Sierra Dental Health Fullerton 714-534-7020 760-480-5600 9190 Sierra Ave Ste 101, 92335- DC003989  1/0 (KO SP VI) 0/1 (HI JA SP) 8613 NEWPORT DENTAL 909-356-4200 1718 W Orangethorpe Ave, DC055976  DC191801  1/0 (SP VI) 92833-4538 Peach Dental FAMILY CARE DENTAL 714-525-3855 12462 Brookhurst St Ste C, 1114 W Valley Pkwy, 92025-2559 DC062789  11/0 (SP) 92840-4759 760-738-1070 Dentists of Fontana Dental 714-638-7470 0/1 (SP TA VI) Group DC004716  1/0 (AR FR KO SP TA VI) 16944 S Highland Ave Ste 400, US DENTAL GROUP DC196901  92336-3464 1441 Brea Blvd, 92835-3507 DC056098  VILLAGE DENTAL CENTER 909-275-7179 714-992-0300 Garden Grove Dental Care 8895 Lawrence Welk Dr, 92026- 2/0 (SP) 1/0 (AR AM PE SP) 12630 Brookhurst St Ste B, 6407 92840-4886 760-749-7500 DC325201  DC010101  714-530-4920 1/0 (SP) GUPTA DENTAL CORPORATION FULLERTON DENTAL CENTER 1/0 (AR HE SP VI) 11623 Cherry Ave Ste B2, 92337- 446 E Commonwealth Ave, 1212 Fontana 92832-2019 DC059432  909-355-1485 DC007661  714-680-6767 Western Dental Services Inc 1/0 (HI PE SP) DR VORAS GATEWAY DENTAL 1/1 (KO SP) 12141 Garden Grove Blvd, 92843- OFFICE 1628 15032 Summit Ave Ste 410, Foothill Ranch DC015258 714-530-9801 92336-5393 DC019421  SUNSHINE DENTAL 23/0 909-899-3940 TOWNE CENTRE DENTAL 506 W Commonwealth Ave, 1/0 (HI SP) GROUP 92832-1723 DC061969  45 Auto Center Dr Ste 110, 714-738-7777 My OC Dental Care DC014116  92610-2848 1/0 (SP) 13732 Euclid St, 92843-3419 TRIANGLE DENTAL GROUP 949-588-5906 714-530-0921 14305 Baseline Ave, 92336-3631 2/2 (HI SP) DC033363  1/0 (CH SP) 909-355-1700 FULLERTON FAMILY DENTAL 5/2 (SP) Fountain Valley 906 W Orangethorpe Ave, DC062097  DC036364  92832-2827 Joeun Dental Group DC015612  BRIGHT NOW DENTAL 714-871-3900 9872 Chapman Ave Ste 102, VAHAN GRIGORYAN DDS 18633 Brookhurst St, 92708- 3/0 (AR CA FinnishFR GE KO 12 92841-2718 7993 Sierra Ave Ste D, 92336- 6748 SP TA) 714-539-8947 3330 714-274-4222 3/0 (KO SP) 909-428-5111 13/1 DC043707  1/0 (AM RU SP TA) FULLERTON DENTAL ART DC062247  DC058403  717 N Placentia Ave, 92831-3289 Coastal Dental Care DC017952  Fountain Valley Dental Esthetics 714-577-0105 10044 Westminster Ave, 92843- BRIGHT NOW! DENTAL 17900 Brookhurst St Ste A, 0/1 (HI SP) 4721 16135 Sierra Lakes Pkwy Ste 200, 92708-5141 714-539-7070 92336-1253 714-887-4337 DC047625  2/0 (CH SP VI) 909-356-2006 2/0 (SP VI) FULLERTON DENTAL GROUP 23/1 (SP) 1573 S Harbor Blvd, 92832-3402 Gardena DC060004  714-441-0131 DC001813  DC021056  Dental Arts 5/0 (SP) CITY DENTAL CENTER SIERRA LAKES DENTAL GROUP 11703 Edinger Ave, 92708-1208 1300 W 155th St Ste 208, 90247- 16475 Sierra Lakes Pkwy Ste 140, 714-775-1934 DC056743  4061 92336-1259 1/0 (CH SP VI) Eric C Chiang DDS 310-715-2723 909-357-0869 100 N State College Blvd Ste E, 0/1 (SP) 9/1 (SP) DC060643  92831-4236 Andreea Moisiuc DDS Inc 714-738-8452 DC057457  DC030621  17037 Brookhurst St Ste 4, 1/0 (12 SP) Gardena Dental Care GUPTAS’S DENTAL GROUP 92708-3623 1600 W Redondo Beach Blvd 16049 Baseline Ave Unt 3, 714-962-2300 Ste 203, 90247-3228 92336-1830 1/0 (RO SP VI) 310-808-0198 909-356-9752 1/0 (SP) 2/0 (HI SP)

53 DeltaCare® USA

DC063926  DC060192  DC061110  Hanford Western Dental Services Inc Verdugo Hills Dental Group Downtown Dental DC036358  15515 S Normandie Ave, 90247- 3600 N Verdugo Rd Ste 302, 1435 E Route 66 Ste D, 91740- WESTERN DENTAL SERVICES 4013 91208-1258 3748 1560 Lacey Blvd # 107, 93230- 310-953-0900 818-839-7475 626-914-3900 9305 5/0 1/0 (AM SP) 1/0 (AR AM SP) 559-589-6302 29/8 (SP) DC173301  DC062582  DC061718  PLAZA DENTAL Dentists of Glendale Dental Glendora Dental Center DC036586  14240 S Vermont Ave, 90247- Group 610 E Route 66, 91740-3507 WESTERN DENTAL SERVICES 2208 3900 San Fernando Rd Ste 626-335-7727 210 N 11th Ave Ste 101, 93230- 310-515-5511 1017A, 91204-2858 3/0 (AR FR GE SP TA TA) 4591 1/0 (SP) 818-528-4844 559-585-2170 2/0 (SP) Goleta 32/9 (SP) Glendale DC041299  DC001666  DC063843  WESTERN DENTAL SERVICES Harbor City Broadway Dental ALENOUSH BAGDASARYAN 5680 Calle Real, 93117-2317 DC2C9101  727 E Broadway, 91205-1103 DDS 805-979-3155 BAY HARBOR DENTAL OFFICE 818-240-5888 457 Palm Dr Ste 100, 91202-3221 22/1 (SP) 1537 Lomita Blvd, 90710-2024 2/0 (CH SP) 818-956-3733 310-530-5252 1/0 (AM FR PE) DC061833  1/0 (SP) DC235901  Johnson Family Dental-Goleta JOHN YEKIKIAN DDS DC003132  7050 Hollister Ave Ste 101, Hawaiian Gdns ARTEMIS SARADJIAN DDS 1128 N Brand Blvd, 91202-2504 93117-2811 DC013434  205 S Verdugo Rd # A, 91205- 818-242-4703 805-695-3388 NEWPORT DENTAL-HAWAIIAN 1424 1/0 (AM FR PE SP) 15/0 (SP) GARDENS 818-244-4949 21714 Pioneer Blvd, 90716-1236 2/0 (AR AM SP) Glendora Granada Hills 562-421-3737 DC013849  DC020519  15/1 (SP) DC012933  SHAWKY SOLIMAN DDS INC BALBOA DENTAL GROUP CARMEN OHANIAN DDS 150 S Grand Ave Ste F, 91741- 11850 1/2 Balboa Blvd, 91344- Hawthorne 1110 N Brand Blvd Ste 201, 91202- 4720 2753 DC003889 2567 626-914-3150 818-360-1946 SANTA MARIA DENTAL OFFICE 818-244-0215 1/0 (AR SP) 9/1 1/0 (AM RU) 11938 Hawthorne Blvd, 90250- 3016 DC016959  DC038230  310-973-0945 DC013449  WOODGLEN DENTAL CENTER MISSION HILLS DENTAL 1/0 (SP) TOWN CENTER DENTISTRY 220 S Glendora Ave Ste B, 91741- 10515 Balboa Blvd Ste 250, 316 E Broadway Ste A, 91205- 3439 91344-6361 DC015649  1011 626-914-4054 818-365-8600 CASTLE DENTAL CENTERS 818-548-7700 0/1 (AR SP) 1/0 (SP) 1/0 (AM CA CH 12 RU SP) 13220 Hawthorne Blvd, 90250- 5804 DC021055  DC039080  310-679-9019 DC023481  GLENDORA SMILES DENTISTRY KAMRAN RAFIE DDS 17/0 GLENDALE PREMIER DTL AND ORTHODONTICS DENTAL 17656 Chatsworth St, 91344- CENTER 605 W Route 66, 91740-4122 5601 DC030248  819 N Pacific Ave, 91203-1027 626-771-1320 818-363-0200 ALL KIDS DENTAL CARE 818-240-1760 7/1 (AR AM KO 12 SP) 1/1 (SP) 1/1 (AR AM HE RU SP) 13340 Hawthorne Blvd, 90250- 5805 DC036537  DC043477  310-973-8004 DC028405  NEW VISION DENTAL BRIGHT NOW DENTAL 1/0 STARLIGHT DENTAL GROUP 1814 E Route 66 Ste B, 91740- 18121 Chatsworth St, 91344-5610 207 N Central Ave, 91203-2510 3869 818-491-0056 DC055903  818-243-8888 626-963-7000 20/0 (PE SP) 1/0 (AM SP) 1/0 (SP VI) Blue Dental Group 12923 Inglewood Ave Ste 3, DC054785  90250-5139 DC035753  DC043851  Granada Hills Family Dental 310-263-1030 IRINA M SAHAKI DDS FOOTHILL FAMILY DENTAL 16917 Devonshire St, 91344 3/0 (AR AM HI KO PE RU SP TA 520 E Broadway Ste 402, 91205- GROUP 818-360-0957 TR VI) 4912 210 S Grand Ave Ste 420, 91741- 1/0 (RU SP) 818-241-2424 4294 DC057949  1/0 (AM KM FR PE RU) 626-963-3322 DC320001  Western Dental Services Inc 2/0 (AR AM FR PE SP) JOHN BOSAK DMD 14248 Hawthorne Blvd, 90250- DC053763  10727 White Oak Ave Ste 213, 7008 Armen Manssourian DMD DC054957 91344-4656 310-978-2973 1122 N Brand Blvd Ste 102, Glendora Dental Arts 818-368-5676 51/0 91202-2570 1343 E Gladstone St Ste 204, 1/0 (SP) 818-242-2667 91740-6717 2/0 (AM SP) 909-592-1432 Hacienda Hts Hemet 1/0 DC012150  DC023805  DC058594  HEMET DENTAL GROUP AND TRI-CITY SMILES DENTISTRY Comfort Care Glendale DC055400  ORTHODONTICS AND ORTHODONTICS 1134 N Brand Blvd, 91202-2504 Advanced Dental Smiles 4000 W Florida Ave, 92545- 17188 Colima Rd Ste B, 91745- 818-246-2253 455 W Foothill Blvd, 91741-3363 5279 6787 2/0 (AM SP) 626-914-9808 951-658-9980 626-581-7878 1/0 (CH SP VI) 8/2 (SP) 3/1 (SP)

54 DeltaCare® USA

DC016801  DC043394  DC015581  DC062629  BRIGHT NOW! DENTAL RADIANT DENTAL HARBOUR LANDING DENTAL Seascape Cosmetic and Implant 2721 W Florida Ave, 92545-4616 15398 Main St Ste A, 92345-3391 4911 Warner Ave Ste 202, Dentistry 951-925-2226 760-949-7211 92649-4473 18632 Beach Blvd Ste 115, 92648- 15/2 (SP TA VI) 1/0 (SP) 714-846-4414 2047 0/1 (AR KO 12 SP) 714-636-9700 DC036130  DC058268 2/0 (SP) BRIGHT SMILE DENTISTRY Eagle Dental DC029634  1020 E Florida Ave, 92543-4511 12052 Hesperia Rd Ste 4, 92345- COSMETIC & DENTAL IMPLANT DC063542  951-765-1234 1808 CENTER Dental Associates of Huntington 0/1 (AR SP) 844-563-2453 19080 Brookhurst St, 92646- Beach 1/0 (CH SP) 2552 5942 Edinger Ave Ste 101, DC046075  714-968-2527 92649-1774 HEMET SMILES DC062354  0/1 (SP VI) 714-377-4449 1001 S State St Ste B, 92543- Desert Dentist 1/0 (SP) 7188 14661 Main St, 92345-3308 DC030941  951-658-6100 760-244-5047 BIG DENTAL GROUP DC063779  1/0 (SP) 3/0 (KO SP) 18682 Beach Blvd Ste 100, Cardinal Dental 92648-2049 19365 Main St Ste 108, 92648- DC047375  DC063514  714-968-3522 2483 WESTERN DENTAL SERVICES Western Dental Services Inc 1/1 (AR SP TR VI) 949-393-2999 INC 13368 MAIN ST STE 300, 92345- 1/0 (AM 14) 2091 W Florida Ave Ste 100, 4730 DC042025  92545-4800 760-810-4118 HUNTINGTON BEACH DENTAL DC200701  951-929-0582 8/0 (SP) OFFICE BEACHSIDE DENTAL GROUP 65/0 (SP) 15047 Goldenwest St, 92647- 18800 Main St Ste 110, 92648- DC391001  2710 1717 DC059686  DESERT VALLEY DENTAL 714-898-4425 714-842-6151 West Coast Dental Group of GROUP 1/0 2/1 (AR CH FR HE HI 12 RU SP TA Hemet 16868 Main St, 92345-6030 VI) 3027 W Florida Ave P1, 92545- 760-244-2625 DC047468  3617 8/0 (SP) SUBODH SWAROOP DDS INC Huntington Park 951-791-9111 9952 Hamilton Ave, 92646-8016 DC002376  7/0 (AR AM CA KO PE PT SP) Highland 714-593-0256 HUNTINGTON PARK FAMILY DC016135  2/0 (SP) DENTAL DC061691  INLAND DENTAL CENTER 2711 E Slauson Ave, 90255-3002 Bravo Dental of Hemet HIGHLAND DC052189  323-582-4474 1300 E Florida Ave # A20, 6982 Boulder Ave, 92346-3328 Hunting Beach Modern Dentistry 1/0 (AR AM CH SP) 92544-8640 909-862-2121 16071 Goldenwest St, 92647 951-765-5544 1/1 (SP) 714-536-2383 DC052410  1/0 (AR SP) 9/0 (SP) Hamid Imankhan DDS Inc DC027405  2634 Clarendon Ave, 90255- DC062533  HIGHLAND DENTAL GROUP DC054114  4120 Hemet Modern Dentistry Dental AND ORTHODONTICS Celine T. Pham 323-585-2777 Group 27949 Greenspot Rd Ste H, 19059 Bushard St, 92646-2431 2/0 (FR SP) 1115 S Sanderson Ave, 92545- 92346-4444 714-964-2040 9047 909-864-6010 1/0 (SP VI) DC058823  951-404-5307 6/3 (SP) HP Dental Group 1/0 (SP) DC055328  5802 Pacific Blvd, 90255-2618 Hollywood Allure Dental Specialist 323-583-1644 18593 Beach Blvd Ste B, 92648- Hermosa Beach DC175401  3/0 (KO SP) 2053 DC046274 SAMI NOUHAD DDS 714-581-8989 HERMOSA SMILES DENTISTRY 7080 Hollywood Blvd Ste 817, DC060133  1/0 (IT SP TA TA VI) 1559 Pacific Coast Hwy Ste 101, 90028-6935 Smiles West Dental and Braces 90254-3214 323-466-3541 of Huntington Park DC059015  310-372-7686 1/0 (AR SP) 5501 Pacific Blvd, 90255-2534 9/0 Noleen Nguyen DDS Inc 323-586-0600 Huntington Beach 16903 Beach Blvd, 92647-4808 7/0 (AR AM CH FR JA KO 12 PE Hesperia 714-375-0044 PL SP TA TH VI) DC000185  1/0 (SP VI) DC013688  LINA MUSLEH DDS GENTLE DENTAL DC060946  19754 Beach Blvd, 92648-2989 DC060733  16455 Main St Ste 17, 92345- Total Care Dental and 714-964-8830 Safari Dental & Implants 3505 Orthodontics 1/0 (SP) 16511 Goldenwest St Ste 101, 760-244-6077 2630 Zoe Ave, 90255-4132 92647-4484 323-230-6366 2/0 DC003093  714-848-9200 3/0 (AR AM CH FR HI KO PL RU BEACH DENTAL GROUP 1/0 (GE SP) SP) DC018517  19720 Beach Blvd Ste A, 92648- BRIGHT NOW DENTAL 2987 DC062583  17003 Bear Valley Rd Ste D, DC062485 714-593-1010 HB Kids Dentistry Dental Group 92345-1420 Mi Sonrisa Dental Group 6/1 (SP) 9842 Adams Ave Ste 101, 92646- 760-244-1900 7208 Pacific Blvd Ste 200, 4827 90255-5770 13/0 DC011891  714-823-3830 323-582-2200 PEARLY WHITE DENTAL 1/0 (SP) 1/0 (SP) DC026917  16474 Bolsa Chica St, 92649- HIGH DESERT SMILES 2603 DENTISTRY 714-377-3736 12821 Main St Ste 150, 92345- 1/0 (AR AM CH FR PL SP TA VI) 9130 760-947-9853 6/2

55 DeltaCare® USA

DC270201 DC050207 DC002410  DC047026  KIMS FAMILY DENTISTRY WESTERN DENTAL SERVICES ART OF DENTISTRY INSTITUTE THE DENTAL OFFICE ON RED 7601 Seville Ave, 90255-6029 INC 2646 Dupont Dr Ste 200, 92612- HILL 323-587-6600 81735 US Highway 111 Ste A, 1689 17010 Red Hill Ave Ste D, 92614- 1/0 (KO SP) 92201-0715 949-955-3366 5626 760-391-4466 1/0 (HI IT SP) 949-975-0150 Huntington Pk 46/0 (SP) 5/0 DC053100  DC002461  Western Dental Services DC061661  ROYA TOOMARIAN DDS DC048933  2630 E Gage Ave, 90255-4122 Indio Modern Dentistry Dental 16520 Bake Pkwy Ste 155, 92618- GREEN DENTAL 323-587-1788 Group 4694 113 Waterworks Way Ste 130, 45/0 (SP) 82151 Avenue 42 Ste 110, 92203 949-786-0640 92618-3168 760-255-7597 1/0 949-502-5100 Huron 2/0 (SP) 1/0 (SP) DC013086  DC063113  DC062098  DENTAL CARE OF IRVINE DC055967  United Health Centers of the San Pacific Wave Dental 4330 Barranca Pkwy Ste 230, Dent-All By Dr 2 Joaquin Valley 45841 Oasis St Ste 3, 92201-4505 92604-4756 15362 Alton Pkwy, 92618-2362 16928 11th St, 93234 760-289-7116 949-786-1234 949-447-5050 559-945-2541 1/0 (SP) 1/0 (KO SP) 1/0 (AR SP) 1/0 (SP TA)

Imperial Inglewood DC017914  DC059297  DC021677  GENTLE DENTAL Formosa Dental Arts DC185301 LAX DENTAL GROUP 4950 Barranca Pkwy Ste 105, 14200 Culver Dr Ste 290, 92604- SUN DENTAL OFFICE OF DR 4201 W Century Blvd, 90304- 92604-4630 0329 CERVANTES 1617 949-551-4242 949-679-1637 2387 US Highway 86, 92251- 310-981-9000 5/0 (CA HI 12 SP VI) 1/0 (CH 12) 9780 2/0 (SP) 760-353-5100 DC019892  DC061621  1/0 (SP) DC029202  OC DENTAL GROUP Western Dental Services Inc 14130 Culver Dr Ste C, 92604- 14370 Culver Dr Ste A, 92604- Imperial Beach EMMANUEL N OKONKWO DDS 2710 W Manchester Blvd Ste 3, 0321 0319 DC024542  90305-2436 949-653-8888 949-733-3433 IMPERIAL BEACH DENTAL 323-971-5025 0/1 (AR FR 12 SP TA) 11/0 GROUP 1/0 (IboSP) 1340 Imperial Beach Blvd Ste DC034743  DC061710  201, 91932-3046 DC041271  IRVINE SMILE ARTS DENTISTRY BON DENTAL 619-429-6600 NEWHART DENTAL INC 14150 Culver Dr Ste 204, 92604- 4330 Barranca Pkwy Ste 140, 1/0 (SP) 3516 W Imperial Hwy, 90303- 0322 92604-1703 2222 949-726-1001 949-523-2875 Indio 310-677-9101 1/0 (HI) 1/0 (KO) DC017293  3/1 (SP) GENTLE DENTAL INDIO DC034769  DC063284  81557 Doctor Carreon Blvd Ste DC045739  UNIVERSITY PARK DENTAL Dentists of Irvine Dental Group D3, 92201-5563 INGLEWOOD FAMILY 5321 University Dr Ste A, 92612- 5685 Alton Pkwy, 92618-4059 760-998-1569 DENTISTRY 2942 949-236-6527 1/2 (AR CS SP) 327 W Manchester Blvd, 90301- 949-653-2244 2/0 (SP) 1107 1/0 (FR SP) DC017508  310-491-2872 DC339901  MATT T JAM DDS 1/0 (SP) DC040898  FARZAD SHAYGAN DDS 81730 US Highway 111 Ste 8, WALNUT DENTAL GROUP & 4040 Barranca Pkwy Ste 140, 92201-5441 DC057955 ORTHODONTICS 92604-4773 760-347-7505 Western Dental Center 14415 Culver Dr, 92604-0305 949-559-7300 1/0 (SP) 3561 W Centruy Blvd Ste D, 949-733-0486 1/0 (SP) 90303 5/1 (SP) DC021202  323-483-7041 Jurupa Valley INLAND DENTAL CENTER 32/0 (SP) DC042097  DC063511  44100 Jefferson St Ste D404, SEDATION & IMPLANT Western Dental Services Inc 92201-2714 DC062261  DENTISTRY 4834 Etiwanda Ave Ste 200, 760-772-0214 Crown Dental 113 Waterworks Way Ste 220, 91752-1823 7/0 (AR SP VI) 1295 S La Brea Ave Ste 101, 92618-3176 951-688-7106 90301-0972 949-727-0777 12/0 (SP) DC023264  310-672-0129 0/1 (SP) TOWN & COUNTRY DENTAL 1/0 (SP) La Canada DC042860  81637 US Highway 111 Ste 1, DC053724  ALTON IMPLANT CENTER 92201-5439 Irvine Tina Ghotanian DDS 5405 Alton Pkwy Ste F, 92604- 760-342-1448 DC000596  1370 Foothill Blvd Ste 102, 91011- 3719 0/1 (SP) MALEK MANSOUR DDS 2150 949-262-0300 22 Odyssey Ste 265, 92618-7701 818-864-6990 1/0 (HI SP) DC050205 949-585-1515 1/0 (SP) BRIGHT NOW! DENTAL - INDIO 2/0 (AR FR) 42250 Jackson St Ste 102, DC044965  La Canada Flintridge MANAL AZIZ DDS INC 92203-9783 DC000757  14150 Culver Dr Ste 205, 92604- DC046681 760-238-4011 DR AMIR SADJADI DMD PC 0323 LA CANADA SMILES 9/0 4950 Barranca Pkwy Ste 304, 949-559-6565 DENTISTRY DENTAL GROUP 92604-4631 2/0 (AR) 2220 Foothill Blvd Ste A, 91011- 949-861-8441 1413 1/0 (CH FR LO PE SP) 818-248-1021 6/0

