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• 100% Coverage* With No Waiting Period for Covered Services

• No Deductible

• Routine Exam (2 in 12 months)

• Bitewing X-rays (1 in 12 months)

• Cleaning (2 in 12 months)

• Fluoride for children under age 16 (1 in 12 months)

*Percentage of the Allowed Amount.

• 80% Coverage* With No Waiting Period

• $50 annual deductible for basic and major services (per person)

• Full Mouth/Panoramic X-rays (1 in 3 years)

• Sealants for Children Ages 6-16 (1 in 3 years)

• Restorative Amalgams

• Non-Surgical Extractions

• Space Maintainers (child under 16)

*Percentage of the Allowed Amount.

• 50% Coverage* With a 12 Month Waiting Period**

• $50 annual deductible for basic and major services (per person)

• Onlays

• Oral Surgery

• Implants (Benefits payable only for the replacement of those teeth which were extracted while the covered person was insured under this policy.)

• Crowns (1 per tooth, per 7 years)

• Crown Repair (Single Restorative Service)

• Endodontics (nonsurgical + surgical)

• Periodontics (nonsurgical + surgical)

• Denture Repair

• Dentures (1 appliance per 5 years)

• Bridge (1 per 7 years)

• Complex Extractions

• Local Anesthesia

*Percentage of the Allowed Amount. NCD will either waive the 12 month waiting period or give you credit for prior PPO coverage. Must provide evidence of current PPO coverage within 30 days of the effective date on NCD.