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.. |
| 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.. |
| 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 |
| 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 |
| 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, CA, DC, FL, IL, IN, MD, MI, MO, NE, NV, OH and PA.
MAC available in AZ, and NV only.