56 DeltaCare® USA

La Crescenta DC049651 DC013855  La Quinta DC015841  LA JOLLA VILLAGE SMILES BEST CARE DENTAL DC000631  FAMILY DENTISTRY DENTISTRY AND IMPLANTS 15651 Imperial Hwy Ste 206, LA QUINTA DENTAL GROUP 3157 Foothill Blvd Ste A, 91214- 8657 Villa La Jolla Dr Ste 211, 90638-1653 78595 Highway 111 Ste 300, 4247 92037-8309 562-947-2559 92253-2084 818-541-9724 858-272-2260 1/0 (KO SP) 760-771-0300 0/1 (AM RU SP) 6/0 5/1 (SP) DC058175  DC018881  La Mesa Family Dental Works DC019230  NINA SONIN DDS DC051050  15018 La Mirada Blvd, 90638- BRIGHT NOW DENTAL 3043 Foothill Blvd Ste 5, 91214- PAUL H VAN HORNE DDS 4743 79255 Highway 111 # 1A1B, 2773 7200 Parkway Dr Ste 115, 91942- 714-521-6827 92253-8301 818-542-3039 1534 1/0 (FR SP VI) 760-771-1200 0/1 (RU SP) 619-463-5883 10/0 1/0 DC058501  La Habra JOHN WESTERMEYER DDS La Verne 11900 La Mirada Blvd Ste 7, DC002721  DC053128  DC006423  90638-1337 CHESTER JENG DDS INC Jeramel Jardin DDS LAVERNE DENTAL GROUP 562-947-3761 744 W La Habra Blvd, 90631- 8805 La Mesa Blvd, 91942-5406 2216 Foothill Blvd, 91750-2944 1/0 (SP) 5313 619-741-8300 909-392-3899 562-691-0738 1/0 (TA) 9/2 (SP) DC175301  0/1 (CA CH 12 SP) LA MIRADA FAMILY DENTAL DC054905  DC041125 13922 Imperial Hwy, 90638-1725 DC009542  Great Smiles of La Mesa BRIGHT NOW DENTAL- 562-926-7025 HARBOR DENTAL CARE 5208 Jackson Dr Ste 108, 91942- LAVERNE 0/1 (SP) 1150 E Imperial Hwy, 90631-7454 7902 2497 Foothill Blvd Ste E, 91750- 714-992-2200 619-466-4448 3066 DC359401  0/1 (KO SP) 1/0 (SP) 909-451-0329 MAGDY & ALINA GAD 16/0 12252 La Mirada Blvd, 90638- DC025175  DC056334  1306 AKSHAR DENTAL Rancho San Diego Dentists DC060006 562-943-0151 1281 E La Habra Blvd Ste 4, Dental Group Enayda M Enabe DDS 0/2 (AR CH SP) 90631-5661 3767 Avocado Blvd, 91941-7301 2025 Foothill Blvd Ste B, 91750- 619-729-2323 562-697-3788 La Puente 3560 1/0 (HI SP) 5/0 909-593-1347 DC002085  1/0 (SP TA) DC029119  DC056384  SMILESWEST LA HABRA SMILES DENTAL Affinity Dental La Mesa 15448 Amar Rd, 91744-2802 DC063386  1250 W Whittier Blvd, 90631-3611 8881 Fletcher Pkwy Ste 325, 626-498-8971 La Verne Dental and Implant 562-266-9277 91942-3194 8/1 (AR AM CH FR JA KO PE PL Center 0/1 (SP) 619-697-2800 PT SP TA TA TH) 2488 Foothill Blvd Ste C, 91750- 2/0 (SP) 3062 DC031239  DC003823  909-596-1155 KYUNG YU DDS DC058439 VIJAY PHARAR DDS 2/0 (AM SP) 1370 S Beach Blvd Ste E, 90631- La Mesa Modern Dental Group 17311 E Valley Blvd Ste B, 91744- 1178 5620 Lake Murray Boulevard, 5696 Laguna Beach 91942 626-810-2444 562-694-5850 DC001503  619-324-4195 1/0 (AR HI SP) 1/0 (KO SP) LAGUNA BEACH DENTAL 2/0 GROUP DC031436  DC035596  31796 Coast Hwy, 92651-6974 DC062578  FAIRGROVE FAMILY DENTISTRY LA HABRA MODERN 949-415-1020 Smile Dental of San Diego 15260 Fairgrove Ave, 91744-1067 DENTISTRY AND 1/1 (SP VI) ORTHODONTICS 5601 Grossmont Center Dr Ste 626-968-4733 200, 91942-3074 0/1 (CA CH 12 SP VI) 1701 W Imperial Hwy Ste B, Laguna Hills 90631-0604 619-462-2272 DC004941  562-690-5729 3/0 (KO SP) DC049321  S C DENTAL CARE 2/1 (SP) CLINICA DENTAL DEL SOL DC266701  1431 N Hacienda Blvd, 91744-1133 22972 Moulton Pkwy Ste 106, 92653-1219 La Jolla GENTLE DENTAL-GROSSMONT 626-919-2315 5565 Grossmont Center Dr Ste 1/0 (SP) 949-770-3010 DC013282  459, 91942-3023 0/1 (SP) LA JOLLA DENTAL ARTS 619-464-3383 DC053113  7540 Fay Ave, 92037-4839 0/2 (GE KO SP TA VI) Western Dental Service DC014941  858-729-9808 835 N Hacienda Blvd, 91744- BRILLIANT SMILE 1/0 (HI SP) La Mirada 2809 23024 Lake Forest Dr Ste A, 92653-1328 DC002493  626-333-3384 DC018814  949-716-7166 IMPERIAL DENTAL 58/0 (SP) GREY CUNNINGHAM DDS-PROF 1/0 CORP 15769 Imperial Hwy, 90638-2510 DC061635  7300 Girard Ave Ste 206, 92037- 562-902-9898 K-Care Dental Center DC045447  5138 3/0 (AM KO SP) 13757 Amar Rd Ste A, 91746-1692 TADROS DENTISTRY 858-454-4114 23141 Moulton Pkwy Ste 211, DC012760  626-337-0230 0/1 92653-1204 NEW AGE DENTAL 1/0 (SP) 949-916-0568 DC040333  14545 Telegraph Rd, 90638- DC063114  1/0 (AR PE SP) RENAISSANCE DENTAL 1054 La Puente Family Dentistry CENTER 562-777-1188 14285 Amar Rd, 91746-2154 4150 Regents Park Row Ste 320, 1/0 (SP) 626-917-9308 92037-1417 1/0 (SP) 858-453-2070 1/0 (PT SP TA)

57 DeltaCare® USA

DC054185  Laguna Woods DC015836  DC055786  Alicia Parkway Dental DC052477  LAKEWOOD PLAZA DENTAL Lancaster Modern Dentistry 25401 Alicia Pkwy Ste J, 92653- Leisure Dental GROUP Dental Group 4958 24102 El Toro Rd Ste A, 92637 4346 South St, 90712-1152 43531 10th St W, 93534-6005 949-587-3010 949-830-6510 562-408-3500 661-839-7630 1/0 (SP VI) 6/0 (SP) 0/2 (SP) 4/0 (SP)

DC056970  Lake Elsinore DC035364  DC056321  Laguna Hills Family Dentistry CANDLEWOOD SMILES Elite Dental Care DC015327  23961 Calle De La Magdalena Ste DENTAL GROUP 44439 17th St W Ste 201, 93534- MARKETPLACE DENTAL 431, 92653-3685 4443 Candlewood St, 90712- 2856 GROUP 949-588-7525 1736 661-723-1461 29273 Central Ave Ste A, 92532- 1/0 (SP) 562-634-5042 1/0 (AM CA KO 12 SP) 2254 6/2 (SP) 951-245-8664 DC058323  DC058757 4/1 (SP) Loberg Professional Dental DC043229  Eagle Dental Center LAKEWOOD FAMILY DENTAL 1306 W Avenue J Ste A, 93534- DC017778  23141 Moulton Pkwy Ste 210, GROUP 2936 OAK GROVE DENTAL GROUP 92653-1204 5203 Lakewood Blvd, 90712- 844-563-2453 18285 Collier Ave Ste B, 92530- 949-586-1930 2438 1/0 (CH SP) 2786 2/0 (SP) 562-531-7373 951-471-0034 2/0 (AR SP) DC059118  5/2 (SP) DC062570  West Lancaster Dental Group Dr Edward H Moussally DC052901  1669 W Avenue J Ste 305, DC057422 24953 Paseo De Valencia Ste LAKEWOOD DENTAL ARTS 93534-2870 Western Dental Services Inc 23A, 92653-4343 5555 Del Amo Blvd, 90713-2307 661-802-7544 31960 Mission Trl, 92530-4539 949-916-4660 562-866-1735 5/0 (KO SP) 951-643-6094 1/0 4/0 (HI KO SP TA) 33/0 (SP) DC061922  Laguna Niguel DC056576  Western Dental Services Inc Lake Forest DC001925  Lakewood Cerritos Dental 2004 W Avenue J, 93536-5913 DC013278  LAGUNA NIGUEL DENTAL 5819 Adenmoor Ave, 90713-1067 661-949-1970 MARINA DENTAL GROUP 562-804-2296 18/0 (SP) 23591 El Toro Rd Ste 130, 92630- 27901 La Paz Rd Ste D, 92677- 3/0 (AR CH 4 KO 12 PT RU SP TA 4704 3932 TH VI) DC378501  949-206-9508 949-389-9195 KAMRAM SAIDARA DDS 1/0 (SP) 5/1 (SP) DC329201  2030 W Avenue J, 93536-5913 JITEN VASA DDS 661-949-6757 DC062625  DC054520  11455 Carson St Ste E, 90715- 1/0 (AR PE PT SP) Family Smiles Dental Care Choice Dental Care 2581 23082 Ridge Route Dr Ste A, 30262 Crown Valley Pkwy Ste E, 562-860-7116 Lawndale 92630-3691 92677-2364 1/0 (HI SP) DC002783  949-837-2766 949-363-0018 DENTAL CENTER OF REDONDO 2/0 (HI KO RU SP) 1/0 (SP VI) Lancaster BEACH DC001819  16819 Hawthorne Blvd, 90260- DC062869  DC057614  HI DESERT DENTAL CENTER 3219 Dental Wellness of Lake Forest Niguel Family Dentistry 1745 W Avenue K Ste C, 93534- 310-921-3938 22373 El Toro Rd, 92630-5053 30001 Crown Valley Pkwy Ste G, 6504 0/1 (AM SP) 949-444-5833 92677-1723 661-723-5400 1/0 (12 SP VI) 949-495-4245 0/2 (PE RU SP) DC011201  1/0 (AR CH SP) HAWTHORNE DENTAL DC063619 DC021132  15017 Hawthorne Blvd, 90260- Smile On You DC063751  BRIGHT NOW DENTAL 1504 26741 Rancho Parkway Ste 105A, Laguna Surgical & Cosmetic 43456 10th St W, 93534-6004 310-973-6428 92630 Specialist 661-945-2900 0/1 (AM CH KO PT RU SP) 949-716-4892 28202 Cabot Rd Ste 420, 92677- 10/1 (12 SP) 1/0 1273 DC013518  949-347-9990 DC039638  HANNA DENTISTRY DC0C4801  1/0 (SP) WESTERN DENTAL SERVICES 14314 Hawthorne Blvd, 90260- LAKE FOREST DENTAL GROUP 44407 Challenger Way, 93535- 1515 23704 El Toro Rd Ste A, 92630- DC170601  3237 310-676-6400 8906 RANCHO NIGUEL DENTAL 661-341-3100 1/0 (AR SP) 949-770-9355 GROUP 33/4 (SP) 4/2 (SP) 30140 Town Center Dr, 92677- DC020267  2037 DC046791  BRIGHT NOW DENTAL Lakeside 949-249-4180 DESERT BREEZE DENTAL CARE 16128 Hawthorne Blvd, 90260- 2/0 (FR SP) DC054051 44404 16th St W Ste 205, 2931 Gregory Culton DMD 93534-2839 310-370-4511 DC304801  9929 Channel Rd, 92040-3003 661-942-1474 21/0 (IN KO 12 SP) SOBHI BATNIJI DDS 619-561-4430 1/0 (AM SP) 30231 Golden Lantern Ste D, 1/0 Lemoore 92677-5989 DC047016  DC063122  Lakewood 949-363-1200 PREMIER DENTAL CARE United Health Centers of the San 0/1 (AR FR) DC013223  612 W Lancaster Blvd Ste A, Joaquin Valley D AND D DENTAL OFFICE 93534-3108 250 E Hanford Armona Rd, 4180 Woodruff Ave, 90713-3144 661-948-9646 93245-2141 562-938-9514 1/0 (AR FinnishHI KO SP) 559-997-6140 1/1 (SP VI) 2/0 (SP VI)

58 DeltaCare® USA

Loma Linda DC018976  DC062817  DC002540  DC059061  ACCU DENTAL GROUP Family Dentistry WOODSIDE DENTAL Ronald L Moore DDS Inc 6413 E Spring St, 90808-4022 5399 Orange Ave, 90805-6017 1273 Westwood Blvd, 90024- 25835 Barton Rd Ste 104, 92354- 562-938-8388 562-422-1000 4899 3898 0/1 (SP VI) 1/0 (SP) 310-824-0055 909-796-2299 1/0 (TA) 1/0 (SP) DC023648  DC063204  NEWPORT DENTAL Western Dental Services Inc DC002865  DC059207  3383 Long Beach Blvd, 90807- 2306 E 7th St, 90804-4619 CYPRESS DENTAL CLINIC Western Dental Services Inc 4408 562-434-0740 2135 Cypress Ave, 90065-1212 25733 Barton Rd, 92354-3812 562-424-1600 5/0 (SP) 323-223-0731 909-798-2755 19/0 (KO SP) 1/0 (HI SP) 29/0 DC359201  DC024563  MARK COCCHI DDS DC002866 Lomita BASHAR KOMOC DDS 2880 Atlantic Ave Ste 190, JOCELYN CAPISTRANO DDS 3318 E Anaheim St, 90804-4025 90806-1724 628 N Vermont Ave Ste 5, DC008858 562-986-5570 562-426-0778 90004-2154 SHANNON YOON DDS 1/0 (GE RU SP) 1/0 (GE) 323-644-3650 25124 Narbonne Ave Ste 202, 1/0 (SP TA) 90717-2141 DC037979  Los Alamitos 310-530-3260 GARY TROMBATORE & KENNY DC003153  1/0 (SP) DC051429 ABEDINI LOS ALAMITOS FAMILY ADELAIDA QUINGCO DDS 3816 Woodruff Ave Ste 104, 1127 Wilshire Blvd Ste 1103, DC037047  DENTISTRY 90808-2145 90017-4002 DAVID SUH DDS INC 3662 Katella Ave Ste 206, 562-425-0545 213-250-3998 25609 Narbonne Ave, 90717- 90720-3192 2/0 (SP TA VI) 1/0 (SP TA) 2513 562-598-7914 310-326-8572 1/0 DC039876  DC005210  1/0 (JA KO SP VI) WESTERN DENTAL SERVICES DC187701  VENICE DENTAL GROUP INC 1150 E Anaheim St, 90813-3663 12563 Venice Blvd, 90066-3712 DC060233  LOS ALAMITOS DENTAL ARTS 562-437-0646 310-390-2423 St Francis Dental 3724 Katella Ave, 90720-3102 58/10 (SP) 1/0 (AR SP) 2055 Lomita Blvd, 90717-1701 562-936-0071 310-530-3100 1/1 (SP) DC047786  DC005901  1/0 (SP) DR ZAK LONG BEACH DENTAL DC283401  JAMES BLACK DDS CARE 3015 Crenshaw Blvd Ste A, Lompoc ASHOKKUMAR MEHTA DDS 3620 Long Beach Blvd Ste B6, 10900 Los Alamitos Blvd Ste 90016-4264 DC058634  90807-6008 133, 90720-5612 323-731-0801 Ericson Dental Group Lompoc 562-426-6458 562-596-8888 4/0 (FR KO SP) 719 E Ocean Ave, 93436-7014 12/0 (RU SP) 1/1 (AR FR HE HI SP) 805-735-2702 DC006471  1/0 (SP) DC056895 Los Angeles ST GEORGE DENTAL CLINIC Marina Smiles Dentistry dental 7260 W Sunset Blvd Ste 201, DC000635  DC058635  Group 90046-3417 CENTRO MEDICO DENTAL Prasan Mohansinh Parmar DDS 6437 E Pacific Coast Hwy Unit 323-469-8816 FAMILIAR 1133 N H St Ste L, 93436-3383 A-6, 90803-4201 1/0 (AR RU SP) 514 E Washington Blvd, 90015- 805-736-8011 562-280-5200 3723 1/0 (HI SP) 4/0 DC006734  213-749-3934 RAMIN TOUR DDS INC 2/0 (RU SP) Long Beach DC059510  907 N Virgil Ave, 90029-2911 DC000633  Western Dental Services Inc 323-661-8384 DC000759  UNITED FAMILY DENTAL 2360 Pacific Ave, 90806-3051 0/1 (FR SP TA) Samaritana Dental 141 E Willow St Ste P, 90806- 562-595-0731 504 S Alvarado St Ste 208, 2634 27/0 DC007538  90057-2914 562-988-2888 AIRPORT CENTER FAMILY 213-335-3590 1/0 (HI KO SP TA VI) DC061590  DENTAL 2/0 (SP TA) Cherry Dental 5304 W Century Blvd, 90045- DC011675  6616 Cherry Ave, 90805-1715 5910 DC001664  BEAUTIFUL SMILES DENTAL 562-630-2262 310-215-1455 WILSHIRE SMILE STUDIO DTL CARE 1/0 (AR SP) 1/1 (SP) GRP 1729 Termino Ave, 90804-2121 6200 Wilshire Blvd Ste 1609, 562-494-8400 DC061686 DC008727  90048-5817 0/1 (SP) Western Dental Services Inc NEWPORT DENTAL 323-336-8478 4516 Atlantic Ave, 90807 3635 E 1st St, 90063-2345 2/1 (HE) DC013333 562-495-6237 909-624-6199 VICTOR DE LOS SANTOS DDS 47/0 7/1 (SP) DC002326  INC FRED NAYSSAN DDS 3712 Atlantic Ave Ste C, 90807- DC061850  DC009138  10350 Santa Monica Blvd Ste 3542 Carson Dental & Cosmetic OJAN GHALCHI DMD 190, 90025-5073 562-426-1298 Centre 281 Columbia Ave, 90026-5971 310-557-1704 0/2 (SP TA TA) 1200 E Carson St Ste 300, 213-483-3020 2/0 (SP TA) 90807-3075 1/0 (SP) DC015864  562-988-7788 DC002507  OMEGA FAMILY DENTAL 1/0 (CH KO SP) DC009538 BRENTWOOD DENTAL GROUP 816 W Willow St, 90806-2837 BEVERLY HILLS PRESTIGE 11980 San Vicente Blvd Ste 660, 562-595-7077 DC062542  DENTAL 90049-6641 1/0 (CH SP VI) Bixby Knolls Modern Dentistry 1125 S Beverly Dr Ste 400, 310-979-8345 Dental Group 90035-1152 1/0 (AR FR SP) 4578 Atlantic Ave, 90807-1513 310-286-7447 310-579-6465 1/0 (HE SP) 2/0 (SP)

