Dental


Disability


Vision


Dental Plan 100

High Option- Plan Dentist
$avings of Over $10,000
The Money Saver
Members Services* Pay
Amount
Diagnostic Services- 100% Savings

Oral Examination and diagnosis
Full Mouth x-rays (once every 5 years)
Prophylaxis (once every 6-months)
Vitality Test, Emergency Pain Relief

 No Charge
No Charge
No Charge
No Charge
Restorative Dentistry- 100% savings

Amalgam filling, primary and permanent teeth
(One Surface)
Composite, acrylic, plastic restorations
(One surface), Sedative base

 No Charge
No Charge
No Charge
No Charge
Crown and Bridge- 75% savings

Porcelain with Metal (non-precious)Crown/Bridge
(per unit)
Composite, acrylic, plastic restorations
Sedative base

 340.00

No Charge
Periodontics/Endodontics- 80% savings

Subingival curettage, per quadrant
Pulp capping /  Recalcification
Culturing Canal
Root canal Therapy (one root)
70.00
No Charge
No Charge
75.00
Prosthetics- 85% savings

Complete upper and lower denture, per denture
Denture adjustments
Denture repairs
495.00
No Charge
40.00
Oral Surgery- 90% savings

Alveolectomy, per quadrant
Post-operative visits
Simple extractions, uncomplicated
Impactions- Erupted/Soft Tissue
Local analgesia
No Charge
No Charge
25.00
65.00
No Charge

* These are amounts the member pays for the dental expenses, if work is performed by Preferred Provider / Selected Panel of General Dentists only. Member payments will be higher if you choose to use a dentist of your own choice, and some reimbursement will be paid by the insurance carrier. Savings approximates costs for usual and customary charges.

Dental Plan Features