What You’ll Pay for Your Dental Care
Select a type of plan to find out how much you’ll pay.
DHMO is a kind of dental insurance plan that covers only in-network care (except for emergencies), and you need a referral to see a specialist. DPPO plans let you get care from in-network or out-of-network providers without a referral (cost varies between in and out of network).
Edit Benefit
No
Deductible
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No
Annual Benefit Limit
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$350
Individual Out-of-Pocket Maximum (child only)
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$700
Family Out-of-Pocket Maximum (2 or more children only)
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$0
Office Copay
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No
Waiting Period for Children
Services
| Service | Price |
|---|---|
| Diagnostic and Preventive (includes x-rays, exams, cleanings and sealants) | Free |
| Amalgam Filling: One Surface | $25 |
| Root Canal: Molar | $300 |
| Gingivectomy, Per Tooth | $50 |
| Extraction: Single Tooth, Exposed Root or Erupted | $65 |
| Crown: Porcelain With Metal | $300 |
| Medically Necessary Orthodontia | $350 for children Not covered for adults |
Ready to care for your health?
Need help applying?
You can get help from a certified enrollment counselor right away. It’s always free and confidential. Talk to someone about your options and have them guide you through the process. You can enroll in person, by phone or online.
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