View Plan Rates by State

Benefit Maximum:
Per Person, Per Calendar Year: $2000

Deductible:
(applies to Type 2 service only)

Per Person, Per Calendar Year: $50
Type 1 deductible waived
No family maximum

Insured Percent:

Type 1	Type 2	Type 3
100%	80%	50%

Type 1 Services - No Waiting Periods, 100% covered

• Routine Oral Exams - Once every 6 Months.
• Routine Dental Cleaning - Once every 6 Months.
• Bitewing X-Rays - once every 12 months.
• Full Mouth or Panoramic X-Rays - Once every 5 years.
• Periapical X-Rays
• Flouride treatments - For children 13 and under. One per benefit period.
• Sealants - Ages 13 and under.
• Space maintainers

Type 2 Services - No Waiting Periods, 80% covered.

• Restorative Amalgams
• Restorative Composites
• Endodontics - nonsurgical
• Denture Repair
• Simple extractions

Type 3 Services - NOT COVERED

• Onlays
• Crowns - 1 in 10 years per tooth.
• Crown Repair
• Endodontics - surgical
• Periodontics - nonsurgical
• Periodontics - surgical
• Prosthodontics - fixed bridge; removable complete/partial dentures covered once per 10 years.
• Complex Extractions
• Anesthesia