Page 56 - APPENDICES for Neill McLauchlin
P. 56

PREVENTIVE DENTAL



      Oral exam
      In-network: $0 copay
      Out-of-network: $0 copay

      Limits apply




      Cleaning
      In-network: $0 copay
      Out-of-network: $0 copay

      Limits apply



      Fluoride treatment

      In-network: $0 copay
      Out-of-network: $0 copay

      Limits apply



      Dental x-rays
      In-network: $0 copay

      Out-of-network: $0 copay

      Limits apply






      COMPREHENSIVE DENTAL



      Non-routine services
      In-network: $0 copay
      Out-of-network: $0 copay

      Limits apply



      Diagnostic services

      In-network: $0 copay
      Out-of-network: $0 copay

      Limits apply



      Restorative services
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