Dental Cobra Help Center (sm)   

 

 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

Click here for a Free No Obligation Quote and Enroll

 

     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