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Legend. General Arrival/Departure delays are 15 minutes or less. Departures are experiencing taxi delays of 16 to 45 minutes and/or arrivals are .
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Colorado - Revised 1/25/2010**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission

Payer List subject to change without noticePage 1 of 5Pre.Enr.Payer IDNameAdditional InfoState62308Continental Dental58102Covenant Administrators, Inc.39170Custom Benefit Administators 60054CustomCare (Southwestern Bell - Exec)DEW01D.Edward Wright TPA94276DDICDDPFSDelta Dental - Tricare Retiree02027Delta Dental (Northeast - ME, NH, VT)DDAL1Delta Dental Ins.Co.

- AlabamaDDFL1Delta Dental Ins.

Co.- FloridaDDGA1Delta Dental Ins.Co.- GeorgiaDDLA1Delta Dental Ins.Co.- LouisianaDDMS1Delta Dental Ins.Co.- MississippiDDTX1Delta Dental Ins.

Co.- TexasDDUT1Delta Dental Ins.Co.

- UtahDDAK1Delta Dental Of Alaska86027Delta Dental of ArizonaDDPARDelta Dental of Arkansas77777Delta Dental of CaliforniaDDPCODelta Dental of Colorado22189Delta Dental of Connecticut51022Delta Dental of DelawareDDGA1Delta Dental of Georgia82029Delta Dental of Idaho47598Delta Dental of IllinoisCDIA1Delta Dental of IowaCDKY1Delta Dental of Kentucky23166Delta Dental of Maryland04614Delta Dental of Massachusetts43090Delta Dental of MissouriDDMT1Delta Dental of MontanaDDNV1Delta Dental of Nevada22189Delta Dental of New Jersey11198Delta Dental of New York23166Delta Dental of Pennsylvania05029Delta Dental of Rhode Island43091Delta Dental of South Carolina in Missouri54097Delta Dental of South DakotaDDTX1Delta Dental of Texas91062Delta Dental of WA52147Delta Dental of Washington DC31096Delta Dental of West Virginia39069Delta Dental of WisconsinDDCA2DeltaCare USA - ClaimsDDCA3DeltaCare USA - Encounters52133Dental Benefit ProvidersDCP01Dental Care Plus 64246Dental Guard PreferedDNOA1Dental Network of AmericaCX034Dental Network of America - ILLINOISDSL01Dental *If more than 50% of total monthly claim volume is sent to Denti-Cal, you may be subject to a fee of $19.95.25172DH EvansHSP01District Council 37 - State, County & Municipal Emp - AFL-CIODOM01Dominion Dental (115 S.Union St., Ste.

300, Alexandria, VA 22314)CX014Doral Dental of Wisconsin03036EBPA (NH) / CBA (VT)73288EHI, EHIC73288EMPHESYS38241Employee Benefit Concepts37257Employee Benefit Consultants - EBC, Inc

(OH, WI, KY, NM)73288Employers Health Insurance of Wisconsin62308Equicor / Equitable73126Equitable Plan servicesCX046Erin Group Administrators43168Essex Dental Benefits34159E-V Benefits Management, Inc.72630First Ameritas Life Insurance Corp.

of NY71005First Reliance Standard11244Fitzharris & CompanyRevised 1/25/2010**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission

Payer List subject to change without noticePage 2 of 5Pre.Enr
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.Payer IDNameAdditional Power & Light70408Fortis Benefits Insurance Company39065Fortis Insurance (Individual Plans - formerly Time Ins.)GCU01GCU Local 8-M & 96B Health & Welfare Fund67814GE Group Life / Administrators/ FinancialCX014Georgia Medicaid - Grady Healthcare, Inc.13551GHI - New York - (Group Health Inc.)80314GICGWD01Golden West Dental (888 W.

Vantura Blvd., Camarillo, CA)CACX014Grady Healthcare - Georgia MedicaidCX015Group Link of Indiana64246Guardian Life Insurance Co.of AmericaDX029Health CompCX039Health Economics Group Inc.CX009Health Partners ProvidentHGL01Heavy & General Laborers95378Heritage National HealthplanCX013Hershey HealthsmileCX015Hoosier Dental73288Humana22175I.E.ShafferIAT01IATSE Atlanta Health & Welfare Fund36600Illinois Central Hospital AssociationICW01Indiana Carpenters Welfare Fund52196InforMed, LLC88006Insurance Management Services51020Integra Administrative GroupIAT01International Association of Theatrical Stage Employees (IATSE) Atlanta Health & Welfare FundA1117International Brotherhood of Electrical Workers (IBEW), Local 117 Health & Welfare FundA1317International Brotherhood of Electrical Workers (IBEW), Local 38 Health & Welfare FundA1461International Brotherhood of Electrical Workers (IBEW), Local 461Welfare FundA4681International Brotherhood of Electrical Workers (IBEW), Local 481EWF01International Brotherhood of Electrical Workers 36961271J.

F.Molloy and AssociatesJPF01Jefferson Pilot FinancialJEN01Jenkins & Associates (1299 Battlecreek Rd., Ste.200 & PO Box 607, Jonesboro, GA 30237-0607)JiSSPJI Special Services65099John Hancock Health Security Plan34136JP Farley CorporationKBT01Kansas Building TradesA1004Laborers Metropolitan Detroit Healthcare FundLSH01Laborers Southeast Health & Welfare Plan73288Lincoln National of WisconsinNYT01Local 1149 Baldwinsville, NYGCU01Local 8-M & 96B Health & WelfareCX033MAMSICX014Managed Health Services - WI State Employees98010Manulife, W.J.Sutton Co.60054MarriottCX014Maryland Physicians Care MCO56205MBS56205MedCost Benefit Services (MBS)56205Medcost of North CarolinaCX014Medicaid of Georgia, Grady Healthcare, IncCKKY3Medicaid of Kentucky (Doral Dental / Region #3)CX014Medicaid of Maryland, PhysiciansCare MCOCKMA1Medicaid of Massachusetts/Mass HealthCX014Medicaid of Missouri, Blue AdvantageCX014Medicaid of Missouri, Community Care Plus - St.LouisMOCX014Medicaid of Missouri, Community Health\ PlanCX014Medicaid of Missouri, FirstGuard Health PlanCX014Medicaid of Missouri, HealthCare USA - St.LouisCX014Medicaid of Missouri, HealthNetCX014Medicaid of Missouri, TrumanCare - Family Health PartnersMOCX014Medicaid of Nebraska, United HealthCare of the MidlandsNE86047Medicaid of New Jersey (Adminstrated by Americhoice)NJRevised 1/25/2010**** Indicates Pre-Enrollment - Approval from Office Ally and Payer Required Prior to Claim Submission

Payer List subject to change without noticePage 3 of 5Pre.Enr.Payer IDNameAdditional InfoStateCX014Medicaid of New Mexico, Cimmaron Health PlanCX014Medicaid of New Mexico, Lovelace Community Health PlanNMCX014Medicaid of New Mexico, Presbyterian Salud86048Medicaid of New York (Adminstrated by A
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