59 DeltaCare® USA

DC010344  DC019946  DC033797  DC040862  WILSHIRE DENTAL CARE DAVIS FAMILI DDS MAGD INC FLORENCE DENTAL GROUP ALLURE DENTISTRY 6200 Wilshire Blvd Ste 1508, 11500 W Olympic Blvd Ste 508, 1575 E Florence Ave Ste A, 1872 S Sepulveda Blvd Ste 2, 90048-5816 90064-1528 90001-2555 90025-4314 323-931-2000 310-477-7744 323-537-4121 310-444-9121 1/1 (HI PE RU SP) 0/1 (SP) 1/0 (HE SP) 1/0 (AR HE HI PT SP)

DC012440  DC021424  DC034767  DC042201  WILSHIRE DENTAL GROUP NORMANDIE DENTAL CLINIC PICO DENTAL GROUP PATRICK CLERK DDS 6200 Wilshire Blvd Ste 1104, 1690 W Adams Blvd, 90007- 1561 W Pico Blvd, 90015-2407 1200 Wilshire Blvd Ste 615, 90048-5812 1535 213-251-9994 90017-1995 323-525-1819 323-730-0924 0/1 (SP) 213-481-1252 1/0 (AM RU SP) 1/0 (AM RU SP) 1/0 DC036135  DC012441  DC021502  GANJI AND KAMANGAR DC042336  AMY IWATA DDS FOREVER SMILE DENTAL CARE DENTAL DENTAL PARK 3756 Santa Rosalia Dr Ste 504, 6200 Wilshire Blvd Ste 1604, 1005 E Washington Blvd Ste B, 753 S Vermont Ave, 90005-1518 90008-3656 90048-5817 90021-3020 213-385-2875 323-293-2600 323-634-9004 213-765-0004 1/0 (KO SP) 1/0 0/1 (SP) 2/0 (AR SP) DC042903  DC014328  DC022103  DC036164  WESTWOOD DENTAL ARTS THEODORE STOMEL DMD AFAR & GHASRI DENTAL CORP HR IMANKHAN DDS INC CENTER 6333 Wilshire Blvd Ste 208, 6200 Wilshire Blvd Ste 1508, 3356 E Olympic Blvd, 90023- 10921 Wilshire Blvd Ste 501, 90048-5724 90048-5816 3724 90024-4001 323-653-1300 323-931-2000 323-269-5221 310-443-3030 0/2 (RU) 0/1 (SP TA) 1/0 (FR SP TA) 2/0 (SP)

DC014615  DC022394  DC036961  DC043761  MANUEL LAZO JR DDS HENGAMHEH ANARAKI DDS HISTORIC CORE DENTAL CARE BRIGHT NOW DENTAL 3827 W Sunset Blvd Ste A, INC 111 W 7th St Ste R5, 90014-3951 4550 W Pico Blvd Ste C309, 90026-1594 244 S Oxford Ave Ste 12, 90004- 213-629-9222 90019-4271 323-660-5630 5126 1/1 (SP) 323-602-0590 1/0 (TA) 213-388-5533 6/0 1/0 (SP) DC038015  DC014858  Z DENTAL GRP DC043916  PERSONAL DENTAL OFFICE DC024589  6320 Commodore Sloat Dr Ste 1, ANGELENOSMILE 6222 Wilshire Blvd Ste 103, SMILE MAKERS 90048-5453 10921 Wilshire Blvd Ste 510, 90048-5100 998 S Robertson Blvd, 90035- 323-936-9997 90024-4001 323-933-4444 1637 4/0 (AR AM PE RU SP) 310-824-2624 0/1 (PT RU SP) 310-358-1200 1/0 (AR AM FinnishHE PE SP TA) 1/0 (SP) DC039584  DC016202 WOO SUNG PARK DENTAL DC044490  IMPRESSIVE DENTAL DC026085 CORP WEST COAST DENTAL GROUP 1435 S Vermont Ave Ste 101, MARK A MOSES DDS 3130 W Olympic Blvd Ste 320, 2604 S Vermont Ave Ste F, 90006-4543 1839 W Imperial Hwy, 90047- 90006-2494 90007-2298 213-739-3096 5021 323-766-2888 323-731-3333 0/1 (SP) 323-757-1761 1/0 (KO) 7/1 (SP) 1/0 (SP) DC017531  DC039636  DC044501  PREMIER DENTAL CLINIC INC DC027694  WESTERN DENTAL SERVICES WILSHIRE CENTRAL DENTAL 1115 Colorado Blvd, 90041-2503 GENTLE FAMILY DENTIST 1565 S Western Ave, 90006- GROUP 323-255-4600 5207 Whittier Blvd, 90022-4012 4233 3932 Wilshire Blvd Ste 100, 0/1 (AM SP) 323-269-0266 323-734-8843 90010-3307 2/0 (HI SP) 45/5 (SP) 213-386-3336 DC017534  8/0 (SP) WEST COAST DTL GRP 6TH DC028254  DC039892  STREET WESTWOOD DENTAL CARE WESTERN DENTAL SERVICES DC044525 1725 W 6th St, 90017-1000 10921 Wilshire Blvd Ste 601, 906 S Soto St, 90023-1323 BRIGHT NOW DENTAL 213-413-5151 90024-4003 323-263-9063 8611 S Sepulveda Blvd, 90045- 14/1 (AR AM CH FR KO SP VI) 310-208-8551 38/1 4001 1/0 (KO SP) 310-846-0172 DC018373  DC039893  13/2 ARAM ARAKELYAN DDS DC029955  LA BREA FAMILY DENTAL 2426 W 8th St Ste 209, 90057- RAMIN RAVAEI DMD GROUP DC046688  3872 1835 S La Cienega Blvd Ste 200, 3400 S La Brea Ave, 90016-5217 WESTERN DENTAL SERVICES 213-381-3900 90035-4648 323-734-2284 INC 0/0 (AM SP) 310-836-0300 1/0 (KO SP) 4165 Beverly Blvd, 90004-4418 1/0 (KO SP TA) 323-662-0738 DC018953  DC040123  38/0 (SP) LA PAZ CLINIC DC033266  JAY J CHOBDEE DDS 1107 S Alvarado St Ste 102, MICHAEL SCHNEIDER DMD 2105 Beverly Blvd Ste 101, DC046742  90006-4161 10921 Wilshire Blvd Ste 809, 90057-2248 WESTERN DENTAL SERVICES 213-380-9999 90024-4003 213-484-1288 INC 3/1 (HE SP) 310-208-6813 2/0 (SP TA) 1054 Vine Street, 90038-2745 0/1 (JA SP) 323-465-9055 DC040228  43/0 (SP) ANTHONY S PAN DMD INC 3346 N Eastern Ave, 90032-1948 323-227-1800 1/0 (CA CH 12 SP VI)

60 DeltaCare® USA

DC047810  DC057047 DC061085  DC211901  HOUSE OF DENTAL HEALTH Just Smile Dental Center Family Dental Care 4 You CULVER DEL REY DENTAL 530 E Washington Blvd Ste A, 1269 S Union Ave, 90015-2043 5602 W Manchester Ave, OFFICE 90015-3723 213-251-1400 90045-4416 12202 W Washington Blvd, 213-222-2990 1/0 (SP TA) 310-450-0300 90066-5508 1/0 (SP) 1/0 (PL SP TA) 310-915-9797 DC057353  2/0 (AM FR SP) DC047869  Brite Dental DC061201  PACIFIC OCEAN DENTAL 3530 Wilshire Blvd Ste 150, Brighter Dental DC228301  5161 Pomona Blvd Ste 112, 90010-2324 6221 Wilshire Blvd Ste 507, GENTLE CARE DENTAL INC 90022-1772 213-739-2828 90048-5223 3500 Whittier Blvd Ste 101, 323-262-2600 1/0 (KO SP) 323-939-7899 90023-1746 1/0 (KO SP) 1/0 (SP) 323-264-8834 DC057590  1/0 (CH SP) DC050881  Just Smile Dental Center DC061202  BRIGHT AND WHITE 309 S Vermont Ave, 90020-1806 Affinity Cosmetic Center DC270601 DENTISTRY 213-382-5555 1345 S La Brea Ave, 90019-2916 BYUNG CHUL KIM DDS 3171 Glendale Blvd, 90039-1805 1/0 (SP TA) 818-884-4338 765 N Virgil Ave, 90029-3646 323-663-3122 1/0 323-665-5887 1/0 (AM RU SP) DC058347  1/0 (KO SP) The Culver Marina Dental Group DC062139  DC052861 12756 W Washington Blvd, Pico LaCienega Dental Group DC349001  Western Dental Services Inc 90066-2309 8530 W Pico Blvd, 90035-2410 CHERYL BINGHAM DDS 355 W Manchester Ave, 90003- 310-822-6066 310-854-6107 11905 S Central Ave Ste 203, 3327 2/0 (FR SP) 1/0 (SP) 90059-2897 323-751-4100 323-564-7504 33/0 DC058792 DC062179  1/0 (SP) Western Dental Services Inc Welcome Dentistry DC052869 1200 W Martin Luther King Jr 2500 W 8th St Ste 106, 90057- DC353301  Western Dental Services Inc Blvd, 90037-1722 3860 DEVANG GANDHI DENTAL 4364 S Central Ave, 90011-3527 323-295-8004 213-381-2827 CORP 323-232-5266 37/0 (SP) 1/0 (KO SP) 2500 W Florence Ave, 90043- 39/0 (AM RU SP) 5144 DC059229  DC062245  323-750-2082 DC053114  Western Dental Services Inc Smiles West Los Angeles 1/0 (HI SP) Western Dental Service 2839 N Eastern Ave, 90032-2701 1440 W Manchester Ave, 90047- 12420 Venice Blvd, 90066-3840 323-897-1020 5422 DC372501  310-482-0014 8/0 323-753-1141 MEHRDAD MAKHANI DDS 35/0 (SP) 2/0 (AR AM CH FinnishFR JA KO 6200 Wilshire Blvd Ste 1606, DC059380  PL RU SP TH TR) 90048-5817 DC055285  Crystal Dental 323-933-7744 E Dental Center 2206 S Figueroa St, 90007- DC063183  1/0 (SP) 3456 Motor Ave Ste 105, 90034- 2049 Joshua Barkhordar DDS Inc 4737 213-748-8448 2390 Glendale Blvd, 90039- DC375201  424-258-6018 1/0 (SP) 3209 HOLLYWOOD SMILE DENTAL 1/0 (SP TA TA VI) 323-922-6016 CENTER DC060092  1/0 (AM HE SP) 8182 W Sunset Blvd Ste 202, DC055390 Victor De Los Santos DDS 90046-2440 Jabeen Mah Khan DDS Inc 201 S Alvarado St Ste 402, DC092401  323-654-1100 643 W Manchester Ave, 90044- 90057-2353 Smile Comfort Dental 1/0 (AM GE HE RU SP) 5718 213-484-2919 5220 W Washington Blvd Ste 323-753-1411 1/0 (SP TA) 103, 90016-1331 DC393401  1/0 323-933-5641 SID SOLOMON DDS DC060206  2/0 (AR CH 12 RU SP TA) 1620 Westwood Blvd, 90024- DC055462  All In One Dental 5604 Salud Dental 8930 S Sepulveda Blvd Ste 118, DC0C7201  310-475-5598 2621 E 1st St, 90033-3505 90045-3606 AMERICAN HEALTH PRO 0/1 (FR SP) 323-268-9386 310-645-6033 3130 S Sepulveda Blvd Ste D, 2/0 (SP) 2/0 (HE RU SP) 90034-4214 Lynwood 310-268-0646 DC009863  DC056230  DC060411  1/0 (AR AM CH HE 12 RU SP TA) SMILESWEST LA Smiles Dentistry Smile Makers Dental Office 11035 Long Beach Blvd Ste 5, 5010 S La Brea Ave, 90056-1800 2105 Beverly Blvd Ste 229, DC152101  90262-2570 323-296-2300 90057-2283 CALIFORNIA DENTAL CARE 310-945-2704 1/0 (SP) 213-908-6655 11628 Santa Monica Blvd Ste 101, 6/1 (AR AM CH FR HI JA KO 12 1/0 (HE SP) 90025-2965 PE PL PT RU SP TA TA TH TR VI) DC056403  310-207-1060 Afsoon Barkhordar DDS Inc DC060418  0/1 (SP) DC049649 6200 Wilshire Blvd Ste 909, Dental Park UNITED FAMILY DENTAL 90048-5810 3663 W 6th St Ste 110, 90020- DC198001  10721 Atlantic Ave Ste J, 90262- 323-935-2111 3047 UNITED FAMILY DENTAL 2352 2/0 213-380-1767 GROUP 310-761-1111 1/0 (KO SP) 5109 Whittier Blvd, 90022-3926 1/0 DC056767  323-265-2222 Gary Manukyan DDS Inc DC060548  1/0 (SP) DC059509  1828 Hyperion Ave, 90027-4738 Westchester Dental Samia Ali Western Dental Services Inc 323-543-0043 DDS 3680 E Imperial Hwy Ste 100, 1/0 (SP) 8540 S Sepulveda Blvd Ste 90262-2663 1000, 90045-3808 310-761-8100 310-649-2430 26/0 1/0 (AR SP)

61 DeltaCare® USA

Manhattan Beach Mira Loma DC055935  Montebello DC2C1401  DC022611  Saddleback Dental Associates DC025188  MANHATTAN VILLAGE DENTAL MIRA LOMA SMILES DENTISTRY 23166 Los Alisos Blvd Ste 230, MONTEBELLO DENTAL CENTER GRP DENTAL GROUP 92691-7867 2453 W Beverly Blvd, 90640- 1200 Rosecrans Ave Ste 210, 6445 Pats Ranch Rd Ste G, 949-457-0223 2305 90266-2470 91752-4439 1/0 (RU) 323-838-8055 310-414-0620 951-808-5881 1/0 (KO SP) 0/1 4/2 (SP) DC057404  Blessed Smile Dentistry of DC058825 DC2C2701  Mission Hills Mission Viejo Western Dental Center 23032 Alicia Pkwy Ste D, 92692- MANHATTAN BEACH DC053367  2200 W Beverly Blvd Ste 400, 1600 DENTISTRY Devonshire Dental Group 90640 949-916-1610 500 S Sepulveda Blvd Ste 210, 15534 Devonshire St Unit 108, 323-476-3032 2/0 90266-6976 91345-2673 27/0 310-372-8188 818-894-6411 DC059706  0/1 (SP) 2/0 (12 SP) DC060238 Alicia Orthodontic & Pediatric Tigran Shahmanyan DDS Inc Dental Specialties Marina Del Rey DC062434  3001 W Beverly Blvd Ste 100, 24481 Alicia Pkwy Ste B3, 92691- DC021402  Barouir Deirmenjian 90640-2255 4534 MARINA DENTISTRY INC 10331 Sepulveda Blvd, 91345- 323-728-0327 949-586-9800 4292 Lincoln Blvd, 90292-5655 2421 1/0 (AM RU SP) 2/0 (SP) 310-578-5000 818-810-3290 1/1 (AR SP) 3/0 (AM CH JA KO SP TH) DC062503  DC060817  Smiles West Montebello Sunshine Smiles of Orange DC056746  DC063954  1451 N Montebello Blvd, 90640- County MARINA FAMILY DENTAL Mission Hills Modern Dentistry 2584 27725 Santa Margarita Pkwy Ste 13286 Fiji Way, 90292-7119 Dental Group 323-724-9955 270, 92691-6708 310-821-2611 10306 Sepulveda Blvd, 91345- 2/0 (AR AM CH FR KO PL PT SP 949-541-8722 2/0 (AR AM FR HE RU SP) 2422 TH) 1/0 818-722-1576 DC059733  1/0 (SP) DC063177 DC063006  Design Dental Spa Montebello Dental Group H Koh Dental Corp 3206 Washington Blvd, 90292- Mission Viejo 3301 W Beverly Blvd, 90640- 25100 Marguerite Pkwy Ste A, 5553 1536 DC008877  92692-2467 310-822-3833 323-722-6766 GENTLE DENTAL MISSION 949-768-3801 1/0 (AM HE RU SP TA) 1/0 (SP) VIEJO 1/0 (KO SP) 25523 Marguerite Pkwy Ste C, DC363901  Maywood 92692-2925 Monrovia S GHAZARIAN DDS DC039639  949-768-1800 DC039133  433 N Montebello Blvd, 90640- WESTERN DENTAL SERVICES 6/0 (SP) MONROVIA MODERN 4222 4487 Slauson Ave, 90270-2943 460 W Huntington Dr, 91016- 323-722-2922 323-773-9961 DC014271  3202 1/0 (AM SP) 46/7 (SP) MISSION DENTAL GROUP 626-358-3636 26032 Marguerite Pkwy # A1, 3/1 (AM HI SP) DC159601  92692-5281 Monterey Park SOUTHEAST DENTAL GROUP 949-582-8400 DC039748  DC044638  4332 Slauson Ave, 90270-2848 4/1 (SP) CLEAR CHOICE DENTAL DENTAL CARE 2000 PLUS 323-771-7777 2312 S Garfield Ave, 91754-7220 115 W Foothill Blvd, 91016-2144 3/0 (GE 12 SP VI) DC015611  323-722-1315 626-358-1833 MISSION VIEJO FAMILY 0/1 (CH SP VI) 1/0 (AR SP) Menifee DENTISTRY DC053700 DC026853  28201 Marguerite Pkwy Ste 10, Montclair Pacific Smile Dental Group MENIFEE SMILES DENTISTRY 92692-3719 DC050329  2111 S Atlantic Blvd, 91754 30406 Haun Rd Ste 740, 92584- 949-347-0302 GLAMOUR DENTAL CARE 323-261-9999 6816 1/1 (SP) 9509 Central Ave Ste D, 91763- 5/0 951-679-4624 2400 10/2 DC019948  MARGUERITE DENTAL CARE 909-399-3330 DC196401  1/0 (AR AM SP) PACIFIC DENTAL GROUP DC057050 27871 Medical Center Rd Ste 165, 2016 S Atlantic Blvd, 91754-6843 Menifee Dental Group 92691-6425 DC061365 323-725-6797 29950 Haun Rd Ste 302, 92586- 949-364-2529 Eagle Dental 0/1 (AM FR IT KO RU SP) 6527 1/0 (FR SP) 5467 Moreno St Ste A, 91763- 951-679-1667 1682 DC239601  8/0 DC021408  MISSION VIEJO DENTAL 844-563-2453 ISAAC CHEN DDS 1/0 (CH SP) 2071 S Atlantic Blvd Ste F, 91754- DC057987  23482 Alicia Pkwy, 92691-2601 6347 West Coast Dental Group of 949-581-0090 DC179501  323-260-7878 Menifee 13/1 CENTRAL FAMILY DENTISTRY 0/1 (CA 12 SP) 30035 Haun Rd Unit B, 92584- 9197 Central Ave Ste C, 91763- 6805 DC022891  1616 951-566-9090 JAMES VARTANIAN DDS INC Montrose 909-398-1107 5/0 (SP) 26302 La Paz Rd Ste 203, 92691- DC061280  5328 1/0 (SP TA TA) Montrose Smiles DC062540  949-586-5669 3901 Ocean View Blvd, 91020- DC3C2501  Menifee Lakes Dental Group 1/0 (SP) 1514 AMIEL PATEL DDS 29121 NEWPORT RD STE 101, 818-249-3213 4921 Moreno Street, 91763-1522 92584 1/0 (CH 12 SP) 909-625-3865 951-228-9296 1/0 3/0 (SP)

