|
Dental
Insurance: Highlights
Dental
Plans Don’t Get Much Easier
Because
it is a dental HMO plan, the PacifiCare Dental
511 Individual Plan takes the hassle out of
maintaining a healthy, attractive smile. You just
show up for your appointment and make your copayment.
No claim forms. No deductibles. What could be
easier?
Highlights
of PacifiCare Coverage
| Procedure |
Procedure
With PacifiCare Coverage* |
Procedure
Without Coverage* |
|
| Initial
Exam |
No
Charge |
Up
to $65 |
|
| X-rays
(full-mouth) |
No
Charge |
Up
to $111 |
|
| Adult
Cleaning |
No
Charge |
Up
to $75 |
|
Filling
(triple surfaces Ð silver) |
$26 |
Up
to $156 |
|
| Root
Canal (anterior) |
$100 |
Up
to $573 |
|
Porcelain
with Metal Crown
(not for molars)** |
$165 |
Up
to $712 |
|
| Complete
Upper or Lower Denture |
$250 |
Up
to $1,090 |
|
| Braces
(orthodontics) |
$1,895*** |
Up
to $4,000 |
|
|
***Costs
are averages and may vary.
**Plus additional cost of gold if selected
***Refer to the individual Orthodontic Information
sheet for a complete listing of orthodontic
benefits, copayments, exclusions, and limitations.
|
For
additional information, call the Member Services
department of PacifiCare at 1.800.228.3384.
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