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MONTHLY | COMPREHENSIVE DENTAL |
Employee Only | $48 |
Employee + Spouse | $89 |
Employee + Child(ren) | $86 |
Family | $134 |
In-Network | Out-of-Network | |
Preventive & Diagnostic Exams; Cleanings; Bitewing X-Rays; Full Mouth X-Rays; Fluoride Treat- |
100% |
80% |
Basic Fillings; Simple Extractions; Oral Surgery; Periodontics; Root Canals |
80% |
50% |
Major Crowns & Gold Restorations; Bridgework; Full & Partial Dentures; Repair |
50% |
50% |
Annual Maximum (per person) |
$1,500 | $1,500 |
Annual Deductible Per Person |
$50 |
$100 |
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