Services
- Clinical Examination
- X-Rays
- Periodic Cleaning
- Restorative
- Composite Fillings (White Fillings)
- Oral Surgery (Extractions)
- Implants
- Cosmetic Whitening
- Endodontics (Root Canals)
- Crowns & Bridges
- Pediatrics
- Prosthetics
- Periodontics
- Sponsorships
Allowance Rate Schedule
Effective October 1, 2022
| Covered Benefits | Plan 1023 $39.99/Adult $19.99/Child* Monthly $37.99/Adult Family Rate $17.99/Child Family Rate (*Child 11years-) |
|---|---|
| First Initial Clinical Examination, X-Rays and Periodic Cleaning(1) | $20 copay |
| Periodic Cleaning (2 per contracted year) w/ Fluoride treatment | 100% |
| Sealants & Fluorides | 100% |
| Cosmetic Whitening | 50% |
| Implants | 35% |
| Endodontic (Root Canals) | 35% |
| Crowns & Bridges | 35% |
| Pediatrics (up to 11 years of age) | 35% |
|
Periodontics (except LANAP-Osseous Surgery) |
35% |
|
Restorative Composite Fillings (white fillings) |
35% |
| Oral Surgery (Extractions) | 35% |
| ClearCorrect | 10% |
| Sponsorships (Dependents) | Yes |
*Dependents Children 11 years and below*
Participating Dental Specialists
| Oral Surgeon | 25% |
Dental Prescriptions
| Mega Drug Pharmacy | 25% |
Member Option Plans
Plan 1023
$479.88 - 1 year contract for Adult
$239.88 - 1 year contract for Children
* REQUIREMENTS FOR MONTHLY PAYMENT OPTION: Valid Photo ID | $120.00 Security Deposit | Credit Card Authorization Form
