[ HEALTH ]

DENTAL

Your dental benefits include the following — for coverage you can smile about. Note that the dental annual limit per member is $1,000.

Coverage Description Coinsurance Coverage Description Coinsurance
Diagnostic & Preventive 0% Oral Surgery 30%
Space Maintainers 30% Endodontics 30%
Restorative 30% Periodontal Treatment 30%
Crowns 50% Prosthesis 50%
Orthodontics-

Lifetime maximum benefit per member-$1,000.00

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