Dental

Dental PPO

Members have the freedom to choose any dental provider of their choice, plus get additional cost-savings with network participation. And members have access to our vast network of 155,000 dentists.

The plans also include the BEST Life special dental accident benefit. This provides $1,000 per accident to sound and natural teeth and is not counted toward the calendar year maximum.

  In-Network Out-of-Network
Calendar Year Maximum $2,500 $2,000
$2,000 $1,500
$1,500 $1,000
$1,000 $1,000

Calendar Year Deductible

3 per family max

$0, $25, $50, $75 or $100
Waived on preventive services.

Class I: Preventive Services

Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants.

100% 100%

Class II: Basic Services

Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery.

90% 80%

Class III: Major Services

Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures.

60% 50%

Endodontics Class II or Class III

Periodontics Class II or Class III

Waiting Periods 12 month waiting period applies to major and orthodontic services.
Waived for qualifying groups.

Special Dental Accident Benefit $1,000 maximum per accident to sound, natural teeth.

Out-of-Network Reimbursement UCR at 80th or 90th Percentile or MAC
MAC available in AZ, and NV only.

Orthodontics Option 50%

Child Only Orthodontic Benefit Option

Dependent children through age 18.

$1,000 Lifetime / $500 Calendar Year Maximum or
$1,500 Lifetime / $750 Calendar Year Maximum

Adult/Child Orthodontia Benefit Option $1,000 Lifetime / $500 Calendar Year Maximum

Child Good Vision Benefit

Included with orthodontia.

Covers 50% of UCR for an eye exam once every
12 months for children through age 18.
  In-Network Out-of-Network
Calendar Year Maximum $2,000 $1,500
$1,500 $1,000
$1,000 $1,000

Calendar Year Deductible

3 per family max

$0, $25, $50, $75 or $100
Waived on preventive services.

Class I: Preventive Services

Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants.

100% 80%

Class II: Basic Services

Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery.

80% 80%

Class III: Major Services

Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures.

50% 50%

Endodontics Class II or Class III

Periodontics Class II or Class III

Waiting Periods 12 month waiting period applies to major and orthodontic services.
Waived for qualifying groups.

Special Dental Accident Benefit $1,000 maximum per accident to sound, natural teeth.

Out-of-Network Reimbursement UCR at 80th or 90th Percentile or MAC
MAC available in AZ, and NV only.

Orthodontics Option 50%

Child Only Orthodontic Benefit Option

Dependent children through age 18.

$1,000 Lifetime / $500 Calendar Year Maximum or
$1,500 Lifetime / $750 Calendar Year Maximum

Adult/Child Orthodontia Benefit Option $1,000 Lifetime / $500 Calendar Year Maximum

Child Good Vision Benefit

Included with orthodontia.

Covers 50% of UCR for an eye exam once every
12 months for children through age 18.
  In-Network Out-of-Network
Calendar Year Maximum $1,500 $1,500
$1,000 $1,000
$500 $500

Calendar Year Deductible

3 per family max

$0, $25, $50, $75 or $100
Waived on preventive services.

Class I: Preventive Services

Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants.

100% 80%

Class II: Basic Services

Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery.

80% 50%

Class III: Major Services

Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures.

0% 0%

Endodontics Class II or Class III

Periodontics Class II or Class III

Waiting Periods None

Special Dental Accident Benefit $1,000 maximum per accident to sound, natural teeth.

Out-of-Network Reimbursement UCR at 80th or 90th Percentile or MAC
MAC available in AZ, and NV only.

Orthodontics Option Not Offered

Child Only Orthodontic Benefit

Option Dependent children through age 18.

Not Offered

Adult/Child Orthodontia Benefit Option Not Offered

Child Good Vision Benefit

Included with orthodontia.

Not Offered
  In-Network Out-of-Network
Calendar Year Maximum $1,500 $1,500
$1,000 $1,000
$500 $500

Calendar Year Deductible

3 per family max

$0, $25, $50, $75 or $100
Waived on preventive services.

Class I: Preventive Services

Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants.

100% 80%

Class II: Basic Services

Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery.

50% 20%

Class III: Major Services

Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures.

0% 0%

Endodontics Class II or Class III

Periodontics Class II or Class III

Waiting Periods None

Special Dental Accident Benefit $1,000 maximum per accident to sound, natural teeth.

Out-of-Network Reimbursement UCR at 80th or 90th Percentile or MAC
MAC available in AZ, and NV only.

Orthodontics Option Not Offered

Child Only Orthodontic Benefit

Option Dependent children through age 18.

Not Offered

Adult/Child Orthodontia Benefit Option Not Offered

Child Good Vision Benefit

Included with orthodontia.

Not Offered

Available in

AZ, DC, FL, IL, IN, MD, MI, MO, NE, NV, OH and PA.

MAC available in AZ, and NV only.