|
Diagnostic care:
Initial oral exam and charting
Periodic oral exam (once every six months)
Full mouth x-rays (once every 60 months)
Bite wing x-rays
Single tooth x-rays (as needed)
Preventive care:
Oral prophylaxis-cleaning, scaling and polishing
Fluoride treatment
Space maintainers
|
| Restorative and Other Basic Services-normally
covered at 80% |
|
Restorative: Amalgam fillings on permanent teeth or white fillings on
front teeth
Oral surgery-simple surgical tooth extraction
Periodontic: gum surgery, gingival curettage, periodontal scaling
Endodontics: root canal treatment
Prosthetic maintenance: rebase denture, reline denture
Emergency dental care: emergency treatment for relief of pain
|
| Major Restorative Services-normally
covered at 50% |
|
Major restorative
Porcelain and base metal crown
Prosthodentic
Upper partial denture (resin) and bridge ponic (base metal)
|
| Orthodontic-normally
covered at 50% for dependents up to age 19 and subject to a lifetime
annual maximum of $1,000 or $1,500 |
| |
| Carriers |
| |
Blue Cross Blue Shield |
Guardian |
|
Delta Dental |
Met Life |
|
|
| To return to the general discussion of benefit plans, click
here. |
