The Advantage 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 deductibles
• No waiting periods
  
  
  

Type I - Preventive Services	Patient Pays
Office Visit (General Dentist) Office Visit (Specialist) Initial Exam X-Rays (Bitewings) Semi-Annual Cleaning Sealant - per tooth	$5.00   $15.00 No Charge No Charge No Charge No Charge
Type II - Basic Services	Patient Pays
One surface silver filling Two surface white filling, anterior Periodontal scaling & root planing (per quadrant)	$24.00   $31.00   $39.00
Type III - Major Services	Patient Pays
Surgical removal of erupted tooth Crown-porcelain fused to high noble metal Molar root canal therapy Complete upper dentures	$108.00 $466.00 $497.00 $642.00
Type IV - Orthodontics	Patient Pays
Comprehensive orthodontic treatment for children to age 19
Consultation Evaluation Treatment Planning/Records Orthodontic Treatment	$0.00   $35.00 $250.00 $2100.00
Adults 19 years of age or older
Consultation Evaluation Treatment Planning/Records Orthodontic Treatment	$0.00   $35.00 $250.00 $2300.00

This schedule shows only a few of the covered procedures. 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.