62 DeltaCare® USA

Moorpark DC062433  DC040220  DC046526 DC020308  SMILES WEST MORENO BRIGHT NOW DENTAL- WESTERN DENTAL SERVICES MOORPARK DENTAL GROUP VALLEY MURRIETA INC 718 W Los Angeles Ave Ste 3, 12252 Perris Blvd Ste B, 92557- 40790 California Oaks Rd Ste 12700 Sherman Way, 91605-5031 93021-1756 7418 A, 92562 818-764-8843 805-529-1743 951-801-4382 951-704-7740 47/0 6/1 (SP) 5/0 (AR AM CH FinnishFR KO PL 16/3 SP TH) DC349801  DC063230 DC053115 JULIAN GERSHFELD DDS SMILES AVENUE ADVANCED DC063182  Western Dental Services 5160 Vineland Ave Ste 105, COSMETIC DENTISTRY IC Smiles Family Dentistry 25155 Madison Ave Ste 101, 91601-3888 530 Moorpark Ave Ste 140, 24760 Sunnymead Blvd Ste 103, 92562-8975 818-761-8899 93021-1877 92553-3791 951-834-9750 0/1 (RU SP TA) 805-529-5955 951-807-3078 59/0 (SP) 1/0 (HI SP) 1/0 (SP) National City DC058837  DC035369  Moreno Valley DC273301  Gentle Dental Murrieta SOUTH COAST DENTAL ROBERT SILVOLA DDS 39872 Los Alamos Rd Ste A1, DC009130  202 Mile Of Cars Way, 91950- 12810 Heacock St Ste B103, 92562-5871 GENTLE DENTAL MORENO 6605 92553-3171 951-397-4526 VALLEY 619-477-1970 951-242-3441 2/0 12800 Heacock St Ste A1, 92553- 4/0 (SP TA) 1/0 (SP) 2868 DC063337  951-247-2688 DC036282 DC396301  Carlos L Torres 2/2 (SP) WESTERN DENTAL SERVICES DTL ASSOC MORENO VALLEY 25341 Madison Ave Ste 103, 1539 E Plaza Blvd Ste A, 91950- MALL 92562-9000 DC010509  3641 22500 Town Cir Ste 2074, 951-677-2115 BRIGHT NOW DENTAL 619-474-7900 92553-7527 1/0 (SP) 12420 Day St # B4, 92553-7536 33/9 (SP TA) 951-697-6800 951-656-6538 1/0 (HI 4 KO SP TH VI) DC0C2201  16/0 (SP) DC053793  MURRIETA DENTAL GROUP South Bay Plaza Dental Murrieta 40760 California Oaks Rd, DC015837  1210 E Plaza Blvd Ste 405, 92562-5794 ST PATRICK DENTAL CLINIC DC003165  91950-3628 951-677-3078 24655 Sunnymead Blvd, 92553- MURRIETA DENTAL GROUP 619-477-2787 6/1 (SP) 3760 25395 Madison Ave Ste 103, 1/0 951-242-6088 92562-9003 DC3C8601  0/1 (SP TA TA) 951-696-5660 DC056968  2/2 MURRIETA FAMILY DENTAL Beautiful SmilesDental GROUP DC022469  3403 E Plaza Blvd Ste G, 91950- 40643 California Oaks Rd, STONERIDGE DENTAL GROUP DC013121  4140 92562-5729 27110 Eucalyptus Ave Ste A, EAST MURRIETA DENTAL 619-267-6599 951-677-7779 92555-4542 GROUP 2/0 (SP TA) 2/0 (KO SP) 951-616-1759 39209 Winchester Rd Ste 100, 3/2 (SP) 92563-3513 Newbury Park 951-304-1348 N Hollywood DC047796  DC034810  4/2 (SP) DC002840  PARK PLACE DENTAL GROUP IMAGE DENTISTRY PACIFIC DENTAL GROUP 501 S Reino Rd Ste G, 91320- 23205 Sunnymead Blvd, 92553- DC017410  6801 Lankershim Blvd Ste 101, 4276 5246 MARGARITA DENTAL GROUP 91605-6112 805-499-4441 951-242-6242 39400 Murrieta Hot Springs Rd 818-764-0718 2/0 (SP) 1/0 (KO SP) Ste 123B, 92563-7709 0/1 (AM IT KO RU SP) 951-461-7470 DC063833  DC035115  0/1 (AM CH IT PT SP TH VI) DC003546 Community Dental Group DR PAREDES DENTAL OFFICE HAMLIN DENTAL GROUP 587 N Ventu Park Rd Ste C, 23318 Olive Wood Plaza Dr Ste DC017779  12509 Oxnard St Ste 201, 91606- 91320-2743 C, 92553-5219 PLAZA DENTAL GROUP 4440 805-499-1253 951-242-5585 40484 Murrieta Hot Springs Rd 818-285-5757 1/0 (SP) 1/0 (SP) Ste 102, 92563-6437 0/2 (AR AM CA CH IT 12 PT SP 951-461-4306 TA) Newhall 3/1 (SP VI) DC044310  DC014829  DC015654  WESTERN DENTAL SERVICES MITRA SIMANIAN DDS INC DC036403  HERSEL HANASAB DDS 23185 Hemlock Ave Ste 1, 92557- 23107 Lyons Avenue, 91321-2630 FRIENDLY DENTAL CENTER 12926 Sherman Way, 91605- 8043 661-255-7338 39252 Winchester Rd Ste 117, 4953 951-243-0784 2/0 (AM CA CH FR IT KO 12 PE 92563-3511 818-765-4422 60/10 (SP) SP) 951-894-7769 1/1 (AM SP) 2/0 (SP) DC048665  DC032350  DC021129  TOWNGATE FAMILY DENTAL JERROLD SINGER DDS DC037610  NORTH HOLLYWOOD DENTAL AND ORTHO 25061 Peachland Ave, 91321-2517 COPPER CANYON SMILES GRP 12625 Frederick St Ste F4, 661-255-7530 23771 Washington Ave Ste H102, 12125 Vanowen St Ste 2, 91605- 92553-5234 0/1 (SP) 951-697-7750 92562-2265 5665 1/0 (KO SP) 951-691-5096 818-764-4679 Newport Beach 0/1 (SP) 0/1 (AM SP TR) DC013066  DC057020 AMIT SHAH DDS BRIGHT NOW DENTAL- 355 Placentia Ave Ste 100, MORENO BEACH 92663-3301 12761 Moreno Beach Dr Ste 103, 949-646-0818 92555 1/0 (KM GE HI SP) 951-902-6068 9/0 63 DeltaCare® USA

DC016544  North Hills DC003204  DC036283 COASTAL IMAGE DENTAL DC058339  NORWALK FAMILY DENTAL WESTERN DENTAL SERVICES 3991 Macarthur Blvd, 92660 Maghiran Dental Corp 12319 Imperial Hwy, 90650-8303 3125 Vista Way Ste 100, 92056- 949-863-0988 9506 Sepulveda Blvd, 91343- 562-868-7955 3630 3/0 (CH SP) 3306 1/0 (SP) 760-439-0025 818-891-1136 35/14 (SP) DC029951  1/0 (SP TA) DC012590 OMID HARONIAN DDS PIONEER DENTAL INC DC040525  1901 Westcliff Dr Ste 6, 92660- North Hollywood 14034 Pioneer Blvd, 90650- ANDREW K JOHN DDS INC 5505 3900 2123 S El Camino Real, 92054- DC001667  949-646-2481 562-863-8779 6271 FAMILY DENTISTRY 1/0 (SP) 0/1 (SP) 760-757-7720 6738 Lankershim Blvd, 91606- 1/0 (KO SP) 1615 DC047391 DC013140  818-503-9697 NEWPORT DENTAL CENTER NEWPORT DENTAL DC058892  0/1 (RU SP) 2105 San Joaquin Hills Rd, 11481 Rosecrans Ave, 90650- Oceanside Dental & 92660-6507 3830 Orthodontics DC041338  949-721-1730 562-863-3457 4750 Oceanside Blvd Ste A15, ALLURE DENTAL 1/0 (SP) 5/4 (SP) 92056-3064 6058 Lankershim Blvd, 91606- 760-466-0776 4806 DC062099  DC015591  1/0 (SP) 818-766-0056 Leo S Shin DDS Inc BRIGHT NOW DENTAL- 0/1 (AM RU SP) 1401 Avocado Ave Ste 701, NORWALK DC062220 92660-8709 12052 Imperial Hwy Ste 101, Cassidy Smiles Northridge 949-644-4571 90650-3087 605 Cassidy St, 92054-6033 1/0 (KO SP) DC002753  562-863-4775 760-433-6111 HOMA SHAHRIARI DDS INC 12/1 (SP) 1/0 (TA VI) DC062232  8632 Balboa Blvd, 91325-3505 Kids R US Dental And Adults 818-894-6161 DC045730  DC062791  325 Old Newport Blvd Ste 3, 1/0 (SP) NORWALK DENTISTRY Del Oro Smiles Dentistry Dental 92663-4161 11850 Firestone Blvd Ste 6, Group 949-873-5710 DC008246  90650-2979 4171 Oceanside Blvd Ste 100C, 1/0 (SP VI) NORTHRIDGE DENTAL OFFICE 562-864-1011 92056 18519 Devonshire St, 91324-1308 1/0 (PE SP) 760-283-7180 DC062312  818-831-9990 2/0 (SP) Luminous SMiles of Newport 10/1 (SP) DC057655  Beach Dental Care of Norwalk DC063544  180 Newport Center Dr Ste 100, DC018017  14509 Pioneer Blvd, 90650-4875 Western Dental Services Inc 92660-6997 SHANRAM NOURI DENTAL 562-863-5701 3805 Mission Ave Ste A, 92058- 949-719-3400 CORP 1/0 (HI SP) 1873 1/0 (HI SP) 9318 Reseda Blvd, 91324-2926 760-439-0026 818-885-5200 DC364001  7/0 (SP) DC062581  1/0 (AM SP) ROBERT C C LEE FAMILY DTL Kord Cosmetic Dentistry 11780 Firestone Blvd, 90650- Ontario DC056350  200 Newport Center Dr Ste 301, 2899 DC008852  Comfort Dental Group 92660-7504 562-868-9897 HS GILL ARCHIBALD RANCH 9068 Tampa Ave, 91324-3523 949-423-3692 1/0 (CH SP TA) DENTAL 818-734-9030 1/0 (PE SP) 3065 S Archibald Ave Ste B, 1/0 (AM SP) Oceanside 91761-9000 DC125801  DC007275  909-923-3640 DC058952  NEWPORT BEACH DENTAL COLLEGE DENTAL GROUP 1/0 (SP) Northridge Advanced Dentistry 1501 Superior Ave Ste 100, 467 College Blvd Ste 2, 92057- 8954 Reseda Blvd Ste 100, 92663-3606 5436 DC016585  91324-5838 949-650-6772 760-631-3060 EUCLID DENTAL CENTER 818-701-3010 3/0 (GE RO SP) 10/1 (SP) 2905 S Euclid Ave Ste D, 91762- 2/0 (RU SP) 6684 Norco DC011144  909-391-4300 DC061830  DC006984  QUARRY CREEK DENTAL 2/0 (SP) Angela Hoffman DDS Inc GENTLE DENTAL NORCO GROUP 9535 Reseda Blvd Ste 313, 1260 Hamner Ave Ste C & D, 3430 Marron Rd Ste 300, DC019519  91324-6030 92860-3136 92056-4674 ONTARIO VILLIAGE DENTAL 818-885-7230 951-279-5200 760-730-1303 533 W Holt Blvd Ste B, 91762- 1/0 (RU SP) 3/0 4/1 (SP) 3732 909-988-1992 DC176401  DC015152  DC011153  0/1 (SP) HAMLIN DENTAL GROUP HAMNER DENTAL GROUP SOUTH OCEANSIDE DENTAL 8540 Reseda Blvd Ste 101, 140 Hidden Valley Pkwy Ste K, GROUP DC022868  91324-6144 92860-4002 2484 Vista Way Ste B, 92054- ONTARIO FAMILY DENTISTRY 818-701-6667 951-898-8673 5682 528 N Fern Ave, 91762-3210 0/2 (AR AM CH SP TA) 4/2 (SP) 760-439-0334 909-460-9552 9/2 (SP) 1/0 (SP) Norwalk DC142201  NORCO FAMILY DENTAL DC002720  DC033583 DC024466 2031 River Rd, 92860-3307 NORWALK FAMILY DENTISTRY BRIGHT NOW DENTAL ONTARIO SMILES 951-372-9094 15617 Studebaker Rd Ste 5, 4170 Oceanside Blvd Ste 183, 4190 E 4th St Ste C, 91764-5263 0/1 (SP) 90650-5471 92056-6007 909-532-8518 562-484-3936 760-936-0000 4/0 1/0 (SP TA) 13/1

64 DeltaCare® USA

DC037060  DC060675  DC060000  DC054281  Assure Dental Orange Sky Dental Oxnard Premium Dental Tellissi Family Dentistry 961 N Milliken Ave Ste 103, 1916 N Tustin St, 92865-4644 451 W Gonzales Rd Ste 110, 72695 Highway 111 Ste A8, 91764-5022 714-289-5009 93036-0719 92260-3320 909-581-7700 1/0 (HI SP) 805-485-2334 760-340-2160 5/1 (AR CH FR KO 12 SP TA) 1/0 (AM RU SP) 1/0 (FR GE SP) DC061206  DC060741  David M Datu DDS Inc DC063951  DC062653  Spectrum Dental Arts 1107 E Lincoln Ave Ste 201, Oxnard Smiles Dentistry Dental Desert Dental Associates 1049 W Philadelphia St, 91762- 92865-1945 Group 72210 Highway 111 Ste E-1, 6145 714-998-2241 1381 W Channel Islands Blvd, 92260-2782 909-391-2324 1/0 (SP) 93033-4203 760-773-2111 1/0 (HI SP) 805-253-1796 1/0 DC062008  1/0 (SP) DC062904 Glow Dental DC2C3701  Beautiful Smiles 294 S Tustin St, 92866-2307 DC063986  DESERT CROSSING DENTAL 126 W B St, 91762-3503 714-639-4132 Oxnard Modern Dentistry Dental GROUP 909-984-4746 1/0 (SP) Group 72-333 Highway 111 Ste B, 92260- 1/0 (AR SP) 2150 N Rose Ave, 93036-5058 2790 DC063423 805-604-0449 760-674-9666 DC357001  Glassell Dental 4/0 (SP) 6/1 (SP) MISSION DENTAL CARE 245 N Glassell St Ste A, 92866- 941 W Mission Blvd Ste H, 91762- 1408 DC1C3601  Palm Springs 6890 714-532-5600 DENTAL CARE OF OXNARD DC036702  909-984-7883 1/0 (SP) 1350 W Gonzales Rd Fl 2, WESTERN DENTAL SERVICES 1/0 (CH HI 12 SP) 93036-3366 555 S Sunrise Way Ste 400, DC282401  805-988-5888 92264-7894 Orange ORANGE HILL DENTAL 1/0 (AM SP TA) 760-322-6061 DC002804  3138 E Chapman Ave Ste A, 38/7 (SP) GENTLE DENTAL ORANGE 92869-3722 DC395501  424 S Main St Ste H I J, 92868- 714-639-2703 ESTHETIC SMILES DC043816  3828 2/0 (AM SP) 1901 Solar Dr Ste 135, 93036- ARMOUND MAHMOUDI DDS 714-639-1922 0660 1921 E Tahquitz Canyon Way, 5/3 DC367801  805-988-2250 92262-7001 TOWN & COUNTRY DENTAL 1/0 (AR JA SP) 760-325-6480 DC004393  1111 W Town And Country Rd Ste 1/0 (AM PE SP) PREFERRED DENTAL CARE 33, 92868-4667 Pacoima 2022 W Chapman Ave, 92868- 714-285-0505 DC018258  DC061629  2610 3/0 (KM CA CH KO 12 SP TA VI) PACOIMA FAMILY DENTAL Harmony Dental Practice 714-978-3333 CENTER 333 S Canyon Dr Ste A, 92262- 1/2 (CA HI JA SP) Oxnard 9722 Laurel Canyon Blvd, 91331- 7805 DC018175  4106 760-416-0233 DC004715  ROSE DENTAL GROUP 818-897-1234 1/0 (KO) NEWPORT DENTAL 2731 S Rose Ave Ste 101, 93033- 1/0 (AR AM PE SP) 1632 E Katella Ave Ste B, 92867- 3964 DC199801  5097 805-483-3658 DC040985  GENTLE DENTAL DESERT 714-538-2311 2/0 (FinnishKO SP) WAEL H OBEID DDS INC DENTAL 14/1 (SP VI) 13711 Van Nuys Blvd Ste 3, 91331- 1111 E Tahquitz Canyon Way Ste DC019926 3649 210, 92262-0102 DC008670  IRAJ MOVAHHEDI DDS 818-890-2600 760-904-4482 CALIFORNIA DENTAL GROUP 4225 Saviers Rd Ste 9, 93033- 1/0 (AR SP) 2/2 OF ORANGE 7119 1502 E Collins Ave, 92867-5934 805-982-8283 Palm Desert Palmdale 714-288-8464 1/0 (SP) DC022888  DC000997  0/1 (SP) DESERT GATEWAY DENTAL ANDRE KANARKI DDS DC043210  GROUP 1543 E Palmdale Blvd Ste B, DC033008  BRIGHT NOW DENTAL 34460 Monterey Ave Ste 100, 93550-2000 ORANGE DENTAL GROUP 355 W Esplanade Dr, 93036-1234 92211-6008 661-274-1866 235 S Tustin St, 92866-2321 805-288-3080 760-610-0358 1/0 (AM FR SP TA) 714-744-0044 12/2 6/1 (SP) 0/1 DC001732  DC054727  DC026260  HI DESERT DENTAL CENTER DC048221  Downtown Smile Center PARC CENTER DENTAL 2205 E Palmdale Blvd, 93550- TUSTIN PLAZA DENTAL GROUP 826 S A St, 93030-7140 77564 Country Club Dr Ste 350, 1316 1872 N Tustin St, 92865-4605 805-486-3911 92211-0450 661-273-1333 714-637-8662 1/0 (AR AM SP) 760-772-7082 1/1 (PE RU SP) 0/0 (JA PE SP VI) 1/1 (SP TA) DC057711 DC017650  DC053655  Western Dental Center DC031853  SIERRA COMMONS DENTAL Mayfair Dental 455 S C St, 93030-5917 SUNLIFE DENTAL GROUP GROUP 1616 E Mayfair Ave, 92867 805-483-9586 73211 Fred Waring Dr Ste 201, 755 W Rancho Vista Blvd, 93551- 714-744-8164 30/0 (SP) 92260-2888 3735 2/0 (SP) 760-568-3368 661-265-7800 DC057728  1/0 (SP) 9/2 (SP) DC056428  Oxnard Dentistry Orange Village Dentistry Dental 1730 E Gonzales Rd, 93036-3701 DC020968  Group 805-604-9999 BRIGHT NOW DENTAL 2393 N Tustin St Ste A, 92865- 1/0 (SP) 39345 10th St W Ste B, 93551- 3714 3779 714-453-0215 661-274-8065 4/0 (SP) 10/1 (12 SP) 65 DeltaCare® USA

DC025870  Paramount DC040863  Pico Rivera OASIS DENTAL CARE DC018649  PASADENA FAM COSMETIC & DC000013  40008 10th St W Ste F 106, DR CHEBBI DENTAL OFFICE IMPLANT DENTISTRY FAMILY DENTISTRY 93551-3009 16260 Paramount Blvd Ste G, 800 Fairmount Ave Ste 100, 8532 Whittier Blvd, 90660-2520 661-947-2727 90723-5448 91105-3158 562-695-5251 1/0 (SP) 562-633-5070 626-304-3004 1/0 (HI SP) 1/0 (AR FR SP) 1/0 (AR AM CH KO 12 RU SP TA) DC026732  DC021700  GATEWAY DENTAL GROUP DC053010  DC055985  CORD FAMILY DENTAL CARE 38209 47th St E Ste E, 93552- Mahesh A Sejpal DDS Sona Asatryan 9400 Whittier Blvd, 90660-2833 3113 8040 Alondra Blvd Ste E, 90723- 301 S Fair Oaks Ave Ste 206, 562-949-2526 661-236-0046 4355 91105-2536 2/0 (SP) 7/0 (SP) 562-633-1213 626-431-2654 1/0 (HI SP TA TA) 1/0 (AM SP) DC025067  DC039637  BRIGHT SMILE DENTAL WESTERN DENTAL SERVICES Pasadena DC059117  8819 Whittier Blvd Ste 102, 510 W Rancho Vista Blvd, 93551- The Smile Agency DC000491 90660-2673 3737 1175 E Green St, 91106-2505 Western Dental Services Inc 562-699-1000 661-273-9000 626-270-0100 470 N Los Robles Ave, 91101-1302 1/0 (SP) 37/3 (SP) 2/0 (SP) 626-578-1200 37/0 DC039985  DC049984  DC059831  BRIGHT NOW DENTAL ANTELOPE VALLEY DENTAL Art of Dentistry DC004502  8963 Washington Blvd, 90660- GROUP 859 N Fair Oaks Ave Ste 120, PASADENA DENTAL CENTER 3728 1037 E Palmdale Blvd Ste 203, 91103-3078 766 N Lake Ave, 91104-4557 562-566-1004 93550 626-765-9758 626-808-1717 15/1 (SP) 661-272-9181 1/0 (AM) 0/1 (HI SP) 8/0 (AR KO SP) DC320601  DC061015  DC012908  ASHOKKUMAR MEHTA DDS DC057459  Bright Smile Dental NEWPORT DENTAL PASADENA 9514 Whittier Blvd, 90660-2835 Rwigema Dental Corporation 2245 E Colorado Blvd Ste 201, 290 N Hill Ave Ste 1, 91106-1563 562-942-2345 3025 E Avenue S Ste A14, 91107-3651 626-440-0240 0/1 (HI SP) 93550-2472 626-449-3367 8/2 (SP) 661-265-7694 1/0 (KO SP) DC367501  1/0 (FR SP TA) DC016419  DANNY MUDITAJAYA DDS DC061219  TINA GHOTANIAN DDS 9123 Slauson Ave, 90660-4522 DC062016  Genesis Dental Esthetics 212 S El Molino Ave, 91101-2906 562-949-0177 West AV Dental Group 200 S El Molino Ave Ste 2, 91101- 626-792-7900 4/0 (CH IN SP) 38745 Tierra Subida Ave Ste 150, 2985 0/1 93551-4567 626-314-3550 Placentia 661-272-9091 1/0 (AM RU SP) DC017210  DC004485  5/0 (AR KO SP) HASTINGS RANCH DENTAL NAOMI AND ANTHONY WONG DC272401  GROUP DDS DC063249 PASADENA DENTAL 255 N Rosemead Blvd, 91107- 415 W Chapman Ave, 92870- Western Dental Services Inc ASSOCIATES 3102 5905 2140 E Palmdale Blvd, 93550- 1302 N Altadena Dr, 91107-1430 626-351-0195 714-223-2021 1202 626-797-6778 3/1 (SP) 0/1 (CH SP) 661-265-1700 2/0 (CH SP) 1/0 DC018882  DC016013 DC316601  ROSE CITY DENTAL ARTS PLACENTIA FAMILY DENTISTRY Panorama City DAVID WYNDHAMSMITH DDS 1855 E Colorado Blvd, 91107-3554 1525 N Placentia Ave Ste H, 1092 E Green St, 91106 DC013059  626-440-0801 92870-2334 626-795-9328 KOO DDS INC 0/1 (CA HI SP) 714-528-0089 2/0 (AM KO 12 SP VI) 8215 Van Nuys Blvd Ste 220, 1/0 (CH SP VI) 91402-4836 DC019231  Perris 818-782-8261 LAKEVIEW DENTAL DC049420  0/2 (KO SP) 709 N Lake Ave, 91104-4558 DC022885  COSMETIC AND DENTAL 626-797-8900 CROSSING DENTAL GROUP IMPLANT CENTER DC063003  1/0 (AR FR GE SP) 3150 Case Rd Bldg C, 92570- 1858 N Placentia Ave, 92870- Western Dental Services Inc 5552 2303 8600 Van Nuys Blvd, 91402 DC021778  951-345-4386 714-577-9070 747-201-6014 IBRAHIM RABADI DDS 10/2 (SP) 2/0 (KO SP VI) 4/0 2281 E Washington Blvd, 91104- 1944 DC032981  DC058370  DC063240 626-794-2606 GENTLE DENTAL PERRIS Gentle Dental Placentia Western Dental Services Inc 1/0 (AR AM RU TR) 2560 N Perris Blvd Ste F1, 92571- 620 N Rose Dr Ste B, 92870-7513 7942 Van Nuys Blvd, 91402- 3226 714-294-7134 6084 DC022435  951-657-6466 5/0 (SP) 818-988-3100 GENTLE CARE HEALTH SPA 2/1 8/0 (SP) 247 N Lake Ave, 91101-1828 Pomona DC061383  626-405-2922 DC001718  DC357201  Western Dental Services Inc 0/1 (AR AM SP) BELLA MANCHANDIA DDS GARY KARSH DDS 1688 N Perris Blvd Ste G1, 92571- 551 E Holt Ave, 91767-5623 8628 Van Nuys Blvd Ste 200, 4744 DC028398  909-622-8600 91402-2913 951-940-5771 FAIR OAKS FAMILY DENTAL 1/0 (HI SP) 818-895-1321 929 N Orange Grove Blvd, 91103- 30/0 (SP) 0/1 (AR HE RU SP) 3354 626-449-3700 2/2 (AM SP)

