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Class I - Preventive (exams, x-rays,)
95%†
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Class I - Preventive (cleanings, fluoride)
100%†
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Class II - Basic (fillings, repairs, etc.)
70%†
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Class III - Major (root canals, oral surgery, etc)
65%†
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Class III - Major (bridges, dentures, etc)
65%†
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Class IV - Specialty Care (oral surgery, endodontics, periodontics, pedodontics)
35%
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Deductible
None
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Primary Care Maximum
Unlimited
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Specialty Care Maximum
$1,000
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Orthodontic Maximum (Lifetime)
$1,800 benefit up to age 19
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Orthodontic Maximum (Lifetime)
$1,200 benefit ages 19+ comprehensive cases only
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Provider Directory