The following chart provides a comparison of costs for certain procedures covered by the state-sponsored dental plans. Please consult each dental plan's Evidence of Coverage for detailed information and plan limitations.
Diagnostic and Preventive Benefits (two cleanings annually)
1. Diagnostic and Preventive Benefits are exempt from the deductible.
2. The level of benefits and covered services reflected in the chart are based on services provided by a PPO Plan dentist; for services provided by a non-PPO plan dentist, the level of benefits is lower.
3. The PPO includes a third cleaning for high-risk patients.