A Good Reason to Smile. - Florida
A Good Reason to Smile.
PEOPLE FIRST BENEFIT PLAN CODE 4034 1
Healthy Gums May Lead to a Healthier You!
DID YOU KNOW THAT YOUR ORAL HEALTH COULD BE AN INDICATOR OF YOUR OVERALL HEALTH?
Regular visits to the dentist may do more than brighten your smile. Research has linked periodontal (gum) disease to complications for heart disease, stroke, diabetes, preterm birth and other health issues. Healthy gums support healthy teeth. Follow the suggestions provided to help prevent gum disease. And if you are diagnosed with gum disease, it's important to complete the periodontal treatment plan recommended by your dentist.
Gum disease may be painless, but symptoms can appear, such as:
Tender, swollen or bleeding gums when you brush your teeth
Dark red or receding gums Bad breath or a bad taste in
your mouth Loose teeth Gum disease is treatable. Be
sure to visit your dentist on a regular basis.
Healthy Gums May Mean a Healthier Heart
People with advanced gum disease may be more likely to have heart disease than those with healthy gums1. Bacteria and their byproducts from the gum tissues may enter the blood stream, causing small blood clots that may contribute to the clogging of arteries2. Clots in the coronary arteries can lead to heart attacks. A blood clot in the brain can cause a stroke. Bottom line: care for your gums, and they may help guard your heart!
Healthy Gums May Help Control Blood Sugar
Those with diabetes may have more complications with gum disease. Why? As a general rule, diabetics have a tougher time healing. And research shows they suffer greater tooth loss than patients without diabetes. One study3 found that when diabetic patients' gum infections were treated, they found it easier to manage their blood sugar. Good dental health may be linked to a reduced risk of diabetic complications!
Healthy Gums May Help Reduce the Risk of Pre-term Birth
Mom's gum disease may increase the probability of a pre-term birth. Pregnant women with chronic periodontal (gum) disease during the second trimester are up to seven times more likely to give birth prematurely.3,4 It's recommended that pregnant women should focus on brushing and flossing and getting regular dental check ups. This possible link between gum disease and preterm birth is another reason to protect your dental health!
PREVENTION IS POWERFUL! The American Dental Association (ADA) suggests the following behaviors to help prevent gum disease5. Brush your teeth twice a day with a soft-bristle toothbrush Floss daily Eat a healthy diet and limit snacks between meals See your dentist regularly
1 American Academy of Periodontology (), Feb. 2002. 2 U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD:
U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes for Health, 2000. 3 Journal of the American Dental Association, Oct. 2003. 4 Journal of the American Dental Association, July 2001 "Oral Health During Pregnancy: An Analysis of Information." 5 American Dental Association Frequently Asked Questions.
For more information, visit us on the web at or call 1.800.CIGNA24 (1.800.244.6224)
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Cigna Dental Care We Plan to Make You Smile!
Cigna Dental is proud to offer State of Florida employees one of the most comprehensive dental coverage plans in the market today. Our Prepaid Patient Charge Schedule (PCS) reflects a fixed co-payment amount that allows you to plan and budget for you and your family's dental care needs with confidence. Your benefits include:
If you require specialty care, your network general dentist will refer you to a network specialist. You do not require a specialty referral to visit a network orthodontist or network pediatric dentist. You are responsible for paying the network dentist the applicable co-payments listed on your Patient Charge Schedule (PCS).
Choose from 634 dental offices with 2,376 general dentists throughout Florida.
Orthodontic coverage for children and adults. Coverage on procedure(s) to detect oral cancer in its early
stages. No age limit on sealants. Coverage for most preventive services (exams, x-rays and
routine cleanings) is provided at no charge.* No waiting period, coverage begins immediately. No deductibles to meet. No claim forms to file. No annual or lifetime dollar maximums to exceed. No restrictions on pre-existing conditions, except for work
in progress. Knowledgeable, caring customer service. Participating dentists to complete a credentialing process
and participate in a Quality Management Program. Access to , a secure on-line tool that makes
it easier and faster for you to access: 1) your personalized dental benefits information; 2) dental health articles via WebMD; and 3) the Dental Treatment Cost Estimator, which allows you to estimate and plan dental care costs before receiving services.
