Preventative Care (covered at 100% with no deductible)

• Routine periodic examinations, including bite-wing x-rays at 12-month intervals

• Full mouth x-rays once in any 36-month interval

• Topical fluoride application for dependent children once in any 12-month interva

• Prophylaxis, including cleaning, scaling and polishing, once every 6 months

Basic Care (covered at 80% with $50/$150, individual/family deductible)

• Emergency treatment for relief of pain

• Restorative services: fillings materials such as amalgam, synthetic porcelain and plastic restorations

• Oral surgery: Provides for extractions and other oral surgery

• Endodontics, including pulpotomy, pulp capping and root canal treatment

• Periodontics (treatment for diseases of the gums and bones)

• Repair of full and partial dentures

• Space maintainers

• Stainless steel crowns

Major Care (covered at 50% with $50/$150, individual/family deductible)

• Non-precious restorations

• Crowns (plastic, plastic with non-precious metal, porcelain with non-precious metal)

• Bridges

• Full and partial dentures

• Relining of full and partial dentures

• Non-precious restorations, crowns and prosthetic appliances are a benefit only once in a five year period

Orthodontia (covered at 50%, $1,000 lifetime max. per person)

• Straightening and alignment of teeth for dependent children