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Belvedere Family Dentistry
Daniel Lopez
2734 Rozzelles Ferry Rd
Charlotte, NC 28208
(704) 927-5499
belvederedentistry.com
Office Hours
Monday:
8:00am -
- 4:00pm
Tuesday:
7:00am -
- 3:00pm
Wednesday:
8:00am -
- 4:00pm
Thursday:
7:00am -
- 3:00pm
Friday:
Closed
Saturday:
Closed
Sunday:
Closed
View Our Membership Plans

Plan Summary

Cost of Plan: $300/year
Plan Value: $557/year
Savings: $257/year
Starts on: March 28, 2024
Plan Renews On: March 28, 2025

Membership Plan Benefits Include:

Description CDT Code Qty Value1 You Pay
Professional cleanings D1110 2 87.00 $0
Regular exams D0120 2 52.00 $0
Oral screenings D0431 2 66.00 $0
Routine x-rays Varies As Needed 75 $0
Emergency exam D0140 1 72.00 $0
Total $557
Sign Up For This Plan
Procedure Category Discount
D0000-D0999 (Diagnostic)20%
D1000-D1999 (Preventative)20%
D2000-D2999 (Restorative)20%
D3000-D3999 (Endodontics)20%
D4000-D4999 (Periodontics)20%
D5000-D5999 (Removable Prosthodontics)20%
D6000-D6199 (Implant Services)20%
D6200-D6999 (Fixed Prosthodontics)20%
D7000-D7999 (Oral & Maxillofacial Surgery)20%
D8000-D8999 (Orthodontics)0%
D9000-D9999 (Adjunctive General Services)20%

Exclusions

This membership plan excludes procedures not listed in the accompanying fee schedule. This membership plan does not cover procedures completed outside of this practice.

Disclosures

  • The membership plan is not insurance and is not a qualified health plan under the Affordable Care Act. The membership plan is a direct agreement between you and your dentist. You are electing to make payments directly to your dentist in return for services.
  • The membership plan is administered by AmplePlans, LLC (Ample Plans) for your dentist.
  • Your dentist has established his or her own membership fees, treatment fees, and terms. Ample Plans does not make payments to dentists for medical services. You pay dentists for medical services and Ample Plans charges dentists fees for use of the Ample Plans platform and administrative services.
  • The membership plan includes a 30-day money back guarantee. You can receive a full refund up to 30 days after purchase if no benefits of the plan have been used. Refunds are at your dentist’s discretion if (1) benefits of the plan have been used in the first 30 days, and/or (2) more than 30 days has passed since you purchased the plan.
  • The membership plan runs for 12 months and includes an auto renewal feature. You can opt out of the auto renewal at anytime from your online account. You will receive an email reminder 45 days prior to the renewal date.
  • Your membership plan payments must be current to receive the services and discounts included in the membership plan.
  • Payment for treatment not included in the membership plan is due at the time of service.
  • The pricing offered by your dentist may not be combined with any other offers or discounts including insurance coverage.

1Value is calculated by using the fee schedule from your retail office fees.

Plan Summary

Cost of Plan: $550/year
Plan Value: $680/year
Savings: $130/year
Starts on: March 28, 2024
Plan Renews On: March 28, 2025

Membership Plan Benefits Include:

Description CDT Code Qty Value1 You Pay
Professional cleanings D4910 3 99.00 $0
Regular exams D0120 2 52.00 $0
Oral screenings D0431 2 66.00 $0
Routine x-rays Varies As Needed 75 $0
Emergency exam D0140 1 72.00 $0
Total $680
Sign Up For This Plan
Procedure Category Discount
D0000-D0999 (Diagnostic)20%
D1000-D1999 (Preventative)20%
D2000-D2999 (Restorative)20%
D3000-D3999 (Endodontics)20%
D4000-D4999 (Periodontics)20%
D5000-D5999 (Removable Prosthodontics)20%
D6000-D6199 (Implant Services)20%
D6200-D6999 (Fixed Prosthodontics)20%
D7000-D7999 (Oral & Maxillofacial Surgery)20%
D8000-D8999 (Orthodontics)0%
D9000-D9999 (Adjunctive General Services)20%

Exclusions

This membership plan excludes procedures not listed in the accompanying fee schedule. This membership plan does not cover procedures completed outside of this practice.

