How do I find a dentist?What services are covered?Can my kids get braces?
Network Options: Platinum Network
Dental Select makes using your benefits a snap. Create an account and they will give you simplified access and tools to manage your dental plan. They offer easy online tours on how to find choose a dentist, log in to the web portal, download our app or request a pre-determination of benefits.
(801) 495-3000 | dentalselect.com | Group #030-301027
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Dental Plan |
DENTAL PPO R&C 80TH PERCENTILE - PLATINUM NETWORK
In-Network
Out-of-Network*
Annual Deductible
January 1 - December 31
January 1 - December 31
You pay up to
$50 per individual / $150 per family
$50 per individual / $150 per family
Annual Maximum
January 1 - December 31
January 1 - December 31
Plan pays up to
$2,000 per individual
$2,000 per individual
Waiting Period
None for Preventive, Basic, Major, or Orthodontic Services
Preventive Services
Cleanings, Exams, X-rays, and Fluoride for child(ren) up to age 14
Cleanings, Exams, X-rays, and Fluoride for child(ren) up to age 14
Plan pays
100% for covered services
No Deductible Applies
100% for covered services
No Deductible Applies
Plan pays
100% of R&C for covered services
No Deductible Applies
100% of R&C for covered services
No Deductible Applies
Basic Services
Fillings, Extractions, Oral Surgery, Endodontics, Sealants, and Space Maintainers
Fillings, Extractions, Oral Surgery, Endodontics, Sealants, and Space Maintainers
You pay
20% AD
20% AD
You pay
20% AD
20% AD
Major Services
Bridges, Crowns, Dentures, and Periodontics
Bridges, Crowns, Dentures, and Periodontics
You pay
40% AD
40% AD
You pay
40% AD
40% AD
Orthodontic Services
Children to age 19
Children to age 19
Plan pays
50% per lifetime
50% per lifetime
Orthodontic Lifetime Maximum
$1,000 per child to age 19
AD: After Deductible
R&C: Reasonable & Customary
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
Employees premiums are paid 100% if enrolled in Medical.
This information is designed to help you choose a benefit plan for 2023 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
R&C: Reasonable & Customary
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
Employees premiums are paid 100% if enrolled in Medical.
This information is designed to help you choose a benefit plan for 2023 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
