National Internet Services Disctrict 3
AT&T-Patient Benefit Page
Yearly Insurance Maximum For General Dental: $1300.00;
Ortho: $1400.00
Lifetime Deductible: $25.00 (provided you have
your teeth cleaned at least 1 time each year.)
| Dental Services |
Patient Pays |
PREVENTATIVE PROCEDURES
Teeth
Cleaning (2 times per year)
X-rays
Examinations
Fluoride Treatments |
$0.00 -You Pay Nothing! |
Periodontal Procedures
Gum Therapy
Deep Cleanings w/anesthesia |
% Co-Pay Applies |
Fillings:
Silver Fillings
Composite “Tooth Colored” Fillings |
% Co-Pay Applies |
| Inlays
Onlays |
% Co-Pay Applies |
| Root Canal Procedures |
% Co-Pay Applies |
| Crowns (Caps) |
% Co-Pay Applies |
| Bridges (Permanently
placed to fill in for missing teeth) |
% Co-Pay Applies |
| Partial Dentures (Removable
appliance to fill in for missing teeth) |
% Co-Pay Applies |
| Full Dentures (Removable
appliance to replace all missing teeth) |
% Co-Pay Applies |
All Benefits Are Subject To Patient Eligibility
And Plan Provisions. Always-Contact Insurance For Details
