Welcome Federal Employees & Retirees

Compare Plans

Which plan is right for you?

Below you can compare features and your cost for certain procedures for each DHMO dental option – Select Standard and Select High. For more details, you can view a Complete List of program details for each option at the bottom of the charts.  

  Select
Standard
Select
High
Features
Office Visit Copay $10 $10
Deductibles None None
Annual Maximum Limits  None None
Lifetime Maximum Limits for Orthodontics None None
Waiting Periods None None
Claims Forms None None
Must Use a Network Dentist Yes Yes
Examples
 
Average Cost 
Without a Plan1
You Pay You Pay
 I.  Basic
Oral Examination $85 $0 $0
Bitewing X-Rays (1-4 Films) $33 $0 $0
Cleaning for Adults (2 per year) $101 $0 $0
Sealant (per tooth) $57 $0 $0
Fluoride Varnish $40 $0 $0
 II. Intermediate
Complete Series X-Rays $160 $0 $0
Silver Filling (Three Surfaces) $217 $76 $0
Composite Filling (Two Surfaces) $217 $68 $20
Extraction (Erupted Tooth) $170 $58 $47
 III. Major 
Periodontal Scaling/Root Planing $247 $105 $31
Perio Surgery (Gingivectomy/Gingivoplasty)  $678 $351 $205
Root Canal (Molar) $1,074 $587 $416
Crown (Porcelain Fused to Base Metal) $1,298 $555 $380
Denture (Complete Upper/Lower) $1,784 $702 $455
Implant (Endosteal, surgical placement) $2,503 $1,292 $830
 IV. Orthodontia
Children $6,552 $3,422 $3,422
Adults $7,025 $3,658 $3,658
Complete List of Program Details Select
Standard
Select
High
1 Approximate percentage of coverage based on the Captiva context fee schedule’s 80th percentile. A specific fee schedule applies and will be mailed with your Membership Card. Please see the Complete List of Benefits for a list of member fees.