Benefits
Coinsurance
Plan pays:
In Network
100% Diagnostic & Preventive / 80% Basic / 50% Major
Out of Network
90% Diagnostic & Preventive / 70% Basic / 40% Major
Deductibles
$50 per adult (adult max $150)1
Annual Maximums
$1,500 per member
Waiting Periods
There is a six-month waiting period for basic services and a twelve-month waiting period for major services.
Receive Care From
Elite PPO network dentist or any licensed dentist
States Available
DC, MD, PA, VA
Preventive Care
Plan pays:
In Network
100%
Out of Network
90%
Services Include:
- Comprehensive Oral Exam
- Bitewing X-Rays (2 Sets)
- Full and Panoramic X-rays (100% covered in-network)
- Teeth Cleanings (Adult)
Basic Services
Plan pays:
In Network
80%
Out of Network
70%
Services Include:
- Amalgam Filling (silver)
- Composite Filling (white)
- Extraction, Erupted Tooth
Major Services
Plan pays:
In Network
50%
Out of Network
40%
Services Include:
- Crown (Porcelain/Metal)
- Bridges
- Complete Denture
- Relining of Dentures
- Periodontics (root planing and therapy)
- Endodontics (root canals)
- Oral Surgery (extraction of impacted teeth)
Orthodontics:
Orthodontia services are not covered.
Elite PPO Premium Kids
Enrolled dependents under the age of 19 will automatically be enrolled in our pediatric dental plan.
PLAN DETAILS
Explore Everything Included in the Dental Plan
Prevention Rewards
Get Cleanings. Get Rewarded!
With our Prevention Rewards Program, primary subscribers receive $20 for themselves and each enrolled family member who completes two cleanings in a calendar year with a participating dentist. It's simple, rewarding and included in every dental plan.*Shop Plans* The Discount Program does not include Prevention Rewards. Please see plan documents for full terms and conditions.
Vision Plan
Complement your dental coverage with a vision benefit or enroll in just a vision plan.
Explore plans to see if a vision benefit is available in your area.
Shop Plans - Deductibles apply to basic and major services.
- Dominion National Internal Performance Report, 2024. Mid-Atlantic includes D.C., Delaware, Maryland, New Jersey, Pennsylvania and Virginia. Participating providers are subject to change