66 DeltaCare® USA

DC005493  DC007273  DC059654  Rancho Santa Margarita FAMILY DENTAL CLINIC POWAY FAMILY DENTAL GROUP Sarah Yang DDS DC3C6501  2280 S Garey Ave, 91766-5645 13616 Poway Rd Ste 100, 92064- 9310 Baseline Rd, 91701-5821 RANCHO DENTAL GROUP 909-364-0633 6548 909-989-1868 30592 Santa Margarita Pkwy Ste 2/1 (SP) 858-391-9300 1/0 (CH) D, 92688-5802 1/1 (SP) 949-766-5740 DC011143  DC060120  7/0 (SP) PEARL DENTAL CARE DC009629  Talent Dental 2407 Valley Blvd Ste C, 91768- POMERADO FAMILY DENTAL 10590 Town Center Dr Ste 180, Rch Cucamonga 2719 GROUP 91730-0364 DC014841  909-839-1004 15706 Pomerado Rd Ste 201, 909-313-0044 BRIGHT NOW DENTAL 0/1 (HI SP) 92064-2033 1/0 (AR SP) 11561 Foothill Blvd Ste 104, 858-674-5252 91730-3999 DC011786  1/0 (HI SP) DC060376  909-483-7811 KENT HUNG DMD A Plant Dental Center 19/3 (HI SP) 520 E Foothill Blvd Ste B, 91767- DC039641  7333 Hellman Ave, 91730-1302 1200 WESTERN DENTAL SERVICES 909-483-0600 DC047480 909-624-1781 12649 Poway Rd, 92064‑4415 1/0 (CH KO SP) WESTERN DENTAL SERVICES 0/1 (SP) 858-486-6100 INC 30/8 DC063175  8678 19th St Ste 140, 91701-4559 DC034442  Ocean Dental Group 909-257-2013 ANGELIC DENTISTRY Rancho Cucamonga 9349 Foothill Blvd Ste B, 91730- 56/0 847 Philadelphia St, 91766-5714 DC004956  3567 909-627-4177 909-980-6363 JIA LEE DDS DC1C7401  1/0 (RO RU SP) 7/0 (AR FR KO 12 SP TR) 9477 Haven Ave, 91730‑5844 RANIA REFAAT DDS 909-989-5598 7388 Carnelian St Ste C, 91730- DC056723 DC063384  0/1 (CH SP) 1160 Pomona Dentistry Dental Group All About Smile Dental Group 909-989-1758 2071 Rancho Valley Dr Ste 140, 10630 Town Center Dr Ste 131, DC014115  1/0 (AR SP) 91766-7105 WINERY ESTATE DENTAL 91730-8600 909-374-1815 909-987-6643 GROUP Redlands 3/0 7369 Day Creek Blvd Ste F103, 2/0 (CA HI JA 12 SP) DC005437  91739-8020 REDLANDS DENTAL GROUP DC057159  909-646-7902 DC063827 422 Orange St, 92374-3206 Armen Mardirosian DDS Inc 5/3 (SP) Ponderosa Dental Group 180 E Mission Blvd Ste A, 91766- 8463 Haven Ave, 91730-3845 909-792-7500 8/1 (SP) 1843 DC018520  909-481-0025 909-623-5278 GINA BARRAMEDA DMD 2/0 DC010256 1/0 (AM SP) 8351 Rochester Ave Ste 109, ALEJANDRA GALINDO 91730-3998 DC117701  MAGALLANES DC348001  909-466-5352 STAR DENTAL GROUP 321 Cajon St, 92373-5901 DONALD HODSON DDS 0/2 (TA TA) 12729 Foothill Blvd Ste A, 91739- 1956 Hill Blvd, 91767-3620 9334 909-888-3688 0/1 (SP) 909-621-5848 DC022886  909-899-8757 1/0 (FR PE SP) MONET DENTAL GROUP 3/0 (SP) DC016012  12455 Victoria Gardens Ln Ste BRIGHT NOW DENTAL DC357101  190, 91739-7534 DC390301  1285 Alabama St, 92374-2813 POMONA DENTAL GROUP 909-646-3057 RANCHO CUCAMONGA 909-793-5777 850 Hill Blvd, 91767-5308 7/2 (SP) DENTAL CARE 909-626-3541 10470 Foothill Blvd Ste 126, 10/1 (RO SP) 1/0 (KO SP) DC047337  91730-6945 DC028395  RANCHO CUCAMONGA SMILES 909-989-7888 ELITE DENTAL ASSOCIATES Port Hueneme DENTISTRY GROUP 1/0 (AM 12 SP VI) 245 Terracina Blvd Ste 207A, DC059054  7319 Milliken Ave Ste 110, 91730- 92373-4869 All Care Dental 6794 DC3C7001  909-798-4111 607 W Channel Islands Blvd, 909-945-3650 GHAZAL DENTAL 2/0 93041-2136 7/0 (SP) CORPORATION 805-985-5500 10797 Foothill Blvd, 91730-3858 DC044332  1/0 DC048663  909-581-0888 WESTERN DENTAL SERVICES HORIZON DENTAL PRACTICE 6/2 (SP) INC Porterville 9353 Fairway View Pl Ste 200, 1715 W Redlands Blvd Ste B, 91730-0962 Rancho Mirage DC036350  92373-9601 909-987-9933 DC022862  WESTERN DENTAL SERVICES 909-801-8140 2/0 (AR SP) RANCHO MIRAGE DENTAL 1213 W Henderson Ave, 93257- 39/14 (HI SP) 1454 GROUP DC049527  71817 Highway 111 Ste 1, 92270- 559-306-3100 DC061112  GENTLE DENTAL FOOTHILL 4446 31/5 (SP) Tri City Family Dental 8880 Foothill Blvd Ste 5, 91730- 760-340-5155 1402 Industrial Park Ave, 92374- 7198 3/2 (SP) Poway 4517 909-945-0595 DC001867  909-798-5777 4/0 Rancho Palos Verdes A POWAY DENTAL GROUP 1/0 12921 Pomerado Rd, 92064-5325 DC057033 DC057601  858-679-4949 RANCHO PALOS VERDES DC062409 Terra Vista Dental Care 0/1 DENTISTRY Rana Dentistry 7211 Haven Ave Ste D, 91701- 28901 S. Western Avenue 1748 E Lugonia Ave Ste 126, 6064 Suite135, 90275 92374-2732 909-256-8484 310-750-2470 909-794-5860 1/0 (HI SP) 4/0 1/0 (HI SP)

67 DeltaCare® USA

Redondo Beach DC059405 DC006976  DC042936  DC041128  Smile Brite Dental GENTLE DENTAL RIVERSIDE ARLANZA FAMILY HEALTH BEACH CITY DENTAL GROUP 18909 Sherman Way, 91335 3630 Central Ave Ste 6, 92506- CENTER 1509 Hawthorne Blvd Ste 102, 818-345-1343 5903 8856 Arlington Ave, 92503-1365 90278-3957 1/0 (FR HE SP) 951-682-1720 951-710-3970 310-376-5252 5/1 12/0 (SP) 4/1 (SP) DC061209  Canby Dental DC006983  DC046532  DC055010  18440 Sherman Way, 91335-4218 GENTLE DENTAL RIVERSIDE TYLER DENTAL CENTER Bayside Dental Care 818-343-4024 10168 a Ave, 92503-5302 4080 Tyler St Ste D, 92503-3432 1884 1/2 S Pacific Coast Hwy, 1/0 (SP) 951-352-9747 951-359-0149 90277-6117 5/1 1/0 (HI SP) 310-792-4627 Rialto 1/0 DC004514  DC010631 DC053111  RIALTO DENTAL GROUP JULIA ROMITAN DDS INC WESTERN DENTAL SERVICES DC126601  1629 S Riverside Ave, 92376- 6860 Brockton Ave Ste 12, 3485 Madison St, 92504-3716 GALLERIA DENTAL CARE 7707 92506-3816 951-688-7105 2772 Artesia Blvd Ste 103, 909-421-2225 951-684-9917 77/0 (SP VI) 90278-3370 5/2 (SP) 1/0 (GE RO SP) 310-370-1586 DC055006  2/0 (FR IT SP) DC022887  DC012718  WESTERN DENTAL SERVICE METTA SURYA DDS FAMILY PARISSA DJAFARI DDS INC Reseda DENTISTRY 6900 Brockton Ave Ste 2, 3880 Chicago Ave, 92507-5354 92506-3801 951-643-6100 DC004480  1734 N Riverside Ave Ste 3, 951-682-2245 48/0 (SP) SMILE MASTERS DENTAL 92376-8058 1/0 (FR SP) CENTER 909-875-1279 DC056751  17703 Vanowen St, 91335-5602 1/0 (IN SP) DC014141  Kalyani DDS Inc 818-609-0009 GROVE DENTAL GROUP 17024 Van Buren Blvd Ste B, 1/0 (AM FR HI SP) DC047466 WESTERN DENTAL SERVICES 8735 Trautwein Rd, 92508-9474 92504-5921 951-776-1330 951-892-0022 DC012592  INC 14/1 (SP) 1/0 (HI SP) VALLEY DENTAL CENTER 260 W Foothill Blvd, 92376- 19231 Victory Blvd Ste 357, 5048 DC014243  DC057746  91335-6354 909-546-1366 REZA RAJABI DMD Jurupa Springs Family Dental 818-785-5445 73/0 7776 Limonite Ave, 92509-5314 8880 Limonite Ave, 92509-5021 0/1 (SP) DC056287  951-360-0696 800-881-0393 1/1 (SP) 1/0 (GE SP) DC027180  Soyoung Kim DDS INC HENIDE ARIAS DDS 1374 W Foothill Blvd Ste 2E, DC014338  DC058013  19231 Victory Blvd Ste 252, 92376 GATEWAY DENTAL GROUP Palm Dental Group 91335-6341 909-874-7444 10286 a Ave, 92503-5357 6862 Palm Ave, 92506-2812 818-881-8940 1/0 (KO) 951-359-5200 951-683-5490 0/1 (SP) DC063210  9/3 (SP) 1/0 (KO SP) DC040015  Atef E Hana DDS INC DC015584  DC058019  RESEDA DENTAL GROUP 2836 W Rialto Ave Ste A, 92376- CANYON SPRINGS DENTAL Riverside Plaza Dentistry Dental 18437 Saticoy St Ste 1, 91335-2911 6816 GROUP Group 818-344-8338 909-820-9454 2878 Campus Pkwy Ste 1, 92507- 3602 Riverside Plaza Dr. Suite 1/0 (AM SP) 1/0 (AR SP) 0945 101, 92506 951-571-0011 951-228-9576 DC042340  DC063425  7/1 (SP) 3/0 (SP) ESTHITIC SMILE Luxe Dental Studio 19231 Victory Blvd Ste 455, 1733 N Riverside Ave, 92376- DC017776  DC059209  91335-6366 8062 ANWAR NASSER DDS Western Dental Services Inc 818-344-4929 909-875-2548 6326 Mission Blvd Ste B, 92509- 4024 12th St, 92501-3561 1/0 (AR AM HU RU SP TA) 1/0 (SP) 4121 951-784-0636 951-367-1666 33/0 DC042499 DC117501  1/0 (AR SP) MONICA HERDOIZA DDS DRS EBENEZER AND RACHEL DC060085  6915 Reseda Blvd Unit 3, 91335- JOHNSON DDS INC DC024651  Riverwalk Dental Spa 4246 511 S Riverside Ave, 92376-7027 ORANGECREST FAMILY 11695 Slate Ave Ste 200, 92505- 818-881-6844 909-820-2274 DENTAL PRACTICE 5197 1/0 (SP) 2/0 (SP) 19348 Van Buren Blvd Ste 117, 951-353-0050 92508-9158 2/0 (SP VI) DC043062  DC166001  951-789-9905 RUBTSOV DDS INC DENTAL CARE OF RIALTO INC 1/0 (SP) DC060887  19301 Saticoy St Ste D, 91335- 1817 N Riverside Ave, 92376- My Riverside Dentist 2358 8069 DC025621  6339 Brockton Ave, 92506-2031 818-772-4222 909-879-1024 REGAL DENTISTRY 951-369-3597 0/1 (RU SP) 2/0 (CH 12 PT SP) 3950 Pierce St Ste L, 92505- 1/0 (SP) 3809 DC043476  Riverside 951-688-0082 DC062755 BRIGHT NOW DENTAL RESEDA DC000767  2/0 (AM CA HR 12 RU SP TA) Young Kwun Kim 19361 Saticoy St Ste A, 91335- NEWPORT DENTAL 6859 Magnolia Ave Ste 2, 92506- 2360 3724 La Sierra Ave Ste F1, DC037609  2866 818-739-1028 92505-3066 RAINCROSS DENTAL 951-682-0810 20/1 951-688-2400 7028 a Ave Ste A, 92506-4157 1/0 7/3 (SP VI) 951-367-1345 0/1 (SP VI)

68 DeltaCare® USA

DC063272  DC011183  DC063927  DC002826  Dental Specialists of Riverside ARROWHEAD FAMILY All Smile Dental Group NASER OSTAD DDS 10181 Magnolia Ave, 92503-3444 DENTISTRY 2015 N Waterman Ave Ste B, 12330 Carmel Mountain Rd Ste 951-689-0701 407 S E St, 92401-2012 92404-4810 C4, 92128-4654 4/0 (RU SP) 909-889-3300 909-713-2077 858-485-0555 0/1 (AR HI SP) 1/0 (PE SP) 2/0 (SP) DC172501  VIVIAN KWON DDS DC011723  DC193801  DC003121  2955 Van Buren Blvd Ste H4, SURE SMILE DENTAL OFFICE CITRUS DENTAL SUNSHINE DENTISTRY 92503-5675 275 E 9th St Ste L, 92410-4400 242 E Airport Dr Ste 100, 92408- 4230 30th St, 92104-1312 951-689-8544 909-381-5555 3408 619-282-1007 1/0 (KO SP VI) 0/2 (HI SP) 909-890-0050 1/0 (SP TA) 1/0 (SP) DC267501  DC012744  DC004767  DENTAL ASSOCIATES OF HUB PLAZA DENTAL GROUP DC1C7601  GENTLE DENTAL SORRENTO RIIVERSIDE 1047 Harriman Pl Ste B, 92408- INLAND DENTAL CENTER VALLEY 3487 Central Ave, 92506-2115 4203 362 E Vanderbilt Way, 92408- 11230 Sorrento Valley Rd Ste 130, 951-369-1001 909-796-6700 3593 92121-1338 1/1 (4 KO SP TH) 6/3 (SP) 909-384-1111 858-458-9126 3/1 (KO SP TA) 2/1 (SP) DC2C0201  DC015305  ARLINGTON DENTAL AHMED NAJI DDS DC396401  DC007133  3297 Arlington Ave Ste 101, 1799 N Waterman Ave Ste E, WATERMAN DENTAL CENTER WESTVIEW DENTAL OFFICE 92506-3250 92404-5107 1428 N Waterman Ave Ste A, 13350 Camino Del Sur Ste 6, 951-683-6055 909-883-8282 92404-5382 92129-4473 8/3 (SP) 1/0 (AR SP) 909-889-1111 858-484-9977 1/0 (SP) 0/1 (HI JA SP TA) Rolling Hills DC015306  DC3C3801  IAN SHWARTZMAN DDS San Clemente DC010687  PENINSULA DENTAL ARTS 330 N D St Ste 360, 92401-1524 DC004795  COAST DENTAL CARE 550 Deep Valley Dr Ste 347, 909-475-5565 SAN CLEMENTE DENTAL 6585 El Cajon Blvd, 92115-2706 90274-7603 1/0 (SP) GROUP 619-265-0072 310-377-9575 943 Avenida Pico Unit A, 92673- 0/2 (SP) 0/1 (SP) DC025852  3914 MGO DENTAL 949-366-9555 DC012742  Rosemead 654 W 4th St Ste A, 92410-3216 4/3 (SP) TIERRASANTA DENTAL GROUP 909-386-3650 10405 Tierrasanta Blvd, 92124- DC002496  0/1 (AR FR SP) 2603 STEVEN HOU DDS DC009035  858-492-9300 2240 San Gabriel Blvd, 91770- TALEGA DENTAL GROUP DC036585 7/2 (SP) 3644 1151 Puerta Del Sol Ste A, 92673- WESTERN DENTAL SERVICES 626-288-8357 6311 1199 N E St, 92410-3507 DC014130  1/0 (12 SP) 949-369-8300 909-388-2415 0/1 (SP) COSMETIC AND FAMILY 55/10 (SP) DENTISTRY DC055325  9636 Tierra Grande St Ste 105, Glenrose Dental DC012354  DC049131  92126-6502 8951 Glendon Way Ste 1, 91770- ARTISTIC DENTISTRY INLAND FAMILY COMMUNITY 858-549-4511 1892 439 N El Camino Real Ste E, HEALTH CENTER 1/0 (AM) 626-288-7667 92672-4700 665 N D St, 92401-1109 1/0 (CA SP) 949-366-1177 909-708-8168 1/0 (PE SP) DC017306  3/0 (GE 4 SP) GENTLE DENTISTRY DC055576  4765 Carmel Mountain Rd Ste Jun and Shan Dental Service Inc DC037851  DC053679  205, 92130-6657 2111 San Gabriel Blvd Ste I, SAN CLEMENTE DENTAL Sonrisas Dental Studio 858-350-7400 91770-3600 ASSOC 570 S Mount Vernon Ave Ste E, 1/0 (AR CH GE SP TA) 626-280-4976 638 Camino De Los Mares Ste 92410 2/0 (CA CH 12 SP) C140, 92673-4813 909-219-5229 949-234-0500 DC018955  1/0 (SP) PEARL COSMETIC-FAMILY DC056529  1/0 (SP) DENTISTRY Chang Family Dentistry DC054399  13522 Sabre Springs Pkwy Ste 8038 Garvey Ave Ste B, 91770- DC059737  Western Dental Services Inc 201, 92128-4687 2483 Seascape Cosmetic and Implant 2094 E Highland Ave, 92404- 858-513-1747 626-571-7000 Dentistry 4626 0/1 1/0 (CA 12 SP) 675 Camino De Los Mares Ste 909-388-2420 304, 92673-2837 S El Monte 39/0 949-496-5001 DC020249  1/0 BERNARDO HEIGHTS DENTAL DC056404  DC057649  GROUP DURFEE DENTAL OFFICE Orange Show Dental Group & San Diego 15731 Bernardo Heights Pkwy Ste 2001 Santa Anita Ave Ste 204, Orthodontics 101, 92128-3156 DC000752  91733-3441 290 W Orange Show Rd Ste 105, 858-674-6813 Dental Arts of Coronado Avenue 626-443-3915 92408-3345 6/1 (SP) 2987 Coronado Ave Ste A, 1/0 (12 SP VI) 909-567-2223 92154-2180 1/0 (SP) DC021704  619-429-5959 San Bernardino RAY DERAKSHAN DMD 1/0 (SP) DC007367  DC063435  11134 Rancho Carmel Dr Ste 103, SOUTHLAND DENTAL GROUP Carlos L Torres DDS 92128-4671 DC001895  399 E Highland Ave Ste 120, 290 W Orange Show Rd Ste 102, 858-485-1010 PACIFIC DENTAL 92404-3812 92408-3345 1/0 9330 Mira Mesa Blvd Ste B, 909-881-0645 951-677-2115 92126-4822 1/0 (AR SP) 1/0 (SP) 858-695-3177 1/1 (SP VI) 69 DeltaCare® USA

