SiteImpact • 2023-2024 Benefits Guide
DENTAL UNITEDHEALTHCARE
Although you can choose any dental provider, when you use an in-network dentist, you will generally pay less. If you choose an out-of-network provider, you may be billed the difference between what UHC pays, and what your out-of-network provider charges for the services. To locate an in-network provider, please visit www.myuhcdental.com or call them at 877-816-3596.
Dental
DPPO
DHMO
In-network
Out-of-network
In-network
Annual deductible (Individual/Family)
$50/$100
$50/$100
N/A
Annual maximum (per person)
Unlimited
Unlimited
N/A
Diagnostic and preventive care
2 basic cleanings within 12 months
Oral Exam
100%
100%
Schedule of Benefits
Bitewing X-Rays
100%
100%
Schedule of Benefits
Full Month X-Rays
100%
100%
Schedule of Benefits
Teeth Cleaning 2X Per Year
100%
100%
Schedule of Benefits
Fluoride Treatment
100%
100%
Schedule of Benefits
Sealants
100%
100%
Schedule of Benefits
Basic services Fillings
100%
80%
Schedule of Benefits
Periodontics (Gum disease)
100%
80%
Schedule of Benefits
Endodontics (Root Canal)
100%
80%
Schedule of Benefits
Simple & Surgical Extractions
100%
80%
Schedule of Benefits
Major services Inlays, Onlays, Crowns
60%
50%
Schedule of Benefits
Dental Implants
60%
50%
Schedule of Benefits
Prosthodontics (Bridges & Dentures)
60%
50%
Schedule of Benefits
Denture Reline and Rebase Services
60%
50%
Schedule of Benefits
Orthodontia Orthodontic Age Limit
Adult and Children
Adult and Children
Orthodontics (Adult Coverage)
50%
$2,050
Lifetime Maximum
$1,000 (Lifetime Max)
N/A
Plan includes out-of-network benefits, see plan summary for additional details.
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