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DENTAL INSURANCE

METLIFE | PPO DENTAL PLAN
With the Metlife Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and
benefit from the negotiated rate or visit a non-network dentist. When you utilize a PPO dentist, your out-
of-pocket expenses will be less. You may also obtain services using a non-network dentist; however, you
will be responsible for the difference between the covered amount and the actual charges and you may
be responsible for filing claims.

METLIFE
PPO DENTAL PLAN
Network In-Network Non-Network
DENTAL BENEFITS
Calendar Year Maximum Benefit $3,000
Annual Deductible
Individual $50
Family $150
Preventive Services (Plan Pays)
Oral Exams, Full Mouth/Bitewing X-Rays,
Cleaning, Topical Fluoride Applications,
Sealants, Space Maintainers, Periodontal 100% 100%
Maintenance, Emergency Pallative
Treatment, Harmful Habits Appliances
Basic Services (Plan Pays)
Amalgam and Composite Fillings,
Prefabricated Crowns, Repairs,
Endodontics Root Canal, Periodontal
Surgery, Periodontal Scaling & Ded, 100% Ded, 100%
Root Planing, Oral Surgery (Simple
Extractions, Surgical Extractions, and
Other Extractions), General Anesthesia,
Consultations
Major Services (Plan Pays)
Crowns/Inlays/Onlays, Bridges, Dentures, Ded, 60% Ded, 60%
Implant Services
Orthodontia
Covered Family Members Adults & Child(ren) up to Age 26
Coinsurance 50%
Lifetime Maximum Benefit $1,500 per Person

FINDING A DENTAL PROVIDER:
Go to www.metlife.com/dental or call (800) 438-6388. Refer to the “PDP Plus” network when
prompted.

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