Fee Schedule
Preventive
Dental Benefits Routine exams, teeth cleanings, topical fluoride for children up to age 16.
No waiting period. Policy Pays
100%
Basic
Dental Benefits X-rays, simple extractions, fillings.
6 month waiting period. Plan Pays
80%
Major
Dental Benefits Crowns, bridges, oral surgery (surgical extractions & impactions), endodontics, periodontics, dentures.
18 month waiting period. Plan Pays
50%
Dental
Deductible Per calendar year, per insured person for Basic, & Major Services. $50
Maximum
Dental Benefits Per calendar year, per insured person. $1000
发表于 2020-4-3 20:19:12
