Dental
Plan Preferred
Scheduled
Indemnity Benefits - See the dentist of your
choice.
- $1500 annual maximum
- Low $50 deductible - waived for preventive
services.
- Set reimbursements for procedures - no surprises!
- Cash paid directly to you or your provider
- For New York Residents over 65,
Click Here
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Click here for a Free No Obligation
Quote and Enroll
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Sample Reimbursements
| ADA Code |
Description |
Reimbursement |
| 0150 |
Comprehensive oral evaluation -
new or established patient |
$33.00 |
| 0274 |
X-Ray - bitewings - four
films |
$26.00 |
| 1110 |
Routine Prophylaxis - adult (once
every six months) |
$38.00 |
| 2331 |
Resin filling - two surfaces,
anterior |
$50.00 |
| 2750 |
Crown -porcelain fused to high
noble metal* |
$187.00 |
| 3330 |
Root Canal - Molar* |
$196.00 |
| 4341 |
Periodontal scaling and root
planning - per quadrant* |
$48.00 |
| 7110 |
Single tooth (extraction) |
$40.00 |
There are four
levels of procedures:
Level
1: Preventative Procedures ($50 deductible will
be waived for these procedures).
Level
2: Basic
Procedures (There is a $50 deductible applied to these
procedures that must be met per
person per Calendar Year, and a $150
deductible applied to Family Coverage).
Level
3: Restorative
Procedures (There is a $50 deductible applied to these
procedures that must be met per
person per Calendar Year, and a $150
deductible applied to Family Coverage).
Level
4: Major
Procedures (There is a $50 deductible applied to these
procedures that must be met per
person per Calendar Year, and a $150
deductible applied to Family Coverage.
There is a 12 month
preexisting
condition
limitation that applies to these
procedures.
Click Here for full reimbursement
schedule
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