|
Insured
Portion*
|
Dental
Partner
Savings*
|
Total
Coverage*
|
Diagnostic and Preventative
- annual exam**
|
80%
|
20%
|
100%
|
Minor Restorative
- fillings & space maintainers
|
70%
|
20%
|
90%
|
Extractions
- surgical removal of teeth (limited to two wisdom teeth per benefit year)
|
50%
|
20%
|
70%
|
Endodontic & Periodontic
- periodontal and other oral surgery (up to 2 units of scaling and/or root planing per benefit year)
- endodontic (root canals)
|
15%
|
20%
|
35%
|
Major Restorative (excludes orthodontics)
- bridges and crowns
|
15%
|
20%
|
35%
|
Benefit year maximum of $750 and specific category limits may also apply.
|