Willamette Dental TrueCare

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Benefit Plan 1 Copayments Plan 2 Copayments
Annual Maximum No Annual Maximum No Annual Maximum
Deductable No Deductible No Deductible
General Office Visit You pay a $35 Copay You pay a $25 Copay
Specialist Office Visit You pay a $35 Copay You pay a $30 Copay
Dental Exams and X-Rays You pay a $0 Copay You pay a $0 Copay
Teeth Cleaning You pay a $0 Copay You pay a $0 Copay
Fluoride Treatment You pay a $0 Copay You pay a $15 Copay
Sealants per Tooth You pay a $0 Copay You pay a $15 Copay
Filling – Amalgam You pay a $45 Copay You pay a $25 Copay
Filling – Resin (Anterior) You pay a $70 Copay You pay a $50 Copay
Filling – Resin (Posterior Primary) You pay a $80 Copay You pay a $50 Copay
Filling – Resin (Posterior Permanent) You pay a $132 Copay You pay a $102 Copay
Stainless Steel Crown You pay a $90 Copay You pay a $70 Copay
Porcelain/Metal Crown You pay a $500 Copay You pay a $400 Copay
Complete Upper or Lower Denture You pay a $600 Copay You pay a $500 Copay
Bridge (per tooth) You pay a $500 Copay You pay a $400 Copay
Root Canal Therapy (Anterior Tooth) You pay a $225 Copay You pay a $200 Copay
Root Canal Therapy (Bicuspid) You pay a $325 Copay You pay a $225 Copay
Root Canal Therapy (Molar) You pay a $425 Copay You pay a $250 Copay
Osseous Surgery (Per Quadrant) You pay a $325 Copay You pay a $300 Copay
Root Planning (Per Quadrant) You pay a $100 Copay You pay a $75 Copay
Routine Extraction (Per Tooth) You pay a $75 Copay You pay a $50 Copay
Surgical Extraction (Per Tooth) You pay a $190 Copay You pay a $100 Copay
Pre-Orthodontic Service You pay a $150 Copay You pay a $150 Copay
Comprehensive Orthodontia You pay a $3,000 Copay You pay a $2,800 Copay
Nitrous Oxide Per Visit You pay a $40 Copay You pay a $40 Copay

Rate Table

Members Plan 1 Plan 2
Member Only $49.50 $54.95
Member & Spouse/Partner $99.00 $109.50
Member & Children $101.50 $112.65
Member, Spouse/Partner & Children $151.00 $167.50
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