- Diagnostic and preventive services: X-rays and cleanings
- Restorative services: fillings, oral surgery, root canals and gum treatments
- Prosthodontics: crowns, bridges, dentures and implants
Note: Out-of-network reimbursements and maximums are based on reasonable and customary (R&C) charges as determined by each Dental Plan administrator. Please refer to the Health Benefits and Insurance Summary Plan Description for details.