DC022122  DC044371  DC056532 DC062456  WILLIAM CARLO DMD MISSION VALLEY DENTISTS East Village Dental Group Bright Now! Dental-Carmel Plaza 9040 Friars Rd Ste 535, 92108- 5638 Mission Center Rd Ste 107, 1455 G St, 92101-7309 Dental 5863 92108-4348 619-324-4981 11738 Carmel Mountain Rd Ste 619-285-0950 619-220-0159 6/0 170, 92128-4635 1/0 (SP) 9/1 (SP) 858-675-1180 DC057406  7/0 DC023305  DC045672  Extreme Smile Makeover ADVANCED DENTISTRY STONECREST DENTAL GROUP 1450 Frazee Rd Ste 209, 92108- DC062624  4320 Genesee Ave Ste 101, 92117- 3737 Murphy Canyon Rd Ste C2, 4342 Serra Mesa Modern Dentistry 4900 92123-4454 619-574-6678 Dental Group 858-277-8100 858-694-0790 1/0 (SP) 3268 Greyling Dr, 92123-2230 0/1 (IT SP) 7/0 (SP TA) 858-617-0620 DC057790 1/0 (SP) DC031631  DC046483 Bay Park Dentistry Dental Group SMILE SAN DIEGO WESTERN DENTAL SERVICES 2995 Clairemont Dr Ste A, 92117- DC062757  2650 Camino Del Rio N Ste 102, 4123 University Ave, 92105-1418 6766 SABRE SPRINGS DENTISTRY 92108-1630 619-521-0033 858-200-0827 11385 Poway Rd Ste 103, 92128- 619-298-0521 38/0 6/0 5600 0/1 (KO SP TA VI) 858-486-8611 DC046680 DC058437  1/0 (KO SP) DC034682  WESTERN DENTAL SERVICES Dr Zak San Diego Dental Care & DR ELLIES GENTLE DENTISTRY 2948 University Ave, 92104-2934 Orthodontics DC062877  2020 Camino Del Rio N Ste 101, 619-294-4661 5625 Ruffin Rd Ste 200, 92123- SmilePlus Dentistry - Mission 92108-1542 37/0 (SP) 6392 Valley 619-542-1800 858-569-9651 1333 Camino Del Rio S Ste 202, 0/1 (AR SP) DC049357 10/0 (AR AM FR RO RU SP TA) 92108-3520 CLAIRMONT SMILES DENTISTRY 619-260-4990 DC035574  AND ORTHO DC058878  3/0 (AR SP) OASIS SMILES 5675 Balboa Ave, 92111-2705 Toma & Petros DDS Inc 11611 Rancho Bernardo Rd Ste 858-268-0110 3737 Moraga Ave Ste B311, 92117- DC063501  103, 92127-1412 7/0 5361 San Ysidro Health King Chavez 858-592-9500 858-483-2093 Health Center 1/0 DC050872  1/0 (SP) 950 S Euclid Ave, 92114-6201 WESTERN DENTAL SERVICES 619-662-4100 DC037980  3802 Clairemont Mesa Blvd, DC060126  2/0 MESA FAMILY DENTAL 92117-2712 Coastal Dental Arts 5450 Clairemont Mesa Blvd Ste 858-273-8390 1230 Columbia St Ste 870, 92101- DC063535  C, 92117-2360 35/0 (SP) 8539 Reesor Dental Group PC 858-503-6789 619-858-8080 11968 Bernardo Plaza Dr, 92128- 1/0 DC054458  1/0 2538 PB Smiles Dentistry Dental 858-521-0000 DC038328  Group DC060128  2/0 (AR SP) ARVINDA REDDY K DDS INC 1975 Garnet Ave Ste E, 92109- University Avenue Dental Group 5440 Morehouse Dr Ste 1800, 3594 6324 University Ave, 92115-5813 DC063577  92121-6705 858-866-0808 619-582-4224 Dr Natalya Carmichael 858-433-8798 5/0 (SP) 1/0 (AR SP TR) 9728 Carmel Mountain Rd Ste B, 1/0 (LO SP) 92129-2849 DC054481  DC061162  858-484-2560 DC039542  Kensington Dental Group College Grove Dentistry Dental 1/0 (RU SP TA TR) EDWARD FARAJZADEH DDS 4142 Adams Ave Suite 104, 92116- Group 3867 Clairemont Dr, 92117-5831 2508 3408 College Ave, 92115-7134 DC063625  858-581-6535 619-326-0157 619-363-3881 Serenity Dental Group 0/1 7/0 (SP) 1/0 12396 World Trade Dr Ste 208, 92128-3788 DC040427  DC056205  DC061713  858-673-1000 MESA DENTAL Pacific Highlands Dentistry San Diego Family Care 1/0 (SP) 7625 Mesa College Dr Ste 100, Dental Group 7011 Linda Vista Rd, 92111-6307 92111-5343 5965 Village Way Suite E-206, 858-810-8729 DC063984  858-514-4290 92130-2475 3/0 (SP VI) Rancho Dental Care 0/1 (SP TA) 858-900-3541 9912 Carmel Mountain Rd Ste B, 6/0 (SP) DC062180  92129-2808 DC040744  San Diego Advanced Dental 858-538-9182 AMERICAN DENTAL CLINIC DC056447  Centers 1/0 (SP) 5382 Clairemont Mesa Blvd, Affinity Dental of Hillcrest 1901 4th Ave Ste 300, 92101-2381 92117-2213 3330 3rd Ave Ste 400, 92103- 619-236-7959 DC0C2001  858-277-6620 5639 3/0 (SP) SUNSHINE DENTAL OFFICE 1/0 (TA TA) 619-291-8750 9888 Carmel Mountain Rd Ste B, 1/0 (SP TA) DC062181 92129-2807 DC041671  Fill Dental Group 858-780-8870 PRIME DENTAL CARE DC056531 2845 Nimitz Blvd Ste A, 92106- 1/0 (CH TA) 10717 Camino Ruiz Ste 150, Downtown SD Modern Dentistry 2387 92126-2362 Dental Group 619-223-8179 DC171301 858-831-9288 435 4th Ave, 92101-6234 1/0 (SP TA) GLENN E HALDY DDS 1/0 (PE SP) 619-850-2550 3670 Clairemont Dr Ste 14, 92117- 4/0 5961 DC042861  858-273-0540 A STREET DENTAL ARTS 1/0 (SP) 450 A St Ste 200, 92101-4217 619-233-3338 1/0 (SP)

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DC252901  DC055402  San Juan Capistrano DC024235  STEPHEN BARAL DDS Fawzy Tadros DDS DC036579  GRAND PLAZA DENTAL GROUP 5189 Clairemont Mesa Blvd, 774 N Maclay Ave Ste A, 91340- SAN JUAN DENTAL GROUP 137 S Las Posas Rd Ste 250, 92117-1446 2143 31897 Del Obispo St Ste 100, 92078-2470 858-277-3900 818-403-6436 92675-3207 760-752-7000 1/0 1/0 (AR FR SP) 949-487-0284 1/0 1/0 (IT PE SP) DC377901  San Gabriel DC033585 MARK RIEDLER DDS DC001455  DC055252  BRIGHT NOW! DENTAL SAN 4167 Ohio St, 92104-1926 DEL MAR FAMILY DENTAL Paradise Dental MARCOS 619-281-6635 702 S Del Mar Ave Ste A, 91776- 31726 Rancho Viejo Rd Ste B109, 752 S Rancho Santa Fe Rd Ste 2/0 (SP) 2440 92675 752, 92078-3935 626-287-9781 949-481-2121 760-936-0002 DC385601  0/1 (AR AM SP) 1/0 (SP) 15/1 BERNARDO DENTAL OFFICE 16466 Bernardo Center Dr Ste DC001457 DC057737  DC041200  185, 92128-2522 DR. M LWIN Beautiful Smilez Dentistry WESTERN DENTAL SERVICES 858-676-1845 1739 S San Gabriel Blvd, 91776- 31734 Rancho Viejo Rd Ste D, INC 1/0 (HI SP TA) 3927 92675-2782 169 S Rancho Santa Fe Rd, 626-288-5777 949-496-2930 92078-2501 DC3C6901 0/2 (CA 12 SP) 1/0 (GE SP) 760-916-9595 MISSION BAY DENTAL 33/9 (SP) 1324 Garnet Ave, 92109-3011 DC001807  DC0C9701  619-275-2750 SAN GABRIEL FAMILY MEHRVARZI MEHRDOKHT DC044397  1/0 (SP) DENTISTRY DENTAL CORP LAS POSAS DENTAL PRACTICE 531 W Las Tunas Dr Ste B, 91776- 31952 Camino Capistrano Ste 145 S Las Posas Rd Ste 162, San Dimas 1166 C14 And Ste C16, 92675-3229 92078-2419 DC011722  626-281-1628 949-240-6888 760-736-4247 SAN DIMAS DENTAL OFFICE 1/0 (12 SP) 1/0 2/2 (SP) 923 W Arrow Hwy, 91773-2420 909-592-5599 DC013313  San Luis Obispo DC044944  BUSINESS PARK DENTAL 7/0 (SP) SAN GABRIEL VALLEY FAMILY DC007574  960 W San Marcos Blvd Ste 120, DTL DISBELL MANSILLA DDS 92078-1125 DC035071  6503 Rosemead Blvd, 91775- 862 Meinecke Ave Ste 200, 760-736-4300 SUNSHINE SMILE DENTAL 1936 93405-3704 0/0 1033 W Arrow Hwy, 91773-2422 626-286-2156 805-547-7010 909-447-7092 1/0 (CA 4 12 SP TH VI) 3/1 (IT 12 PT SP) 1/0 (SP) DC058889  Rancho Palomar Dental Care DC023902  DC032053  637 S Rancho Santa Fe Rd, DC045957  SAN GABRIEL DENTAL GROUP RICUCCIO NEGOM DDS 92078-3973 ALEMAN SUNRISE DENTAL 6909 Rosemead Blvd, 91775- 735 Tank Farm Rd Ste 170, 760-744-8199 1111 W Covina Blvd Ste 240, 1412 93401-7071 1/0 (SP) 91773-3205 626-286-8600 805-549-9000 909-305-2324 0/2 (CA 12 SP) 0/1 (SP) 1/0 (SP) DC059186  Babak Shahrokh DMD Inc DC038500  DC058619  365 S Rancho Santa Fe Rd Ste DC061799  HAI-SOU CHEN DDS R&R Dental Care 105, 92078-2338 Dr Zak Plaza Dental Office 301 W Valley Blvd Ste 222, 973 E Foothill Blvd #101, 93405- 760-471-9560 1120 Via Verde, 91773-4401 91776-3759 1311 1/0 (AR SP TA) 909-599-2444 626-573-5637 805-544-9440 9/0 (AR AM FR HE RO RU SP TA) 1/0 (CA 12) 8/0 (SP) DC062767  Sun Smile Dental San Fernando DC058443  San Marcos Sunday Dental 1582 W San Marcos Blvd Ste 201, DC002380  DC003532  1434 S San Gabriel Blvd, 91776- 92078-4081 TOOTH FAIRY DENTAL ANNA DURKIN DDS 3656 760-744-1300 556 S Brand Blvd, 91340-4002 1344 E Mission Rd Ste C, 92069- 626-571-8210 2/0 (CH 12 SP) 818-365-3004 3038 1/0 (SP TA) 1/0 (CH SP) 760-740-0070 San Pedro 1/0 (RU SP) DC019218  DC062710  DC019925  Agape Dental SAN PEDRO DENTAL CALIFORNIA DENTAL DC009368  314 W Valley Blvd, 91776-3727 697 S Gaffey St, 90731-3026 2040 Glenoaks Blvd Ste F, SAN MARCOS DENTAL GROUP 626-458-3410 310-548-1273 91340-1662 709 Center Dr Ste 101, 92069- 2/0 (CH IN SP VI) 17/0 (SP VI) 818-361-3889 2502 1/0 (AM SP) 760-746-2045 San Jacinto DC039543  4/3 (SP) DC020926  DC024844  SAN PEDRO FAMILY DENTIST 204 N Pacific Ave, 90731-2016 HEAVENLY DENTAL SAN JACINTO SMILES DC019237  310-832-8800 321 N Maclay Ave Ste A, 91340- 1643 S San Jacinto Ave Ste 100- WOODLAND DENTAL GROUP 1/0 (KO SP) 2945 101, 92583-5181 979 Woodland Pkwy Ste 100, 818-837-9744 951-654-7744 92069-2282 DC044347  0/2 (SP) 6/1 (SP) 760-745-1100 SAN PEDRO DENTAL CARE 0/1 (SP VI) DC052867  DC035557  520 W 7th St, 90731-3116 310-832-5361 Western Dental Services Inc SAN JACINTO DENTAL GROUP DC023810  0/1 (SP) 1101 Truman St Ste A, 91340- 701 W Esplanade Ave Ste KL, SMILES OF SAN MARCOS 3254 92582-4540 630 Nordahl Rd Ste D, 92069- 818-898-1433 951-654-3424 3541 42/0 (SP) 1/0 (HI SP) 760-480-1750 1/0 (HI SP)

71 DeltaCare® USA

San Ysidro DC046471 DC047395 Santa Fe Spgs DC000375  LDJ FAMILY DENTISTRY LYNDON LAMBETH DDS APDC DC002239  San Ysidro Dental Care 1125 E 17th St Ste N257, 92701- 504 W Pueblo St Ste 204, SANTA FE DENTAL 2004 Dairy Mart Rd Ste 120, 2215 93105-6211 10009 Orr And Day Rd, 90670- 92173-1882 714-558-4895 805-687-2656 3506 619-428-2436 1/0 1/0 562-484-0808 1/0 (SP) 1/0 (SP) DC048924 DC063391  DC063524  BRIGHT NOW! DENTAL - SANTA Ericson Dental Group Santa Maria ANA-BRISTOL & ALTON 1919 State St Ste 102, 93101- San Ysidro Health San Ysidro DC013162  3358 S Bristol St, 92704-8202 0406 Health Center FRIENDLY SMILES DENTAL 714-361-2141 805-884-1874 4004 Beyer Blvd, 92173-2007 GROUP 16/0 2/0 (SP) 619-662-4100 1670 S Broadway, 93454-7602 3/0 (SP TA) 805-928-6776 DC058041 DC0C6701  2/0 (AM SP) Santa Ana Saint Paul Dental SEA BREEZE DENTAL DR ZAK 1424 N Broadway, 92706-3905 5168 Hollister Ave, 93111-2526 DC007333  DC039647  714-550-6088 805-683-5300 NANDINI MURTHY DDS WESTERN DENTAL SERVICES 1/0 (AR SP) 1/2 (RU SP) 2723 N Bristol St Ste D7, 92706- 2205 S Broadway, 93454-7813 1419 805-346-2130 DC060863  Santa Clarita 714-569-0021 21/0 (SP) Tri Do DDS Dental Corp 0/1 DC008536  3801 S Harbor Blvd Ste D, 92704 LYONS DENTAL CARE DC046454  714-444-2744 DC011738  24036 Lyons Ave, 91321-2446 PACIFIC COAST SMILES 1/0 (SP VI) MY DENTIST 661-255-1015 426 Barcellus Ave Ste 101, 2001 W 17th St, 92706-2322 1/0 (SP) 93454-6926 DC061644  714-547-4444 805-925-8767 Dentistry by Andy Tran 1/0 (SP) DC008605  1/0 (SP) 2739 W Edinger Ave, 92704- CANYON COUNTRY DENTAL 3523 DC013085 GROUP DC046652  714-957-0308 DENTAL 4 26877 Sierra Hwy, 91321-2274 MATTHEW LANE DDS 1/0 (SP VI) 102 E 4th St Fl 2, 92701-4602 661-251-2002 2506 Professional Pkwy, 93455- 714-558-1464 4/0 1602 DC062110  1/0 (FR SP) 805-938-0100 Smileday Dental DC022749  1/0 601 W 17th St, 92706 DC013087  BRIGHT NOW DENTAL 714-852-3117 PRAKASH PATEL DDS 26477 Golden Valley Rd, 91350- DC046653  2/0 (SP) 2637 N Grand Ave, 92705-8707 2973 ZEN DENTAL GROUP 714-288-9980 661-253-1010 2050 S Broadway Ste E, 93454- DC062879 0/1 (SP) 12/2 (CH SP) 8801 Mi Pueblo Dental Group 805-925-3717 516 W 17th St Ste A, 92706-3677 DC021406  DC034141  2/0 (CA CH 12 SP VI) 714-972-2506 BRIGHT NOW DENTAL GOLDEN TRIANGLE DENTAL 1/0 (SP) 1601 W 17th St Ste G, 92706- 22770 W Soledad Canyon Rd, DC054061  3340 91350-2629 Prasan Mohansinh Parmar DDS DC062958 714-567-9255 661-259-5540 Inc Geva Dental 13/0 (SP) 2/0 (AR HI SP) 1414 S Miller St Ste 7, 93454-6916 1126 N Flower St Ste A, 92703- 805-922-5884 2385 DC022140  DC043064  1/0 (HI SP) 657-247-0570 ORANGE COAST DENTAL COMFORT DENTAL 1/0 (SP) 1717 Old Tustin Ave Unit A, 27916 Seco Canyon Rd Ste 201, Santa Monica 92705-7879 91350-3853 DC160501 DC011705  714-835-9188 661-513-0655 BAY DENTAL AMERICAN FAMILY DENTAL 1/0 (SP) 1/0 (AM KO SP) 3620 S Bristol St Ste 307, OFFICE 900 Wilshire Blvd Ste 440, 92704-7316 DC046718  DC026173  90401-1879 714-540-2836 WESTERN DENTAL SERVICES Assure Dental Family Care 310-576-1341 1/0 (SP VI) INC 940 N Grand Ave, 92701-4208 1/0 (SP) 714-541-9494 23130 Lyons Ave, 91321-2631 Santa Barbara 661-260-3200 2/0 (CA HE KO 12 SP) DC012072  DC046450  45/0 (SP) WILLSHIRE DENTAL CECILIA ORDONEZ DDS FAMILY DC030578  3201 Wilshire Blvd Ste 110, DENISTRY DC057778  SWEET TOOTH DENTAL 90403-2335 1412 San Andres St Ste D, 93101- Stoney Creek Dental 301 1/2 N Main St, 92701-4852 310-829-5181 4219 23238 Lyons Ave, 91321-2633 714-547-6600 0/2 (FR SP TH) 0/2 (SP) 805-962-7471 661-255-3459 1/0 (SP) 1/0 (AR AM RO RU SP) DC048636  DC042516  COLUMBIA DENTAL GROUP DC046658 DC060406  WESTERN DENTAL SERVICES 1807 Wilshire Blvd Ste A, 90403- JEFFREY A STRATFORD-JONES Raymond Lotuaco DDS Inc 500 N Main St, 92701-4620 5678 DDS 26324 Bouquet Canyon Rd, 714-973-9006 310-453-5436 5370 Hollister Ave Ste E, 93111- 91350-2308 42/7 (SP) 1/0 (CH 12 SP TA) 2359 661-481-3078 805-967-0344 1/0 (SP TA) DC042518 DC063245  1/0 (SP) WESTERN DENTAL SERVICES Brightleaf Dental 2701 W 1st St, 92703-3443 1304 15th St Ste 209, 90404-1811 714-973-2022 310-395-1810 42/6 1/0 (AR SP)

