-
Class I - Preventive (exams, cleanings, x-rays, etc.)
100% †
-
Class II - Basic (fillings, repairs, etc.)
85% †
-
Class III - Major (bridge, dentures, root canals, oral surgery, etc)
80% †
-
Class IV - Specialty Care (oral surgery, endodontics,periodontics,pedodontics)
50%
-
Deductible
None
-
Primary Care Maxiumum
$3,000
-
Specialty Care Maximum
$1,000
-
Orthodontic Maximum (Lifetime)
$1,800 Up to age 19, $1,200 Adults 19+ Comprehensive Case Only
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Schedule of Benefits
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Provider Directory
† PERCENTAGES are APPROXIMATE, see benefit breakdown as listed on the Benefit Summary.
