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Dental Benefits Summary: The Greenbrier Plan

Benefit Coverage
Calendar Year Deductible
  • $50 per person; $100 per family
Calendar Year Maximum
  • Fund pays up to $1,500 per person per calendar year toward all covered expenses.

Note: Calendar Year Maximum does not apply to pediatric oral care.

Preventive Care Services
  • Oral exams and routine cleanings: twice in a calendar year
  • Bitewing x-rays and fluoride applications for children under 19: once per calendar year
  • Sealants for dependent children: once every three consecutive calendar years
  • Full mouth x-rays: once every three consecutive calendar years
  • Brush biopsy to detect oral cancer
  • Emergency treatment to relieve pain
  • Cleanings following periodontal therapy
In- and Out-of-Network: Fund pays 100%, up to the reasonable and customary charge. There is no deductible.
Non-Preventive Services (below are some examples; for a complete list, contact the Fund Office.)
  • Space maintainers once per lifetime
  • Extractions and oral surgery services
  • Fillings and crowns, repairs
  • Root canal therapy
  • Gold inlays
  • Bridges, implants and dentures once per tooth in any five-year period
  • Periodontic services to treat gum disease
In- and Out-of-Network: Fund pays 80% of covered expenses for Basic Services and 50% of covered expenses for Major Services, after deductible, up to the reasonable and customary charge.
Orthodontia (Children only) In- and Out-of-Network: Fund pays 50% of covered expenses, after deductible, up to $1,000 lifetime maximum.