Dental and Vision
Choose either DINA's low cost Prepaid Discount Plan with No Waiting Periods No Annual Maximums and No Deductibles or the Passive PPO, where you can go to ANY Dentist!

Those with DINA's PPO plan can keep their current coverage, but if your dentist is not in-network and you would like a plan that pays based on Usual and Customary with any dentist, check out our newer plan!


Choices:

   Passive PPO
     
Go to ANY Dentist - based on usual and Customary Charges


  Prepaid Discount Plan
     Must use dentist in network


  PPO Plan (no longer offered)
      Preferred providers - Use any dentist but claims based on a

      network scheduled charge



To find a Dentist on DINA's Prepaid or PPO plans - click here

Have the NEWER Passive PPO and want to save more money?
Choose a Dentemax dentist and let them know you have DINA - click here



 For information on the Vision Discount Plan - click here    


                          Passive PPO Dental Insurance
Use ANY Dentist




TYPE I - PREVENTATIVE SERVICES - 100%

  • No waiting period, no deductible
  • Routine Exams 
  • Prophylaxis (Cleanings-one per 6 months)
  • Emergency exams for dental pain (minor procedures)
  • Fluoride treatments for dependent children under age 19 (one per 12 months)
  • Bitewing X-rays (once per 6 months

  TYPE II - BASIC SERVICES - 80%

  • No waiting period
  • Full mouth or panorex X-rays (1 per 36 months)
  • Simple restorative services (fillings)
  • Simple extractions
  • Sealants for children ages 6-15 (1 per tooth)

 TYPE III (MAJOR SERVICES) - 50%

  • 12 month waiting period (takeover provisions apply)
  • Major restorative services (crowns and inlays)
  • Prosthetics (bridges, dentures)
  • Replacement of prosthodontics, dentures, crowns and inlays
  • Denture relines
  • Space maintainers
  • Oral Surgery
  • General anesthesia (for services dentally necessary
  • Endodontics/root canal therapy
  • Periodontics

 ORTHODONTIC SERVICES

  • 12 month waiting period
  • $50 separate deductible
  • 50% coverage
  • $1,000 lifetime maximum benefit
  • Children under 19 only

Annual Benefit—Per Person . . . . . . . . . . . . . . . . .$1,500.00

Benefit Year Deductible, Per Person  $50  / Per Family $150

This deductible applies to Type II and III Services

Payment is based upon allowable charges in the area in which service is rendered. 

Services provided at a non-contracting provider are paid at the 90th percentile. 

To save money, you can choose a dentist that is a member of the Dentemax network, go to www.dentemax.com


Click for Application

        
 


Prepaid Plan

No Deductibles
No Claim Forms

No Annual Maximums
No Waiting Periods

Choose a dentist from DINA's Prepaid Network for the family to use. 
When you go to the dentist, you pay the co-payment - Savings of 30-60%

Fee schedule effective June 1, 2012


     
 

PPO Insurance
No Longer available, but existing customers can keep their existing plan.  If you regularly go out of network, look at DINA's NEW Indemnity-Passive PPO Insurance.  It is based on Usual and Customary Charges.



PREVENTATIVE AND DIAGNOSTIC SERVICES – Pays 100% of Scheduled Charge

Scheduled Charge
Periodic oral evaluation * . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.00
Comprehensive oral evaluation *  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.00
Routine Teeth Cleaning – Adult * .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.00
X-Rays – bitewing – 2 films * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.00
X-Rays – bitewing – 4 films * . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25.00
Fluoride treatment – child ^ . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.00
Sealant – each tooth + . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.00
* once in any 6 month period
^ once in any 12 month period
+ once in any 36 month period

BASIC RESTORATIVE – Pays 80% of Scheduled Charge

Scheduled Charge
Amalgam filling – 1 surface – permanent . . . . . . . . . . . . . . . . . . . . . . . . . 52.00
Amalgam filling – 2 surface – permanent . . . . . . . . . . . . . . . . . . . . . . . . . 68.00
Amalgam filling – 4 surface – permanent . . . . . . . . . . . . . . . . . . . . . . . . . 98.00
Resin filling – 1 surface – anterior  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70.00
Resin filling – 4 surface – posterior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175.00
Extraction – single tooth . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.00
Extraction – soft tissue . . . . . . . . .   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159.00
Removal of impacted tooth – bony   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229.00

MAJOR RESTORATIVE – Pays 50% of Scheduled Charge

12 months waiting period – unless switching from another dental plan

Scheduled Charge
Crown – porcelain – fused to high noble metal . . . . . . . . . . . . . . . . . . . . 550.00
Crown – porcelain – predom. base metal . . . . . . . . . . . . . . . .. . . . . . . . . 500.00
Crown – full cast – predom. Base metal   . . . . . . . . . . . . . . . . . . . . . . . . . 420.00
Core buildup – including any pins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101.00
Cast pore and core – in addition to crown . . . . . . . . . . . . . . . . . . . . . . . . 173.00
Root canal – Anterior. (Endodontic therapy). . . . . . . . . . . . .. . . . . . . . . . .430.00
Root canal – Molar. (Endodontic therapy) . .  . . . . . . . . . . . . . . . . . . . . . . 540.00
Gingivectomy – per tooth   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79.00
Scaling / root planning – per quadrant . . . . . . . . . . . . . . . . . . . . . . . . . . . 120.00
Periodontal maintenance (following therapy)  . . . . . . . . . . . . . . .. . . . . . . . 70.00
Denture – complete upper or lower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .690.00
Partial – complete upper or lower – resin base . . . . . . . . . . . . . .. . . . . . . 600.00

Use ANY dentist or a DINA PPO Dentist!


Deductible: $50 per person / $150 maximum per family – After 1st year No deductible for Preventative Care


Benefit Year Maximum: Per covered person –1st year $750 / 2nd year $1,000 / 3rd year and thereafter $1,500


The Scheduled Charge is the maximum amount which benefits will be paid. If your dentist charges less than the scheduled charge, the benefit will be paid on the lower amount. If your dentist charges more, you will pay the normal copayment plus the amount over the scheduled charge.


        
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