Daimler Chrysler Corporation
 

Annual Maximum                                                   

Diagnostic – Preventive
Oral Exam                                                            
Cleanings (every six months)                              
Fluoride to age 14                                                         
X-rays                                                                    

Restorative
Silver Amalgams                                                    
Composite Fillings (front teeth)                             

Endodontics
Single Root Canal                                                  
Double Root Canal                                                
Triple or more Root Canal Filling  
Apicoectomy                                                                  

Periodontics 
Root Scaling and Planing                                                        
Gingivectomy, Gingivoplasty (per quadrant)         
Osseous Surgery (per quadrant)                          

Oral Surgery Extractions
Extraction of Erupted Tooth                                                      
Extraction of Soft Bony Impaction                        
Extraction of Partial Bony Impaction                      
Extraction of Complete Bony Impaction                

Prosthetics
Crowns                                                                 
Dentures                                                              
Bridgework (Exclusions Apply)                              

Orthodontics - Comprehensive 
To age 19 (Maximum, Twenty-four months)         

This is a brief benefit summary. For a complete explanation of benefits as well as Exclusions and Limitations call toll free
1-800-544-6374 or 313-581-6824.

None  


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Need to make a change in your dental coverage? 

Here are important phone numbers for you to enroll!
ACTIVE – Call 1-888-456-7800
SALARIED – Call 1-888-409-3300

 Do you have questions about Midwestern Dental Plans, Inc.?
Call our toll free number 1-800-544-6374
 

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