What You’ll Pay for Your Dental Care
Select a type of plan to find out how much you’ll pay.
DHMO is a kind of dental insurance plan that covers only in-network care (except for emergencies), and you need a referral to see a specialist. DPPO plans let you get care from in-network or out-of-network providers without a referral (cost varies between in and out of network).
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$50 Deductible for Adults
$75 for Children
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No Annual Benefit Limit for Children
$1,500 Annual Benefit Limit for Adults
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$350
Individual Out-of-Pocket Maximum (child only)
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$700
Family Out-of-Pocket Maximum (two or more children only)
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$0
Office Copay
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Six-Month Waiting Period
for Major Services for Adults
Services
| Service | Price |
|---|---|
| Diagnostic and Preventive (includes x-rays, exams, cleanings and sealants) | Sin costo |
| Amalgam Filling: One Surface | Pay 20% of bill |
| Root Canal: Molar | Pay 50% of bill |
| Gingivectomy, Per Tooth | Pay 50% of bill |
| Extraction: Single Tooth, Exposed Root or Erupted | Pay 50% of bill |
| Crown: Porcelain With Metal | Pay 50% of bill |
| Medically Necessary Orthodontia | Children: pay 50% of bill Not Covered for Adults |
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