any dentist
High Plan Low Plan
$2,000 Annual Maximum
All Procedures
6
$1,000 Annual Maximum
Preventive Procedures do not reduce this maximum*
No Deductible $25 Deductible (waived for Preventive Procedures)
Preventive – Covered at 100% Preventive – Covered at 100%
Oral Exams & Cleanings – 2 per calendar year Oral Exams & Cleanings – 2 per calendar year
Topical Fluoride Application – 1 per calendar year (Adult & Child) Topical Fluoride Application – 1 per calendar year (Child only)
Bitewing X-rays - 1 set per calendar year Bitewing X-rays - 1 set per calendar year
Full Mouth X-rays – 1 per 60 months Full Mouth X-rays – 1 per 60 months
Palliative (Emergency Treatment) Palliative (Emergency Treatment)
Oral Cancer Screening Oral Cancer Screening – NOT COVERED
Basic – Covered at 60% Basic – Covered at 50%
Fillings – Amalgam & Resin Fillings – Amalgam & Resin
Periodontal Services (gingivectomy, gingivoplasty, osseous
Periodontal Services (gingivectomy, gingivoplasty, osseous
surgery, scaling, and root planing)
surgery, scaling, and root planing)
Periodontal Maintenance after Therapy – 4 per year
(less number of cleanings received)
Periodontal Maintenance after Therapy – 2 per year
(less number of cleanings received)
Periodontal Surgery Periodontal Surgery
Simple & Surgical Extractions/Oral Surgery Simple & Surgical Extractions/Oral Surgery
Endodontics/Root Canals Endodontics/Root Canals
General Anesthesia General Anesthesia
Consultations Consultations
Denture Repair
Major – Covered at 50% Major – Covered at 50%
Bridges & Dentures– Replace once every 5 years Bridges & Dentures – Replace once every 5 years
Denture Relining, Rebasing & Adjustments Denture Repair, Relining, Rebasing & Adjustments
Tissue Conditioning Tissue Conditioning
Crowns – 1 per tooth every 5 years Crowns – 1 per tooth every 5 years
Implants** Implants – NOT COVERED
Monthly Rates High Plan Low Plan
Member Only $ 47.76 $ 36.12
Member & Child(ren) $ 74.40 $ 70.56
Member & Associate ** $ 95.52 $ 72.24
Member & Spouse $ 107.48 $ 86.56
Member, Spouse & Child(ren) $ 133.68 $ 119.96
* This means you can have 2 cleanings and exams and still have $1000 left for any Basic or Major procedures.
** Initial replacement of a tooth is only covered if tooth was extracted while you were covered by NCRGEA dental plan.
*** Associate is a dues-paying spouse of an active NCRGEA Member.
This highlight sheet contains a sample listing of procedures. See your dental certificate for a full listing of procedures, frequencies, and
exclusions.