Ford Motor Company
 
  Benefit Midwestern
 


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)                         
 Adult (19 years and older)                                      

 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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No Charge
$1,250.00
 

Need to make a change in your dental coverage? 

Here are important phone numbers for you to enroll!
 ACTIVE – Call 1-800-333-7444
SALARIED – Call 1-800-537-6555

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

 

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