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PPO or Premier
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QUESTIONS
ABOUT
BENEFITS
For questions,
contact Human
Resources at
919-469-4070 or
TotalEmployeeHealth@
carync.gov
Dental Insurance
COVERED SERVICES
PPO
DENTIST
PREMIER
DENTIST
NONPARTICIPAT-
ING DENTIST
PLAN PAYS PLAN PAYS PLAN PAYS*
DIAGNOSTIC & PREVENTATIVE
Diagnostic and Preventative Services – includes exams,
cleanings, fluoride, and space maintainers
100% 100% 100%
Periodontal Maintenance (D4910) – cleanings by a specialist 100% 100% 100%
Sealants – to prevent decay of permanent teeth 100% 100% 100%
Brush Biopsy – to detect oral cancer 100% 100% 100%
Radiographs – X-rays 100% 100% 100%
Surgical Extractions – surgical removal of teeth 100% 100% 100%
BASIC SERVICES
Emergency Palliative Treatment to temporarily relieve pain 80% 80% 70%
Minor Restorative Services – fillings and crown repair 80% 80% 70%
Endodontic Services – root canals 80% 80% 70%
Periodontic Services – to treat gum disease 80% 80% 70%
Periodontal scaling and root planning – limited to once every
24 months
100% 100% 100%
Other Oral Surgery – dental surgery other than extractions 80% 80% 70%
Simple Extractions – non-surgical removal of teeth 80% 80% 70%
Major Restorative Services – crowns 80% 80% 70%
Other Basic Services – misc. services 80% 80% 70%
Relines and Repairs – to bridges and dentists 80% 80% 70%
MAJOR SERVICES
Prosthodontic Services – includes bridges, implants & dentures 80% 80% 70%
ORTHODONTIC SERVICES
Orthodontic Services – includes braces 80% 80% 70%
Orthodontic Age Limit No Age Limit No Age Limit No Age Limit
CARY Benefits Handbook Page 15
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