Page 12 - Allegacy 2017 booklet 8.5x11

Allegacy Benefit Solutions Page 12

Buy – Up Dental Benefits

Provided by MetLife

Type 1 Procedures: Diagnostic & Preventive Services
 Cleanings and exams-2 per benefit period 100% covered
 X-rays (bitewings allowed twice per benefit No deductible
period)
 Fluoride for dependent children age 18 & under
 Space Maintainers
 Sealants for dependent children age 16 & under

Type 2 Procedures: Basic Services
 Fillings 90% covered
 Simple & complex extractions, oral surgery Deductible applies
 Endodontics
 Periodontics
 Emergency treatment
 Denture repair

Type 3 Procedures: Major Services
 Anesthesia 50% covered
 Crowns repair Deductible applies
 Dentures, bridges

Type 4 Procedures: Orthodontia
 Available for adults and dependent children 50% covered
 Lifetime maximum benefit is $2,500 per covered No deductible
person