72 DeltaCare® USA

DC0C9801 DC062074  South El Monte DC016138  SANTA MONICA DENTAL Dent All by Dr. Z DC043573  ROYAL DENTAL SPA 1244 7th St Ste 101, 90401-1648 15301 Ventura Blvd Ste U5, ANTHHONY S PAN 11711 Moorpark St, 91604-2112 310-393-0743 91403-6647 9328 Garvey Ave Ste A, 91733- 818-505-1211 1/0 (SP) 818-788-7711 4602 0/1 (AM RU SP) 1/0 (AR SP) 626-350-0588 Santee 0/1 (CA CH 12 SP VI) DC063832  DC006421  Simi Valley Dentists of Studio City Dental TOWNE CENTER DENTAL DC006362  South Gate Group 12050 Ventura Blvd Ste C101, GROUP SIMI VALLEY DENTAL GROUP DC012712  91604-2639 9862 Mission Gorge Rd Ste E, 2410 Sycamore Dr Ste A, 93065- DR NAZIRI DENTAL CLINIC INC 818-296-9142 92071-3873 2358 4186 Tweedy Blvd, 90280-6159 2/0 (SP) 619-596-1600 805-522-2600 323-569-7131 7/2 (SP) 7/0 (SP) 1/0 (AR FR HE SP) Sun City DC023560  DC012685  DC016011  DC029914  SANTEE TOWN CENTER FIRST STREET DENTAL GROUP CASTLE DENTAL CENTER SUN CITY DENTISTRY DENTAL GROUP 1197 E Los Angeles Ave Ste E, 9918 Atlantic Ave, 90280-6449 28125 Bradley Rd Ste 210, 246 Town Center Pkwy, 92071- 93065-2868 323-567-1227 92586-2248 5803 805-583-5700 9/1 (AR AM CA KO 12 RU SP) 951-679-0520 619-312-6006 5/2 (SP) 1/0 (SP) 4/3 (SP) DC059976 DC029185  Western Dental Services Inc Sun Valley DC054230  SIMI VALLEY SMILES 4444 Tweedy Blvd, 90280-6304 DC063349  Santee Smiles Dentistry Dental 2650 Tapo Canyon Rd Ste 107, 323-564-2444 Bright Now! Dental-Sun Valley Group 93063-2308 52/0 (SP) 8345 Laurel Canyon Blvd, 91352- 9331 Mission Gorge Rd Ste 105, 805-522-5516 3809 92071 2/1 (SP) DC060669  818-351-3582 619-448-2158 All Kids Dental Care 7/0 (SP) 6/0 (SP) DC040224  3173 Tweedy Blvd, 90280-5739 BRIGHT NOW! DENTAL-SIMI 323-564-4554 Sunland DC219501  VALLEY 1/0 DC134101  EDWARD REIDY DDS 2490 Sycamore Dr Ste A, SUNLAND DENTAL CARE 9280 Mast Blvd, 92071-2150 93065-2302 DC061949  7902 Foothill Blvd, 91040-2937 619-449-8530 805-426-6163 South Gate Family Dentistry 818-353-5520 1/0 (RU) 18/1 2639 Santa Ana St, 90280-2025 1/0 (AM FR SP) 323-583-1481 Seal Beach DC057730  2/0 (SP) Sylmar DC048166 Western Dental Center DC022488  ROSSMOOR DENTAL GROUP 1397 E Los Angeles Ave Ste F, South Pasadena SAINT MINA FAMILY DENTAL 12419 Seal Beach Blvd, 90740- 93065-2866 DC011027  12601 San Fernando Rd Ste H, 2710 805-577-9100 HEALTHY SMILE FAMILY 91342-7733 562-431-0393 37/0 (SP) DENTISTRY 818-364-1991 9/0 1315 Fair Oaks Ave Ste 103, DC058846  1/0 (AR FR SP) 91030-3868 DC058665  PRODEN DENTAL 626-799-8068 DC025912  Philip P Nguyen DDS Inc 3605 Alamo St Ste 310, 93063- 0/1 (CA CH 12 SP) KINGS FAMILY DENTAL GROUP 1900 Saint Andrews Dr Ste A, 2186 14114 Polk St, 91342 90740-5553 805-526-3331 DC047783  818-364-9444 562-430-1054 1/0 (AM SP) NEW VISION DENTAL 1/0 (SP) 1/0 (SP) 1506 Huntington Dr, 91030-4520 DC058865  626-799-2888 Aura Dental DC034824  Sherman Oaks 1/0 (SP VI) 3090 Cochran St Ste E, 93065- AMERICAN SMILE DENTAL DC007604  2795 CARE KW CHENG & V THAY INC DC057542 805-955-0181 13203 Gladstone Ave Ste A, 13732 Ventura Blvd, 91423-3024 Dentists of South Pasadena 1/0 (AR AM) 91342-3116 818-907-9533 Dental Group 818-833-0444 1/1 (SP) 813 Fair Oaks Ave, 91030-2605 DC058951  2/0 (PE SP) 626-593-0053 FAMILY DENTAL CARE DC018911  11/0 495 E Los Angeles Ave, 93065- DC055535  ANAIT ALABYAN DDS 7706 Triple Dental 4910 Van Nuys Blvd Ste 200, Stanton 805-584-2228 13060 Glenoaks Blvd Ste 105, 91403-1727 1/0 (SP) DC012597  91342-3963 818-788-2121 BRIGHT NOW! DENTAL - 818-899-1800 1/0 (AM RU SP) DC176101  STANTON 1/0 (AR AM SP) DENTAL CARE OF SIMI VALLEY 11001 Beach Blvd, 90680-3216 DC047311  1687 Erringer Rd Ste 201, 93065- 714-891-6623 DC059511  COMFORT CARE DENTAL 6509 14/0 (SP) SMILES DENTAL GROUP 5151 Hazeltine Ave, 91423-1116 805-527-3534 12737 Glenoaks Blvd Ste 6, 818-788-2023 1/0 (AM PE SP) Studio City 91342-4757 2/0 (AM SP) DC005484  818-369-5881 S C DENTAL CARE 1/0 (AM RU SP) DC060308 Solvang 4366 Tujunga Ave, 91604-2751 LA DENTAL EXPERTS DC049045  818-985-5462 Tarzana 4521 Sherman Oaks Ave Ste 201, JOHNSON FAMILY DENTAL 1/0 (PT RU SP TA) DC014329  91403-3807 GROUP THEODORE STOMEL DMD 818-668-5008 678 Alamo Pintado Rd, 93463- 19525 Ventura Blvd, 91356-2906 1/0 (SP) 2200 805-688-9999 818-708-7101 14/0 (CH SP) 0/2 (RU)

73 DeltaCare® USA

DC041283  DC025685  DC063144  DC3C3001  TARZANA DENTAL SPECIALIST CREEKSIDE DENTAL Anthem Dental TINA GHOTANIAN DDS 18663 Ventura Blvd Ste 200, 41785 Nicole Ln Ste A3, 92591- 29049 Overland Dr Ste C, 92591- 10916 Riverside Dr, 91602-2210 91356-4197 3874 3637 818-762-9966 818-881-9000 951-699-3250 951-506-4900 1/0 (SP) 0/1 (KO SP) 1/0 (SP) 1/0 (AR KO SP) Torrance DC050778  DC036408  DC3C7101  DC012660  VICTORY COSMETIC FRIENDLY DENTAL CENTER TEMECULA DENTAL PRACTICE BLUE SKY DENTAL GROUP DENTISTRY 28314 Old Town Front St, 92590- 29560 Rancho California Rd Ste 17311 Yukon Ave, 90504-2316 19231 Victory Blvd Ste 451, 1814 100, 92591-5294 310-324-3333 91335-6360 951-676-8920 951-699-2144 0/1 (KO SP) 818-345-3355 1/0 (SP) 7/2 (SP) 1/0 (SP) DC021679  DC037119  Temple City BEAVERLY GRACE CATALAN DC053766  PROMENADE DENTAL CARE DC022355  DMD Tarzana Cosmetic Dentistry 26550 Ynez Rd Ste B, 92591- FRIENDLY DENTAL CARE 22759 Hawthorne Blvd, 90505- 19458 Ventura Blvd Ste 10, 4625 10455 Lower Azusa Rd, 91780- 3613 91356-3037 951-296-3011 3470 310-373-9522 818-304-8021 1/0 (SP VI) 626-444-3744 1/0 (SP TA) 1/0 (AM SP) 1/0 (AM FR RU SP) DC055471  DC034768  DC356401  Pore Dental Group INC Thousand Oaks A BEAUTIFUL SMILE DENTAL FARA SALEHI DDS 31205 Pauba Rd Ste 205, 92592- DC006363  CENTER 18740 Ventura Blvd Ste 105, 6220 THOUSAND OAKS DENTAL 1431 W Knox St Ste 800, 90501- 91356-6302 951-506-6872 GROUP 1358 818-344-3357 2/0 (HI) 1760 E Avenida De Los Arboles 310-320-1180 1/0 Ste A, 91362-1392 1/0 (SP TA) DC056687  805-493-5200 Smiles of Temecula Dental Group Temecula 8/1 (SP) DC038322 DC003887  27365 Jefferson Ave Ste L M, E-YONSEI DENTAL OFFICE 92590-5607 SMILECARE-TEMECULA DC013064  24205 Hawthorne Blvd Ste B, 951-719-1199 32909 Temecula Pkwy Ste 102, ROYAL DENTAL SPA 90505-6576 1/0 (SP) 92592-6907 1459 E Thousand Oaks Blvd Ste 310-375-5101 951-972-8080 A, 91362-2806 1/0 (JA KO SP) DC057043  4/1 (SP) 805-494-1831 Contreras Dental Corporation 1/0 (AM FR RU SP) DC046285  DC004223  32140 Temecula Pkwy Ste 203, PCH SMILES DENTISTRY AND 92592-3896 THE OASIS FAMILY DENTAL DC013796  ORTHODONTICS 951-302-4888 41278 Margarita Rd Ste 101, EAST OAKS DENTAL GROUP 2740 Pacific Coast Hwy, 90505- 1/0 (SP) 92591-5579 593 N Moorpark Rd Ste B, 7002 951-695-2290 91360-3732 310-534-3002 DC057727 1/1 (SP) 805-494-5255 4/0 (SP) Western Dental Center 4/2 (SP) DC006422  41115 Winchester Rd Ste 102, DC056728  92591-6001 PACIFIC DENTAL GROUP DC015562  Century Dental 951-331-7020 31754 Temecula Pkwy, 92592- DAR RADFAR DDS 1270 Sartori Ave, 90501-2717 53/0 (SP) 6814 361 E Thousand Oaks Blvd, 310-320-1471 951-694-5255 91360-5805 1/0 (HI SP) DC059019  10/0 (SP) 805-497-9408 Dr Diana O Valdez 1/0 (SP) DC057414 DC014356  31515 Rancho Pueblo Rd Ste DENTISTS OF SOUTH BAY 204, 92592-4837 BRIGHT NOW! DENTAL DC059925  DENTAL GROUP 951-302-3322 30571 Temecula Pkwy Ste D, Aesthetic Dental Group 5023 Pacific Coast Hwy, 90505- 1/0 92592-4821 1655 E Thousand Oaks Blvd Ste 5441 951-693-2079 204, 91362-2838 310-752-4998 DC060522  12/5 (SP) 805-449-2552 5/0 Dr Zak Temecula Dental Group 1/0 (FR SP) DC017606  41593 Winchester Rd Ste 211, DC058330  92590-4857 MEADOWS DENTAL GROUP DC063392  Henry S Lee DDS 951-296-3366 31843 Rancho California Rd Ste 1000 Smiles 23000 Crenshaw Blvd Ste 102, 9/0 (RU SP) 300, 92592 1000 Newbury Rd Ste 138, 90505-3059 951-676-2613 91320-6438 310-534-2469 DC062790  7/1 (SP) 805-454-1000 1/0 (12 SP) Temecula Modern Dentistry 1/0 (HE PE RU SP) DC023259 40705 Winchester Rd Ste A103, DC058756  BRIGHT NOW! DENTAL 92591 Toluca Lake All Care Dental 39804 Winchester Rd Ste B, 951-252-6001 19019 Hawthorne Blvd Ste 100B, DC037096  92591-8320 1/0 (SP) 90503-1533 TOLUCA DENTAL CARE 951-695-7100 310-371-0113 10751 Riverside Dr, 91602-2324 11/3 DC063084  1/0 (AR SP) Anthem Dental 818-760-9912 0/1 (SP) DC024592  32065 Temecula Pkwy Ste C, DC062541 BUTTERFIELD DENTAL 92592-6806 All Kids Dental Care DC0C4401  33321 Temecula Pkwy Ste 104, 951-302-9300 923 W Carson St, 90502-2003 ESTEBAN BONILLA DDS 92592-4847 1/0 (AR SP) 310-533-1300 10745 Riverside Dr Ste B, 91602- 951-302-7508 10/0 (AR AM CH KO SP) 2371 1/1 (CH SP TH) 818-980-2887 1/0 (CH SP TA)

74 DeltaCare® USA

DC063010  DC014939  DC013797 DC062141  Ace Dental Group SIMONA KISS DDS CROSSROADS DENTAL GROUP JR Dental 23000 Crenshaw Blvd Ste 207, 18102 Irvine Blvd Ste 201, 92780- 1875 N Campus Ave Ste C, 23501 Cinema Dr Ste 112, 91355- 90505-3052 3424 91784-8211 5429 310-926-2234 714-730-9656 909-985-2302 661-290-3355 2/0 (KO) 1/0 (FR HU RO SP TA) 7/2 1/0 (FR SP TA)

DC063451 DC015838  DC025179  DC131101  North Point Dental KAY KIM DENTAL GRIORYAN PROFESSIONAL ZAK DENTAL CARE 4350 Redondo Beach Blvd, 13132 Newport Ave Ste 220, DENTAL CORPORATION 23838 Valencia Blvd Ste 150, 90504-1031 92780-3429 536 E Foothill Blvd, 91786 91355-5332 310-370-2966 714-505-2010 909-291-8625 661-253-4000 1/0 1/0 (KO SP) 1/0 (AM RU SP TA) 12/0 (KO SP)

DC0C6101  DC037842  DC040225  Valley Village PCH DENTAL MASOUD ARAM DDS BRIGHT NOW! DENTAL DC013584  3710 Pacific Coast Hwy Ste 101, 13771 Newport Ave Ste 11, -UPLAND ALLEN ZEBRACK DDS 90505-5914 92780-4692 280 S Mountain Ave, 91786-7029 12840 Riverside Dr Ste 406, 310-534-2633 714-838-7777 909-285-3160 91607-3351 1/0 (AR) 1/0 (SP) 10/1 (SP) 818-763-9701 1/0 DC0C8701  DC054261  DC042358  TORRANCE DENTAL ARTS DENTAL OFFICE OF LAMISE KATYUSKA PAREDES DDS DC035058  23326 Hawthorne Blvd Ste 190 KASSEM DDS 615 N Benson Ave Ste F, 91786- SHANRAM NOURI DENTAL Bldg 10, 90505-3753 17482 Irvine Blvd Ste D, 92780- 5076 CORP 310-378-8209 3032 909-949-4070 5216 Laurel Canyon Blvd, 91607- 0/1 (SP TA) 714-480-0790 1/0 (SP) 2710 1/0 (AR SP) 818-769-1347 DC2C4201  DC059945  0/1 (SP) VILLAGE FAMILY DENTAL DC054786 Village Dental and Orthodontics 1235 Sepulveda Blvd, 90502- Dr Haz Dental 1227 W Foothill Blvd, 91786-3681 DC305301  2626 13372 Newport Ave Ste F, 909-608-0700 LAUREL CHANDLER DENTAL 310-530-9656 92780-3426 1/0 (SP) 4717 Laurel Canyon Blvd Ste 0/1 (KM GR SP VI) 714-665-0898 200, 91607-3990 1/0 DC199101  818-508-2250 DC356001  JOHNSON FAMILY DENTISTRY 0/1 (SP TA) WEST COAST DENTAL DC055072 440 N Mountain Ave Ste 101, 1730 Sepulveda Blvd Ste 1, Tustin Smile Care 91786-5183 Van Nuys 90501-6901 13422 Newport Ave Ste E, 909-621-6002 DC002801  310-325-8888 92780-3746 2/0 (SP) HAMLIN DENTAL GROUP 1/1 (SP) 714-665-0005 14401 Hamlin St Ste D, 91401- 2/0 Valencia 1410 Tulare DC007663  818-782-6919 DC059522  DC036310  VALENCIA DENTAL GROUP 1/1 (AR AM CA CH 12 PT SP TA) WESTERN DENTAL SERVICES Wen Lin Liu DDS Inc 24218 Valencia Blvd, 91355-5391 14771 Plaza Dr Ste D, 92780- 1111 E Tulare Ave, 93274-4561 661-288-0288 DC004000 2779 559-688-3313 7/1 (SP) SMILECARE-VALLEY 714-616-4416 30/9 (SP) 15643 Sherman Way Ste 300, 1/0 (12) DC015666  91406-4177 Tustin CANYON DENTAL GROUP 818-786-2209 DC062068  DC002827  28237 Newhall Ranch Rd, 91355- 0/0 Rafi Dental Group A A FAMILY DENTAL GROUP 0986 14591 Newport Ave Ste 108, 18102 Irvine Blvd Ste 205, 92780- 661-257-4242 DC013875  92780-6026 3424 8/1 (HI SP) WEST COAST DENTAL GROUP 949-771-7234 714-731-5656 OF VAN NUYS 1/0 (SP TA) 0/1 (AM CH FR HI PL SP) DC016418  13716 Sherman Way, 91405-2626 VALENCIA DENTAL GROUP 818-988-2020 DC062204  DC004385  28134 Newhall Ranch Rd, 91355- 9/1 (SP) Welcome Dentistry SOUTHLAND DENTAL ARTS 0990 1096 Irvine Blvd, 92780-3527 740 El Camino Real Ste 200, 661-607-0202 DC018879  714-838-2875 92780-4369 3/1 (SP) LOURDES AQUINO DDS 2/0 (KO VI) 714-838-3230 14435 Sherman Way Ste 107, 2/0 (HI SP) DC030725  91405-6227 DC1C6201  GEORGE KOUTSOUKOS DDS 818-785-7498 TUSTIN DENTAL OFFICE DC011530  24155 Magic Mountain Pkwy, 1/0 (SP TA) 13721 Newport Ave Ste 1, 92780- AMIT SHAH DDS 91355-3904 4601 17601 17th St Ste 100, 92780- 661-222-7724 DC021782  714-368-1400 1946 1/0 (AM GR RU SP) GLOBAL DENTAL PRACTICE 3/3 (SP) 714-544-7511 14434 Hamlin St Ste 2, 91401- 1/0 (SP) DC042693  1461 Upland MAYO DENTAL 818-781-5180 DC011651  DC000232  25864 Tournament Rd Ste F, 1/0 (SP) TUSTIN DENTAL CARE ERIC CHIANG DDS 91355-2369 12575 Newport Ave Ste B, 1273 W 7th St, 91786-7069 661-291-6500 DC022741  92780-2452 909-920-9543 0/0 (SP) MARCLAY BROMONT FAMILY 714-731-6100 1/0 (12 SP) DENTAL GROUP 0/1 (AR SP) 14435 Hamlin St Ste 104, 91401- 6205 818-781-0004 0/1 (PE RU SP)

75 DeltaCare® USA

DC023866  DC057710  DC036331  DC364401  SINAI DENTAL GROUP Ventura Dental Group WESTERN DENTAL SERVICES TEIN CHUN WANG DDS 7335 Van Nuys Blvd Ste 101, 1001 Partridge Dr Ste 210, 828 S Mooney Blvd, 93277-2212 1309 N Grand Ave, 91789-1317 91405-1951 93003-0716 559-636-6000 909-594-7899 818-780-7555 805-644-9501 36/6 (SP) 1/0 (CA 12) 1/0 (AM SP) 1/0 (AR CA SP) DC054368 Walnut Park DC025119  DC061979  Packwood Creek Dental Group DC027165  MEHRZAD FIROUZBAKHT DDS R Malekzadeh DDS Inc 4129 S Mooney Blvd Ste B, ALAMEDA DENTAL GROUP 14100 Victory Blvd, 91401-1958 5722 Telephone Rd Ste 4, 93277-9147 7700 S Alameda St Ste A, 818-908-9199 93003-5319 559-732-1953 90255-3745 1/0 (SP) 805-804-5383 6/0 323-585-9200 1/0 (SP) 1/0 (SP) DC030582  DC055580  GOLDEN CARE DENTISTRY DC222901  Visalia Modern Dentistry Dental West Covina 6330 Van Nuys Blvd B, 91401- ANA HERNANDEZ CARR DDS Group DC002401  2610 2100 Goodyear Ave Ste 11, 3206 N Dinuba Blvd Ste F, EDISON DER DDS 818-785-9944 93003-7749 93291-8730 148 N Grand Ave, 91791-1728 0/1 (SP) 805-985-1159 559-334-2013 626-858-3305 1/0 (FR SP) 6/0 (SP) 1/0 DC035480  MIRO ITSKOVICH DDS DC2C5201  Vista DC003510  13251 Victory Blvd, 91401-2025 AMERIDENT GROUP DC045733  NEWPORT DENTAL 818-308-6113 6555 Telephone Rd Ste 8, VISTA DENTAL CARE 151 N Azusa Ave, 91791-1342 1/0 (RO RU SP) 93003-4460 138 Civic Center Dr Ste 115, 626-331-0076 805-642-2790 92084-6042 5/0 (12 SP TA) DC039022  1/0 (SP) 760-630-5000 ST GEORGE DENTAL 1/0 (HE SP) DC004074  6648 Van Nuys Blvd, 91405-4617 Victorville GINA BARRAMEDA DMD 818-781-2500 DC019900  DC050776  1519 E Amar Rd, 91792-1619 1/0 (AR RU SP) DESERT DENTAL GROUP NORTH COUNTY DENTAL CARE 626-964-6799 12640 Hesperia Rd Ste A, 92395- 1000 E Vista Way, 92084-4602 0/2 (TA TA) DC054161  7753 760-940-4266 Affordable Dental 760-241-3336 2/0 (AM CH LO 12 RU SP TH) DC011835  6251 Van Nuys Blvd, 91401-2711 8/0 (AR AM CH HI KO PE SP TA SMARTCARE DENTAL 818-782-5020 TH) DC059345  PRACTICE 1/0 (SP) Gentle Dental Vista 415 S Glendora Ave Ste A, DC021052  1680 S Melrose Dr Ste 108, 91790-3048 DC059505  DESERT SKY DENTAL GROUP 92081-5472 626-918-8338 Western Dental Services Inc 15667 Roy Rogers Dr Ste 101, 760-536-8470 1/0 (SP TA) 14600 Sherman Way Ste 100B, 92394-2159 3/0 (SP) 91405-5867 760-843-5824 DC013596  818-756-6950 5/2 (SP) DC059615 BRIGHT NOW DENTAL 17/0 Vista Dental Group 1000 West Covina Pkwy Ste A, DC026088  435 S Melrose Dr Ste 105, 92081- 91790 DC063846  VICTOR VALLEY DENTAL 6661 626-338-4848 Family Care Dental GROUP 760-758-7580 9/1 14515 1/2 Victory Blvd, 91411-1619 14689 Valley Center Dr Ste 101, 3/0 818-809-2001 92395-4277 DC038242  1/0 (SP) 760-245-0151 DC062127  SUNSET DENTAL 0/1 (SP) Western Dental Services Inc PROFESSIONALS Ventura 1450 N. Santa Fe Ave Suite A&C, 1042 W West Covina Pkwy, DC004109  DC029897  92083 91790-2810 WOODSIDE DENTAL CARE DR HATTAR DENTAL 760-240-7493 626-960-2766 10883 Telegraph Rd, 93004-1272 15366 Eleventh St Ste F, 92395- 9/0 (HI SP) 1/0 (CH SP) 805-647-1322 3726 1/1 760-243-3595 Walnut DC055354  0/1 (AR SP) DC000652  Rubin Nichols DDS Inc DC016444  WALNUT HILLS FAMILY 1031 E Amar Rd, 91792-1340 MAIN STREET DENTAL GROUP DC306401  DENTISTRY 626-330-6655 4360 E Main St Ste C, 93003- S M BHATT DDS 18758 Amar Rd, 91789-4169 3/0 (KO SP TA TA) 8279 14495 Seventh St Ste A, 92395- 626-912-5599 805-644-6110 4233 0/1 (AR FR SP) DC056557 3/0 (SP) 760-245-7800 West Covina Dental Group 1/1 (AR SP) DC014045  2700 E Workman Ave Ste A, DC043599 GARVEY DENTAL OFFICE 91791-1628 WESTERN DENTAL SERVICES DC390901  368 N Lemon Ave Ste E, 91789- 626-634-3393 2750 E Main St, 93003-2875 DESERT VALLEY DENTAL 2345 4/0 805-643-3556 GROUP 626-851-0020 25/4 (SP) 13792 Bear Valley Rd Ste 1, 1/0 (SP TA) DC056626  92392-8713 Dr Luis Javier Vigilarolo DC045115  760-245-2010 DC039447  266 S Glendora Ave Ste A, PLAZA DENTAL GROUP 7/2 (SP) PEDRO GONZALEZ DDS INC 91790-3042 4744 Telephone Rd Ste 4, 20199 Valley Blvd Ste F, 91789- 626-653-9276 93003-5258 Visalia 2671 0/0 (SP) 805-653-0620 DC036329  909-468-0091 0/2 (SP) WESTERN DENTAL SERVICES 0/1 (SP) DC057215  1230 S Mooney Blvd, 93277- Smile Center of West Covina 4436 820 W Merced Ave, 91790-4901 559-624-0503 626-918-3388 33/10 (SP) 1/0 (SP) 76 DeltaCare® USA

