Comprehensive DMO Voluntary Dental Plan
A Quality Employee Dental Program

Monthly Rate Schedule

With Specialty Services at CapDent Specialist Sites*

Low Medium High*** High Enhanced***
Employee only $16.90 $28.17 36.62 $40.85
Employee and spouse 27.46 48.94 64.08 72.54
Employee and children 27.46 48.94 64.08 72.54
Full family 38.02 69.71 91.54 104.23
Rates may change at any time.  

Patient Costs
Per Visit Fee Copayment
High Enhanced $5.00 Per Schedule**
High 5.00 Per Schedule**
Medium 5.00 Per Schedule**
Low 0 Per Schedule**


Patient Copayment
Child $1,200.00
Adult 1,600.00

 *When visiting a CapDent Specialist you will receive a 25% discount off the Specialist's usual fee.
**The Copayment Schedule for services rendered by your CapDent participating general dentist is included in your benefit brochure. The copayments do not apply if services are rendered by CapDent or other specialists.
*** Available to groups with three or more covered employees only.

For your convenience, premiums are automatically deducted from your paycheck. No extra bills to write out!

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