Agent Guide | Dental, Vision & Hearing
ManhattanLife Insurance and Annuity Company
Dental Coverage
DVH
DVH Select
Dental Examinations Cleanings (prophylaxis) Bitewing X-Rays Fluoride Treatments
Semi-Annual Exams Cleaning X-rays
Preventative Services
Limited Oral Evaluation Diagnostic Consultation Emergency Palliative Treatment X-Rays
Panoramic X-Ray Periapical X-Ray Fillings Amalgam Restoration Composite Resin (Synthetic) Restoration Pin Retention Basic Oral Surgery Non-Surgical Extractions Periodontal Services Non-Surgical Services Periodontal Scaling and Root Planning Periodontal Maintenance Major Restorative Services Inlays, Onlays and Crowns (excludes core build-up) Endodontic Services Surgical Periodontal Services Prosthodontic Services Implant Services
X-rays Fillings and Extractions (other than “full mouth”)
Basic Services
Bridges Crowns
Major Services
Full Dentures or Partials Full Mouth Extractions Root Canals
See policy forms for specific limitations
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