No
Deductible (for diagnostic and preventive services)
No
Annual Benefit Limit
$350
Individual Out-of-Pocket Maximum (one child)
$700
Family Out-of-Pocket Maximum (two or more children)
$0
Office Copay
No
Waiting Period
Services
| Service | Price |
|---|---|
| Diagnostic and Preventive (includes x-rays, exams, cleaning and sealants) | Free |
| Amalgam Filling: One Surface | $25 |
| Root Canal: Molar | $300 |
| Gingivectomy, Per Tooth | $50 |
| Extraction: Single Tooth, Exposed Root or Erupted | $65 |
| Extraction: Complete Bony | $160 |
| Crown: Porcelain With Metal | $300 |
| Medically Necessary Orthodontia | $350 |
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Children’s dental benefits are automatically included in the Covered California health plans we offer. Learn More arrow_forward
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