Prestige 15 Overview


Main	About	News	Jobs	Members	Groups	Dentists	Contact



Saddle Creek Corporation Members

	About CompBenefits



	Prestige 15 Overview

	Prestige 15 Schedule

	Prestige 15 Frequently Asked Questions

	Search for Providers



	Select 25 Overview (North Carolina)

	Select 25 Schedule

	Select 25 Frequently Asked Questions (FAQs)

	Search for Providers



	Select 25 Overview (CompDent)

	Select 25 Schedule

	Select 25 Frequently Asked Questions

	Search for Providers



	Contact Information

Prestige 15 Overview

The DHMO plan provides a wide variety of benefits through your participating provider. At the time of services, you pay the dentist for any applicable copayments according to your schedule of benefits. The plan features:

	No claims to file
	No hidden costs
	No maximums
	No waiting periods

Type I � Preventive Services	Patient Pays
Office Visit	$5.00
Initial Exam	No charge
X-Rays (Bitewings)	No charge
Semi-Annual Cleaning	No charge
Sealant - per tooth	$7.00

Type II � Basic Services	Patient Pays
One surface silver filling	No charge
Two surface white filling, anterior	$37.00
Single tooth extraction	No charge
Surgical removal of erupted tooth	$25.00

Type III � Major Services	Patient Pays*
Porcelain crown (high noble)	$240.00
Porcelain bridge	$240.00
One surface inlay	$85.00
Molar root canal therapy	$240.00
Complete upper dentures	$260.00

Type IV � Orthodontics	Patient Pays*
Treatment for children to age 19
Evaluation	$35.00
Treatment Planning	$250.00
Orthodontic Treatment	$1650.00

* Some services require additional lab fees.

Calendar Year Deductible	None
Annual Maximum Benefit	None
Pre-Existing Condition Exclusion	No pre-existing condition exclusion applies
Exclusions and Limitations	Certain exclusions and limitations apply

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. For a complete listing of benefits and exclusions and limitations, please reference your certificate of coverage.

To submit comments or questions, please visit our Contact Center.

Your Privacy Choices