Click here for a plan brochure
| 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 |
Search for an in-network provider: