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CareFirst Dental Plan

The dental coverage offered by Dog Tag Bakery is designed to assist you and your covered dependents by paying a portion of eligible expenses incurred for a wide range of dental services. You will need to complete the CareFirst enrollment form to have coverage.

Your Cost

Your cost for dental coverage is generally deducted from your pay on a pretax basis. Contributions for domestic partners is generally deducted on an after-tax basis, unless otherwise permitted by state or federal law. Refer to Employee Contributions for the applicable cost.

Vol Preferred Dental w/Current Dental Cov, Plan 2 w/$1,000 Annual Max, DDZDBA24

Key Features

In-Network

Out-of-Network

Deductible applies to all basic and major services

$25 Ind./$75 Family

$50 Ind./$150 Family

Annual maximum applies to all services except orthodontic services

Plan pays $1,000 Combined Maximum

Preventive & Diagnostic Services

  • Oral Exams (two per benefit period)
  • Prophylaxis (two cleanings per benefit period)
  • Bitewing X-rays
  • X-ray (once per 36 months)
  • Fluoride treatments (two per benefit period per member, until age 19)
  • Sealants on permanent molars (once per tooth per 36 months per member, until age 19)
  • Space maintainers (once per 60 months)
  • Palliative emergency treatment

No charge

20% of Allowed Benefit

Basic Services
  • Direct placement fillings
  • Simple extractions
  • Periodontal scaling and root planing (once per 24 months, one full mouth treatment)

20% of Allowed Benefit after deductible

40% of Allowed Benefit after deductible

Major Services
  • Surgical periodontic services
  • Endodontics
  • Oral surgery
  • Full and/or partial dentures (once per 60 months)
  • Fixed bridges, crowns, inlays and onlays (once per 60 months)
  • Denture adjustments and relining
  • Dental implants (once per 60 months)

50% of Allowed Benefit after deductible

65% of Allowed Benefit after deductible

Orthodontic Services
  • Benefits for orthodontic services may be available for covered members under age 19

50% of Allowed Benefit

65% of Allowed Benefit

Orthodontic Lifetime Maximum

Plan pays $1,200 Combined Maximum

This summary is provided for general information only. Since exclusions, dollar/frequency limitations and prior authorization apply in many cases, you should refer to the specific plan documents for detailed information.

Plan Documents

Forms & Downloads