Condensed 2 Page Black & White Schedule Of Benefits In PDF Format

These are condensed versions of our Schedule of Benefits listing the most common procedures.

There are two Schedules of Benefits for each state.  The Urban Schedule is used in any metropolitan area with a population greater than 100,000.  The Rural Schedule is used in any area with a population less than 100,000 and at least 50 miles away from an urban area.  If a facility is using the rural fee schedule it will be noted with their information on the Provider Locater page.

These Schedule of Benefits are in a PDF format and guaranteed virus free.  You will need to have Adobe® Acrobat Reader to open them.  If you do not have Acrobat Reader, you may download it for free at www.acrobat.com.  Look for the "Get Adobe Reader" icon.

State State State State State
Alabama - Zone 2
 
Hawaii - Zone 8
 
Massachusetts - Zone 8
 
New Mexico - Zone 3
 
South Dakota - Zone 5
 
Alaska - Zone 8
 
Idaho - Zone 3
 
Michigan - Zone 3
 
New York - Zone 7
 
Tennessee - Zone 2
 
Arizona - Zone 1
 
Illinois - Zone 5
 
Minnesota - Zone 6
 
North Carolina - Zone 4
 
Texas - Zone 4
 
Arkansas - Zone 2
 
Indiana - Zone 3
 
Mississippi - Zone 2
 
North Dakota - Zone 5
 
Utah - Zone 5
 
California - Zone 7
 
Iowa - Zone 4
 
Missouri - Zone 3
 
Ohio - Zone 7
 
Vermont - Zone 6
 
Colorado - Zone 6
 
Kansas - Zone 4
 
Montana - Zone 5
 
Oklahoma - Zone 2
 
Virginia - Zone 6
 
Connecticut - Zone 7
 
Kentucky - Zone 5
 
Nebraska - Zone 5
 
Oregon - Zone 6
 
Washington - Zone 7
 
Delaware - Zone 6
 
Louisiana - Zone 2
 
Nevada - Zone 6
 
Pennsylvania - Zone 5
 
Washington DC - Zone 8
 
Florida - Zone 5
 
Maine - Zone 5
 
New Hampshire - Zone 7
 
Rhode Island - Zone 6
 
West Virginia - Zone 3
 
Georgia - Zone 4
 
Maryland - Zone 8
 
New Jersey - Zone 8
 
South Carolina - Zone 4
 
Wisconsin - Zone 5
 
        Wyoming - Zone 5
 

Perspective Members Please Take Note:  The fact that we have a fee schedule for every state does not guarantee that we have Preferred Providers in that state.  Please be sure to check our Provider Locater and call the dental office to insure their participation in Savon Dental Plan.

Savon Dental Plan Is Not Available For Purchase In The State Of Florida
 
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Corporate Offices Located In Phoenix, Arizona  1-800-809-3494
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