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
Oral Exam $71 $0 $0
Complete Series X-rays $189 $0 $0
Bitewing X-Rays (2 Films) $61 $0 $0
Semiannual (2) Teeth Cleanings $120 $0 $0
Topical Flouride for Children $49 $0 $0
Sealants $74 $0 $0
Filling (3-Surface/Silver) $338 $76 $0
Crown (Porcelain/Metal) $1,291 $555 $380
Implants $2,825 $1,292 $830
Complete Denture $2,164 $702 $455
Root Canal (Anterior Tooth) $1,134 $391 $260
Perio Scaling/Root Planing $342 $105 $31
Extraction, Erupted Tooth $232 $58 $47
Child Orthodontics $6,233 $3,422 $3,422
Adult Orthodontics $6,420 $3,658 $3,658
Complete List of Program Details Select
Standard
Select
High
1 Based on the Context4Healthcare’s 80th percentile. Coverage for orthodontia is based on the 80th percentile of Dominion Dental Services’ out-of-network claims data for D8080 and D8090 (excluding Invisalign) from 2015 to 2018. Based on zip 223.