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Emory Dental Plan


Corporate Information

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Accesss Plan T – 185 Dental Option

  T-185 Co-pay Overview  
  T-185 Benefit Schedule  
  T-185 FAQs  
  T-185 Search for Providers  

Residents Only Dental Option

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  Traditional Benefit Schedule  
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T-185 with Ortho Plan

Our Access plan offers the flexibility of one premium rate and immediate access to in-or-out-of-network benefits for all employees. Members are not required to fulfill a deductible or pre-authorize any care. Additional plan features are:

bulletFreedom to choose any dentist
bulletFixed member in-network co-payments
bulletScheduled reimbursement for out-of-network
dental services

Office Visit Co-Pay : $10.00
Applies only when Preventive and Diagnostic procedures are performed
Patient Pays
Periodic Oral Exam No charge $24.00
(Bitewing - four films)
No charge $27.00
Panoramic Film No charge $50.00
Semi-Annual Cleaning, Adult No charge $45.00
Semi-Annual Cleaning, Child No charge $30.00
Sealant - per tooth No charge $23.00
Fluoride - child only No charge $35.00
Two surface silver filling, primary $18.00 $52.00
Two surface white filling, anterior $23.00 $52.00
Steel Crown $90.00 $19.00
Porcelain crown (noble) $354.00 $136.00
Pulp Cap $9.00 $23.00
Scaling & Root Planing $33.00 $79.00
Root canal therapy - Bicuspid $114.00 $289.00
Complete upper dentures $472.00 $132.00
Treatment for children up to 19 years of age
   Evaluation $35.00  
   Treatment Planning $250.00  
   Orthodontic Treatment $2,300.00  
Treatment for adults 19 years of age and over
   Evaluation $35.00  
   Treatment Planning $250.00  
   Orthodontic Treatment $2,500.00  
Retention $450.00  
Annual Maximum Benefit
per Family Member

*The Out-of-Network maximum reimbursement amount may vary for Type I procedures based on the Preventive and Diagnostic office visit copayment amount applied towards the cost of services rendered.

This schedule shows only a few of the covered procedures. Please see your Benefit Administrator for a complete schedule. This schedule is intended for comparison purposes only. The benefits for each plan will be determined by the contract. This plan contains certain exclusions and limitations. For a complete listing of benefits and exclusions and limitations, please reference your certificate of coverage.





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