Coverage Table

Diagnostic & X-rays

Service Description Membership Discount
Comprehensive Exam (New patient, initial visit) 100%
Periodic Exam (1 per year) (Child under age of 18 – 2 per year) 100%
Limited Oral Exam (Problem focused – 1 per year) 100%
Complete Series or Panorex (1 every 3 years) 100%
Periapical, First Film (Each add’l film covered at 100%) 100%
Bitewings (1 time per year) 100%

Preventative

Service Description Membership Discount
Child Prophylaxis (Cleaning – 2 per year) 100%
Adult Prophylaxis (Cleaning – 2 per year) 100%
Fluoride (2 per year – no age limit) 100%
Sealants 20%

All Other Procedures

Service Description Membership Discount
Fillings and Core Buildups 20%
Crowns & Bridges (Permanent) 20%
Veneers 20%
Periodontics 20%
Dentures & Partials (including Reline) 20%
Oral Surgery 20%
Root Canals 20%
Implants 20%
Implant Post/Crown 20%
Orthodontics* (including Invisalign)
*For Orthodontics – Member must remain a plan member for the duration of treatment to retain discount plan benefits.
$500 off