Meritain Dental DPPO Plan
Services
In-Network
Out-of-Network
$100/$300
$100/$300
Annual Deductible
$2,500
$2,500
Annual Maximum Benefit
Plan pays 100%
Plan pays 100%
Preventive Dental Services (exams, fluoridee, bitwing x-rays, cleanings)
Frequency
See schedule below
See schedule below
Deductible
Deductible
Basic Dental Services (periodontal maintenance, peridontal surgery, root canal)
then 20%
then 20%
Frequency
See schedule below
See schedule below
Deductible
Deductible
Major Dental Services (crowns, bridges, dentures, implants)
then 50%
then 50%
See schedule below
See schedule below
Frequency
50%
50%
Orthodontia Services
$1,000
$1,000
Orthodontia Lifetime Max
Preventitive Dental Services Frequency: Exams & Cleanings: 1in 6 months | Fluoride & Bitewing X-rays: 1in 12 months Basic Dental Services Frequency: Periodontal Maintenance: 2 in 1year less the number of teeth cleanings Peridontal Surgery: 1in 36 months | Root Canal: one per tooth per lifetime
Major Dental Services Frequency: 1in 5 years
12
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