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Class I - Diagnostic and Preventive (exams, cleanings, x-rays, etc.)
100%
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Class II - Restorative (fillings, repairs, etc.)
75%
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Class III - Prosthetic (crowns, bridges, partial and complete dentures)
60%
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Class IV - Specialty Care (oral surgery, endodontics, periodontic, pedodontics)
50%
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Deductible
None
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Primary Care Maxiumum
$1,500
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Orthodontic Maximum (Lifetime)
$1,800 up to age 19, $1,800 adults 19+ (Comprehensive Case Only)
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Provider Directory
Policy will cover dependents up to age 26 for CLASS I-IV only.