DC058740  West Hollywood DC040518  DC396701  American Dental Group of West DC011841  TAYLOR PHAM DENTAL CORP FRIENDLY HILLS FAMILY Covina OMID FARAHMAND DMD 15310 Goldenwest St, 92683- DENTISTRY 436 N Sunset Ave, 91790-1652 9201 W Sunset Blvd Ste 915, 6150 14544 Whittier Blvd, 90605-2129 626-337-7271 90069-3710 714-893-2411 562-698-9855 3/0 (PE SP) 310-273-3650 1/1 (SP VI) 1/0 (HI SP) 1/0 DC060235  DC042515  Wildomar APEX IMPLANT CENTER AND DC016502  WESTERN DENTAL SERVICES DC010723  DENTISTRY VICTORIA OLSHANSKY DDS 8001 Westminster Blvd, 92683- DIANA DOYABUT & BRYAN 360 S Glendora Ave Ste 1, 91790- INC 3302 WATANABE 5939 1136 N Fairfax Ave, 90046-5307 714-889-4131 23905 Clinton Keith Rd Ste 108, 626-671-5800 323-650-6936 38/11 (SP VI) 92595-7898 1/0 (HI SP) 1/0 (HE RU) 951-304-9700 DC058764  8/1 (SP) DC063243 DC050079  Pavilion Dental Western Dental Services Inc SUNSET SMILE DENTAL CORP 16430 Beach Blvd, 92683-7859 DC011291  1208 W Francisquito Ave, 91790 8606 W Sunset Blvd # A, 714-848-8100 BEAR CREEK DENTAL GROUP 626-917-0900 90069-2302 1/0 (AR FR SP) & ORTHO 7/0 310-424-3690 36068 Hidden Springs Rd Ste H, 2/0 (AR AM CH HE 12 RU SP TA) DC063802  92595-7681 DC160201  Lavang Dental Center 951-678-0790 WEST COVINA FAMILY West Los Angeles 9435 Edinger Ave, 92683-7425 7/2 (FR SP) DENTISTRY 714-775-1818 DC016570 450 S Glendora Ave Ste 106, 1/0 (FR VI) AFSHIN GOLYAD DDS Wilmington 91790-3068 12340 Santa Monica Blvd Ste DC012740  626-856-3317 Whittier 241, 90025-0405 WILMINGTON DENTAL 0/1 (AR SP VI) 310-820-7010 DC000026  1610 N Avalon Blvd, 90744-1431 0/1 (SP) RODOLPHO BURQUEZ DDS 310-835-3131 DC221001  11574 Hadley St, 90606-1955 15/0 (SP) RAFIK YANNI DDS Westlake Village 562-699-3838 2413 S Azusa Ave, 91792-1536 1/0 (SP) DC017527  626-913-1421 DC011740  SONA GEORGIAN DDS DENTAL OFFICE 1/0 (AR SP) DC044913  32144 Agoura Rd Ste 213, 91361- 445 E Anaheim St Ste M, 90744- WHITTIER DENTAL 4054 4600 DC329601  16406 Whittier Blvd, 90603- 818-991-4664 310-835-3535 QUEENS DENTAL GROUP 3043 1/0 (AM RU SP) 0/1 (HE SP) 910 S Sunset Ave Ste 3, 91790- 562-694-0396 3409 1/0 (KO SP) Winchester 626-337-6166 DC046272  LINDERO CANYON DENTAL DC1C5101  3/0 (AR AM HI SP TA) DC046712  GROUP WINCHESTER DENTAL CENTER WESTERN DENTAL SERVICES 5784 Lindero Canyon Rd Ste B, 33040 Simpson Rd, 92596 DC355001  INC 91362-4088 951-926-2489 SOUTHERN CALIFORNIA 14880 Whittier Blvd, 90605-1727 818-706-0131 1/0 (KO SP) DENTAL SERVICE 562-698-6555 5/0 (CH SP) 1014 S Glendora Ave, 91790- 57/0 (SP TA) 4920 Winnetka DC057171  626-918-2886 DC056521  DC002853  WELLNESS DENTAL CENTER 1/0 (CH SP) Village Dental Center EDWIN PAPAZIAN DDS INC 3665 E Thousand Oaks Blvd, 6742 Greenleaf Ave Ste 300, 7616 Winnetka Ave Ste 1, 91306- 91362-3606 West Hills 90601-5154 2686 805-496-3347 DC013266  562-945-1684 818-772-6222 1/0 (RU SP) STEPHEN CHEUNG DDS 2/0 (CA CH 12 SP) 1/0 (AM SP) 23101 Sherman Pl Ste 417, 91307- DC060028 2017 DC059428  Woodland Hills Dental Wellness of Westlake 818-348-9595 Saman Edalat DDS Inc DC011398  Village 1/0 13431 Telegraph Rd, 90605-3435 AROUND THE CORNER DENTAL 4685 Lakeview Canyon Rd, 562-946-2838 SPA 91361-4028 DC015734  5/0 (AR AM PE SP) 22030 Clarendon St Ste 102, 818-879-7480 PLATT VILLAGE DENTAL 91367 -6370 1/0 (HI SP) GROUP DC060275  818-999-4445 6446 Platt Ave, 91307-3216 Tigran Shahmanyan DDS INC 1/0 (SP) Westminster 818-716-7001 12640 Whittier Blvd, 90602- 9/1 (SP) DC004491  2926 DC013689  NEWPORT DENTAL 562-698-1314 EDWARD ROSEN & DC021392  15458 Beach Blvd, 92683-6210 1/0 (AM RU SP) ASSOCIATES FALLBROOK DENTAL GROUP 714-898-3220 21500 Ventura Blvd Ste 200, 6739 3/4 Fallbrook Ave, 91307- 7/2 (SP VI) DC062003  91364-1939 3522 Whittier Family Dental Care 818-999-6165 818-592-6060 DC034668  10420 Whittier Blvd, 90606- 0/3 (AM CH SP TA TA VI) 1/0 (SP TA) ERIC W HWANG DDS INC 1336 14120 Beach Blvd Ste 112, 92683- 562-463-3332 DC030553  DC060732  4454 1/0 (SP) AFFINITY DENTAL GROUP Birva B Joshi DDS Inc 714-894-0574 5312 Comercio Ln Ste B, 91364- 7301 Medical Center Dr Ste 305, 1/0 (SP) DC283501  2026 91307 WHITTIER DENTAL CENTER 818-884-4338 818-887-7172 14564 Whittier Blvd, 90605-2129 0/0 (SP) 1/0 (AM HI SP) 562-693-8202 1/0 (HE 13 KO PE RO SP TA)

77 DeltaCare® USA

DC040681  Southern California #367601  Encino NEW AGE FAMILY DENTAL offices (open) Family Dental Center #054894  GROUP 5436 Riverside Dr, 91710 Dr. Abadi & Associates Dental 23111 Ventura Blvd Ste 204, 909-465-5551 Office 91364-1160 (HI SP) 16633 Ventura Blvd Ste 850, 818-225-1630 Arcadia 91436 0/1 (SP) #013023  #017483  818-990-5900 Ou And Chan Dental Inc (SP) Yorba Linda Drs Cheng & Kim 5562 Philadelphia St Ste 103, 1043 W Huntington Dr, 91007 DC011539  91710 Fontana 626-445-9660 909-464-2399 YORBA LINDA DENTAL GROUP #151301  (SP) (12 SP) 18432 Yorba Linda Blvd Ste D, Fontana Dental Group 92886-4008 9193 Sierra Ave Ste D, 92335 Bakersfield #055128  714-970-2801 909-822-2226 #018808  Valdez Family Dentistry 6/2 (PL SP) Javier Central Valley Dental 4129 Riverside Dr, 91710 1415 Brundage Ln, 93304 909-591-9211 DC017522  Glendale RICHARD HAMATY DMD 661-323-0076 (SP TA) #3C4601  18509 Yorba Linda Blvd, 92886- (SP TA) Montrose Dental Group 4135 Chula Vista  3600 Ocean View Blvd Ste 6, 714-779-1313 #131001 #006103  91208 0/1 Kenneth Krauss DDS Maria Luisa Vales DMD 818-541-9010 1919 G St, 93301 88 E Bonita Rd Ste F, 91910 (AM RO) DC022020  661-323-8585 619-427-2646 YORBA LINDA DENTAL ARTS (GE SP) (TA) #018577 19831 Yorba Linda Blvd Ste A, Teeth & Gums Central Dentistry 92886-2851 Bellflower City Of Industry 730 S Central Ave Ste 116, 91204 714-406-0556 #354901  #043072  818-545-3515 0/2 Benjamin Woo DDS Unique Family Cosmetic (SP TA) 17802 Clark Ave, 90706 Dentistry DC038104  562-925-8338 18558 Gale Ave Ste 266, 91748 Glendora YORBA LINDA SMILES (CA 12 SP TA) 626-581-3188 DENTISTRY ORTHO DENTAL #054482  GROUP Beverly Hills Compton Minal Patel DDS Inc 16691 Yorba Linda Blvd, 92886-  641 W Route 66 Ste D, 91740 #019891 #2C6401 2046 626-914-3068 David Abri DDS Inc Qureshi Compton Family Dental 714-854-9920 (SP) 50 N La Cienega Blvd Ste 217, 1315 N Bullis Rd Ste 3, 90221 2/1 (SP) 90211 310-639-5330 310-275-0032 Hacienda Heights DC057194  (AM RU SP TA) Culver City #058737  Blessed Smile Dentistry of Yorba Jung-Hsiang Chen DDS Linda Brea #374401  2440 S Hacienda Blvd Ste 233, Gary Wirtschafter DDS 4846 Valley View Ave Ste B,  91745 #025702 10811 Washington Blvd Ste 302, 92886-3600 Brea Dental Arts 626-968-0052 714-579-8888 90232 (12) 710 N Brea Blvd Ste E, 92821 310-839-8033 1/0 714-529-8558 (SP) Hawthorne DC062033  #042874  Cypress #286801  Joseph Rajabi DDS Inc Signature Dental Burton Schnierow DDS  17540 Yorba Linda Blvd, 92886- 1770 E Lambert Rd Ste 200, #012688 13450 Hawthorne Blvd, 90250 3825 92821 Samuel Au DDS 310-679-0106 714-986-9293 714-255-9700 5305 Lincoln Ave, 90630 (AR CH CS HI IT SP VI TA) 1/0 (SP) (12) 714-826-9988 (CA 12 SP) Hemet Yucaipa Canoga Park Downey #004077  DC000925  #022417  Hemet Dental Clinic IMPERIAL DENTAL PRACTICE Allure Dental #002755 940 E Morton Pl, 92543 34880 Yucaipa Blvd, 92399- 8358 Topanga Canyon Blvd, Soheir Azer DDS 951-652-2796 4235 91304 10800 Paramount Blvd Ste 307, (SP) 909-797-1136 818-348-8400 90241 11/0 (SP) (AM SP) 562-923-3714 #034675  (AR SP) Sunshine Dental Care Wells Carson 239 N Sanderson Ave Ste C2, El Cajon DC039545  #012343  92545  WOO ALBERT LEE DDS Jaubin Nguyen DDS #024248 951-925-1223 74900 Highway 111 Ste 110, 92210 1754 E Carson St, 90745 Sun Valley Dental Care (AR AM SP) 760-836-0052 310-518-7068 1209 E Main St, 92021 1/0 (KO) (SP VI) 619-442-0707 Huntington Beach (SP) #151801 Chino Gabriel Capdevila DDS El Monte #016554  6082 Edinger Ave Ste A, 92647  Bright Smile Dental Care #013660 714-846-2895 12345 Mountain Ave Ste O, 91710 Whelan Lok DDS Inc (SP) 909-364-1330 10050 Garvey Ave Ste 105, 91733 (HI SP) 626-444-4220 Huntington Park (CA 12 SP) #012919  Binafard Dentaland Corporation 7136 Pacific Blvd Ste 210, 90255 323-585-1000

78 DeltaCare® USA

Inglewood #012682  Oxnard #051595  #375501  Kosal Kom DDS #019926 Carmel Mountain Dentistry Raymont Johnson Jr DDS 2338 E Anaheim St Ste 108, Iraj Movahhedi DDS 10175 Rancho Carmel Dr Ste 126, 808 E Manchester Blvd, 90301 90804 4225 Saviers Rd Ste 9, 93033 92128 310-671-1234 562-434-9980 805-982-8283 858-675-9055 (SP) (KM TH VI) (SP) (PT SP TA VI)

Irvine Los Angeles Palmdale San Dimas #040624  #018954  #375601  #3C6601  I Smile Dentistry Chinatown Service Center Y Siani DMD Bouz Dental Corporation 33 Creek Rd Ste 300, 92604 767 N Hill St Ste 213, 90012 619 W Avenue Q Ste A, 93551 639 E Foothill Blvd Ste A, 91773 949-333-2717 213-808-1790 661-947-6782 909-599-2029 (AR FR) (SP) (AM SP) (AR RU)

La Habra #000637  Poway San Gabriel Dan Benyamini DDS #1C2401  #036647  #176601  1826 W 7th St, 90057 Harbor Dental Pacific Dental Care Sun Dental 213-484-6660 971 N Harbor Blvd, 90631 12307 Poway Rd Ste B, 92064 1720 S San Gabriel Blvd Ste 101, (SP) 562-690-3551 858-668-3390 91776 (CH SP) (SP) 626-288-9055 #018593  (CA 12) Ladera Dental Group #355701  Rancho Cucamonga 5814 Obama Blvd, 90016 #0C3501  Juliet Chua DDS #026932  310-836-7200 Thomas Wu DDS 2241 W Whittier Blvd, 90631 Renaissance Dental Care (HI SP) 1103 S San Gabriel Blvd Ste A, 562-691-7438 9080 Milliken Ave Ste 100, 91730 91776 #038592  909-987-0040 La Jolla 626-286-7000 Michel Vasquez DMD Inc (CA 12 SP) #059836  1125 S Beverly Dr Ste 750B, Redlands Harmony Dental Group 90035 #040992  Santa Barbara 8950 Villa La Jolla Dr Ste B101, 310-277-7645 Smile Bright Dental #046651  92037 (SP) 414 Tennessee St Ste K1, 92373 Montecito Dental Group 858-550-8000 909-798-4000 1165 Coast Village Rd Ste I, (AR SP) #328501  93108 Watts Healthcare Corporation Rialto 805-565-9837 La Mesa 10300 Compton Ave, 90002 #022890  #358801  323-357-6600 Samir Shah DDS Santa Clarita Smilehaven Dental Center 469 W Base Line Rd, 92376 #008536  4700 Spring St Ste 210, 91942 Monrovia 909-746-0444 Lyons Dental Care 619-464-2801 #366801  (HI SP) 24036 Lyons Ave, 91321 (CA SP TA) Saleh Kholaki DDS 661-255-1015 513 E Lime Ave Ste 204, 91016 Riverside (SP) Laguna Hills 626-301-4220 #047287  #028913  (AR SP) La Sierra Family Dentistry Sunland Akash Lapsi DDS 3410 La Sierra Ave Ste D, 92503 #134101  23521 Paseo De Valencia Ste Montebello 951-354-9550 Sunland Dental Care 206, 92653 #035763  (LO SP TH) 7902 Foothill Blvd, 91040 949-770-7766 Dental Care Of Montebello 818-353-5520 (AR HI SP) 1332 W Whittier Blvd, 90640 #026612  (AM FR SP) 323-888-0999 Riverside Dental Office Lake Forest (AR SP) 1485 University Ave, 92507 Toluca Lake #034498  951-784-4441 Lake Forest Dental Health Care Northridge (HI SP) #120301  Hoosik Najarian DDS 25411 Trabuco Rd Ste 112, 92630 #029567  10655 Riverside Dr, 91602 949-581-1000 At Ease Dentistry Rowland Heights 818-769-1111 (SP) 11155 Tampa Ave, 91326 #012594  (AM) 818-363-3382 Steven Chiu DDS Inc Lawndale (RU SP) 18906 Gale Ave Ste B, 91748 Torrance #043895  626-965-5618 Vadadent Modern Dental Group Norwalk (12) #057783  Crossroads Dental Group 16002 Hawthorne Blvd, 90260 #013590  24231 Crenshaw Blvd, 90505 310-371-4104 Norwalk Dental Assoc Inc San Bernardino 310-326-3657 (AR AM CH SP) 13828 Pioneer Blvd, 90650 #029297  (HI SP) 562-863-7253 Dr Gills Family Dentistry Loma Linda (FR SP VI) 1584 W Base Line St Ste 103, #016541 #059061  92411 Jin Yang DDS Ronald L Moore DDS Inc #029294  909-885-3100 1001 W Carson St Ste G, 90502 25835 Barton Rd Ste 104, 92354 Rose Dental Implant Center (AR AM RU SP) 424-558-3772 909-796-2299 13041 Rosecrans Ave Ste 207, (SP) (SP) 90650 San Diego 562-404-1614 #031633  #058826  Long Beach (KO SP) Boulevard Dental Center MB Dental #037979  3531 El Cajon Blvd Ste A, 92104 18506 Hawthorne Blvd, 90504 Gary Trombatore & Kenny Orange 619-584-8975 310-483-7779 Abedini #056816 (SP VI) (AR SP) 3816 Woodruff Ave Ste 104, Pearl Dental 90808 1714 N Tustin St, 92865 562-425-0545 714-998-5502 (SP TA VI) (HI SP)

79 DeltaCare® USA

Upland Vista West Hills Westminster #013854  #029747  #013266  #046905  Paul Chang Dental Inc La Jolla Townsite Family Dental Stephen Cheung DDS Dr Sam C Morcos 600 N Mountain Ave Ste D205, 706 Townsite Dr, 92084 23101 Sherman Pl Ste 417, 91307 7271 Westminster Blvd, 92683 91786 760-724-4392 818-348-9595 714-894-3306 909-985-9866 (SP) (CA 12) (AR FR SP VI) (CH SP) West Covina Van Nuys #383201  #021219  Gregory Robins Family Dentistry California Smiles Dental Group 1129 S Glendora Ave, 91790 14424 Victory Blvd, 91401 626-919-7707 818-908-9800 (AM CA SP TA)

Visit us at our website: deltadentalins.com. Additional Dental Offices will be added as required. You may call DeltaCare USA Customer Care at 800‑422‑4234 for updates to the provider list. If any office is closed to further enrollment, Delta Dental reserves the right to assign you another dental office as close to your home as possible.

80 Administered by

17871 Park Plaza Drive, Suite 200 Cerritos, CA 90703 KPIC’s dental program information 800‑933‑9312 DeltaCare USA information 800‑422‑4234

Delta Dental is a registered mark of Delta Dental Plans Association.

SA‑01‑904‑05 KA5 PB#129876 (rev. 08/20)