Chartwell Insurance Brokers, Inc.

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Employee Benefits
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Group Dental Plans

Diagnostic and Preventive Services-normally covered at 100%

Diagnostic care:
Initial oral exam and charting
Periodic oral exam (once every six months)
Full mouth x-rays (once every 60 months)
Bite wing x-rays
Single tooth x-rays (as needed)
Preventive care:
Oral prophylaxis-cleaning, scaling and polishing
Fluoride treatment
Space maintainers

Restorative and Other Basic Services-normally covered at 80%

Restorative: Amalgam fillings on permanent teeth or white fillings on front teeth
Oral surgery-simple surgical tooth extraction
Periodontic: gum surgery, gingival curettage, periodontal scaling
Endodontics: root canal treatment
Prosthetic maintenance: rebase denture, reline denture
Emergency dental care: emergency treatment for relief of pain

Major Restorative Services-normally covered at 50%

Major restorative
Porcelain and base metal crown
Upper partial denture (resin) and bridge ponic (base metal)

Orthodontic-normally covered at 50% for dependents up to age 19 and subject to a lifetime annual maximum of $1,000 or $1,500

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