City of Warren Retirees Standard

Class I - Preventive (exams, cleanings, x-rays, etc.)

100%†

Class II - Basic (fillings, repairs, etc.)

75%†

Class III - Major (bridge, dentures, root canals, oral surgery, etc)

70%†

Class IV - Specialty Care (oral surgery, endodontics,periodontics,pedodontics)

50%†

Deductible

None

Office Visit Copay

$15

Primary Care Maximum

$1,200

Specialty Care Maximum

$800

Orthodontic Maximum (Lifetime)

None