DWIHN

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

100% †

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

85% †

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

85% †

Class IV - Specialty Care (when performed at a specialist)

50%

Deductible

None

Primary Care Maximum

$3,500

Specialty Care Maximum

$1,000

Orthodontic Maximum (Lifetime)

$3000 benefit up to age 19, $2000 benefit ages 19+