Basic Dental Benefits
$1,000 per lifetime
for each covered child.
Limited
to covered children under age 19…
Onlays,
Crowns, Bridges, Dentures, repair of Prosthetic Appliances
$25 annually combined
for Classes II and III.
Fillings,
extractions, oral
surgery, preparation for dentures…
$1,000 per person
each benefit year combined for Classes
I, II, and III.
100% of ALLOWABLE charges
Cleaning,
Flouride, Space maintainers, X-rays…