What You’ll Pay For Your Dental Care

Select a type of plan to find out how much you’ll pay.

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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, cleaning and sealants) Free
Amalgam Filling: One Surface $25
Root Canal: Molar $300
Gingivectomy, Per Tooth $50
Extraction: Single Tooth, Exposed Root or Erupted $65
Extraction: Complete Bony $160
Crown: Porcelain With Metal $300
Medically Necessary Orthodontia $350 for children

Not covered for adults

Ready to care for your health?

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Need help applying?

You can get help from a certified enroller 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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