Services & Benefit Options

Indemnity UCR Plan
Calendar Year deductibles4
Select of $25 or $50
Calendar Year maximum Benefit
Select $1,000 , $1,500, or $2,000
Preventative & Diagnostic Services
Type 1 Services
  • Clinical oral examinations (limited to two exams per calendar year)
  • Bitewing X-rays (no less than six months apart)
  • Prophlyaxis (limited to two cleanings per calendar year)
  • Topical Fluoride treatment for children up to age 19,or 23 if a full-time student (0nce per calendar year)
  • Sealants for children under age 14 5
  • Space maintainers for children up to the age of 19 (23 if full-time student)
  • Emergency treatment (If no other service was rendered except x-rays)
100%
The Indemnity Plan allows you the freedom to go to any dentist you choose.
Type II Basic Services
Type II Services
  • Extractions (non-orthodontic)
  • Oral Surgery
  • Restorative-type fillings
  • General anesthetic when administered with oral surgery
  • Endodontics treatment (pulp capping , pulpotomy, and root canal treatment) 6
  • Periodontics 6
80%
The Indemnity Plan allows you the freedom to go to any dentist you choose.
Type III Major Services
Type III Services
  • Crowns, Inlays and Onlays (Single Restorations)
  • Installation Prosthodontics (Bridges and Dentures)
  • maintenance Prosthodontics (adjustments within six months after installation)7

 
50%
The Indemnity Plan allows you the freedom to go to any dentist you choose.
Type IV Orthodontia Services
Type IV Services
  • Lifetime Benefit Maximum $1,000 or $1,500
  • For Children under the age 19 only
  • Only available to groups of five or more7

 
50%
The Indemnity Plan allows you the freedom to go to any dentist you choose.