Advantage Dental: Copays

Oral Examinations* $5 copay

Cleanings, including scaling and polishing* (Adult/Child) $5 copay

Fluoride* $5 copay

Sealants (permanent molars only) $5 copay

Bitewing X-rays* $5 copay

Full-mouth series X-rays* $5 copay

Consultation with primary care dentist $5 copay

Amalgam restorations and related medications $5 copay

Composite restorations and related medications $5 copay

Retention pins as necessary $5 copay

Sedative fillings $5 copay

Minor denture adjustment $5 copay

Scaling and root planing* $5 copay

Emergency Exam $5 copay

Diagnostic Casts and photographs $5 copay

Pulp Vitality tests $5 copay

Endodontics (root canal and pulp treatment) Reduced fee

Nonsurgical extractions and related medications Reduced fee

Crowns and bridges Reduced fee

Removable prosthodontics, including dentures Reduced fee

Oral Surgery (excluding oral surgery covered under the Aetna medical plan) Reduced fee

*Frequency and/or age limitations may apply to these services. These limits are described in the plan documentation.

Office Visit Copay N/A (copays are per service not per visit)

Orthodontic Care (braces) Reduced Fee