Page 10 - Allegacy 2017 booklet 8.5x11

Allegacy Benefit Solutions Page 10

You have an option of a Core and a Buy-Up Dental plan

Core Dental Benefits

Provided by MetLife

Type 1 Procedures: Diagnostic & Preventive Services
 Cleanings and exams-1 per 6 months 100% covered
 Bitewing X-rays, 1 per 12 months No deductible
 Fluoride for dependent children age 13 & under, 1
per 12 months

Type 2 Procedures: Basic Services
 Panoramic X-rays, 1 per 5 years
 Sealants, age 13 and under 80% covered
 Fillings Deductible applies
 Simple extractions
 Denture repair

Type 3 Procedures: Major Services
 Space maintainers 50% covered
 Crowns , 1 in 10 years per tooth Deductible applies
 Crown repair
 Onlays
 Endodontics
 Periodontics
 Dentures, bridges, 1 in 10 years
 Complex extractions
 Anesthesia