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 Dental HMO 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 chart.  

  Select
Standard
Select
High
Features
Office Visit Copay $10 $10
Deductibles None None
Annual Maximum Limit None None
Lifetime Maximum Limit for Orthodontics None None
Waiting Periods None None
Claims Forms None None
Must Use a Network Dentist Yes Yes
Comparison
 
Area Charge1 Your Fee Your Fee
Comprehensive Oral Examination $85 $0 $0
Complete Series X-rays $161 $0 $0
Bitewing X-Rays (4 Films) $74 $0 $0
Cleanings (Adults) $102 $0 $0
Cleanings (Children) $74 $0 $0
Flouride Varnish $41 $0 $0
Sealant $58 $0 $0
Filling (3-Surface/Silver) $217 $76 $0
Crown (Porcelain/Metal) $1,299 $555 $380
Endosteal Implant (Surgical) $2,503 $1,292 $830
Complete Denture $1,785 $702 $455
Root Canal (Anterior Tooth) $747 $391 $260
Perio Scaling/Root Planing $247 $105 $31
Extraction, Erupted Tooth $170 $58 $47
Child Orthodontics $6,552 $3,422 $3,422
Adult Orthodontics $7,025 $3,658 $3,658
Complete List of Program Details Select
Standard
Select
High
1 Based on the Context4Healthcare’s 80th percentile fee information. Based on zip 220.