Disclosures

  • The membership plan is not insurance and is not a qualified health plan under the Affordable Care Act. The membership plan is a direct agreement between you and your dentist. You are electing to make payments directly to your dentist in return for services.
  • The membership plan is administered by AmplePlans, LLC (Ample Plans) for your dentist.
  • Your dentist has established his or her own membership fees, treatment fees, and terms. Ample Plans does not make payments to dentists for medical services. You pay dentists for medical services and Ample Plans charges dentists fees for use of the Ample Plans platform and administrative services.
  • The membership plan includes a 30-day money back guarantee. You can receive a full refund up to 30 days after purchase if no benefits of the plan have been used. Refunds are at your dentist’s discretion if (1) benefits of the plan have been used in the first 30 days, and/or (2) more than 30 days has passed since you purchased the plan.
  • The membership plan runs for 12 months and includes an auto renewal feature. You can opt out of the auto renewal at anytime from your online account. You will receive an email reminder 45 days prior to the renewal date.
  • Your membership plan payments must be current to receive the services and discounts included in the membership plan.
  • Payment for treatment not included in the membership plan is due at the time of service.
  • The pricing offered by your dentist may not be combined with any other offers or discounts including insurance coverage.

1Value is calculated by using the fee schedule from your retail office fees.

Plan Summary

Cost of Plan: $250/year
Plan Value: $448/year
Savings: $198/year
Starts on: March 28, 2024
Plan Renews On: March 28, 2025

Membership Plan Benefits Include:

Description CDT Code Qty Value1 You Pay
Professional cleanings D1120 2 72.00 $0
Regular exams D0120 2 52.00 $0
Fluoride treatment D1208 2 39.00 $0
Routine x-rays Varies As Needed 50 $0
Emergency exam D0140 1 72.00 $0
Total $448
Sign Up For This Plan
Procedure Category Discount
D0000-D0999 (Diagnostic)20%
D1000-D1999 (Preventative)20%
D2000-D2999 (Restorative)20%
D3000-D3999 (Endodontics)20%
D4000-D4999 (Periodontics)20%
D5000-D5999 (Removable Prosthodontics)20%
D6000-D6199 (Implant Services)20%
D6200-D6999 (Fixed Prosthodontics)20%
D7000-D7999 (Oral & Maxillofacial Surgery)20%
D8000-D8999 (Orthodontics)0%
D9000-D9999 (Adjunctive General Services)20%

Exclusions

This membership plan excludes procedures not listed in the accompanying fee schedule. This membership plan does not cover procedures completed outside of this practice.

Disclosures

  • The membership plan is not insurance and is not a qualified health plan under the Affordable Care Act. The membership plan is a direct agreement between you and your dentist. You are electing to make payments directly to your dentist in return for services.
  • The membership plan is administered by AmplePlans, LLC (Ample Plans) for your dentist.
  • Your dentist has established his or her own membership fees, treatment fees, and terms. Ample Plans does not make payments to dentists for medical services. You pay dentists for medical services and Ample Plans charges dentists fees for use of the Ample Plans platform and administrative services.
  • The membership plan includes a 30-day money back guarantee. You can receive a full refund up to 30 days after purchase if no benefits of the plan have been used. Refunds are at your dentist’s discretion if (1) benefits of the plan have been used in the first 30 days, and/or (2) more than 30 days has passed since you purchased the plan.
  • The membership plan runs for 12 months and includes an auto renewal feature. You can opt out of the auto renewal at anytime from your online account. You will receive an email reminder 45 days prior to the renewal date.
  • Your membership plan payments must be current to receive the services and discounts included in the membership plan.
  • Payment for treatment not included in the membership plan is due at the time of service.
  • The pricing offered by your dentist may not be combined with any other offers or discounts including insurance coverage.

1Value is calculated by using the fee schedule from your retail office fees.