* Frequency Limitations apply; see your Patient Charge Schedule, starting on page 4, for further information.
How To Enroll
Enrolling in the Cigna Dental Care plan is easy. Just call People First, toll free 866.663.4735 or enroll online at . For further information, contact the Capital Insurance representative nearest you. Telephone numbers and e-mail addresses are listed for your convenience.
What should I budget for my family's dental health care?
PLAN
BI-WEEKLY MONTHLY
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$14.72 $26.46 $31.13 $37.77
$29.43 $52.91 $62.26 $75.53
People First Benefit Plan Code 4034
CAPITAL INSURANCE AGENCY, INC.
"We're Here To Help You!"
Contact the Capital Insurance Agency Regional Office in your area for assistance.
HOME OFFICE
1425 E. Piedmont Dr., Suite 301 Tallahassee, FL 32308
P.O. Box 15949 Tallahassee, FL 32317-5949
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3
(800) 780-3100
(850) 386-3100
(850) 386-7116 FAX
capitalinsurance @
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REGIONAL LOCATIONS
REGION 1 Robert W. `Buck' Miller, LUTCF, CLU TALLAHASSEE
(850) 671-2029 (800) 226-9808 (850) 671-2149 fax northwestregion@
REGION 2 David L. Corbin, LUTCF, CLF TALLAHASSEE
(850) 942-2323 (800) 881-1871 (850) 942-2360 fax northeastregion@
REGION 3 Kim Sparks, CLTC WINTER PARK
(407) 673-1254 (800) 416-1618 (407) 673-1255 fax centralregion@
REGION 4 David F. Spivey, Jr. TAMPA
(813) 926-9400 (800) 940-2048 (813) 926-9422 fax southcentralregion@
REGION 5 Mariam Spaulding CORAL SPRINGS
(954) 341-8705 (800) 940-5656 (954) 341-5311 fax southflregion@
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Your Patient Charge Schedule
CODE PROCEDURE
DESCRIPTION
PATIENT CHARGE
OFFICE VISIT FEE (Per patient, per office visit in addition to any other applicable patient charges)
Office Visit Fee
$5.00
DIAGNOSTIC/PREVENTIVE
Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: Periodic Oral Evaluations (D0120), Comprehensive Oral Evaluations (D0150), Comprehensive Periodontal Evaluations (D0180), and Oral Evaluations for Patients Under 3 Years of Age (D0145).
D9310
Consultation (Diagnostic Service Provided by Dentist or Physician Other than Requesting Dentist or Physician)
$0.00
D9430
Office Visit for Observation ? No Other Services Performed
$0.00
D9450
Case Presentation ? Detailed and Extensive Treatment Planning
$0.00
D0120
Periodic Oral Evaluation ? Established Patient
$0.00
D0140
Limited Oral Evaluation ? Problem Focused
$0.00
D0145
Oral Evaluation for a Patient Under 3 Years of Age and Counseling with Primary Caregiver
$0.00
D0150
Comprehensive Oral Evaluation ? New or Established Patient
$0.00
D0170
Re-evaluation ? Limited, Problem Focused (Not Postoperative Visit)
$0.00
D0210
X-Rays Intraoral ? Complete Series (Including Bitewings) (Limit 1 Every 3 Years)
$0.00
D0220
X-Rays Intraoral ? Periapical ? First Film
$0.00
D0230
X-Rays Intraoral ? Periapical ? Each Additional Film
$0.00
D0240
X-Rays Intraoral ? Occlusal Film
$0.00
D0270
X-Rays (Bitewing) ? Single Film
$0.00
D0272
X-Rays (Bitewings) ? 2 Films
$0.00
D0273
X-Rays (Bitewings) ? 3 Films
$0.00
D0274
X-Rays (Bitewings) ? 4 Films
$0.00
D0277
X-Rays (Bitewings, Vertical) ? 7 to 8 Films
$0.00
D0330
X-Rays (Panoramic Film) ? (Limit 1 Every 3 Years)
$0.00
D0431
Oral Cancer Screening Using a Special Light Source
$50.00
D0460
Pulp Vitality Tests
$13.00
D0470
Diagnostic Casts
$0.00
D0472
Pathology Report ? Gross Examination of Lesion (Only When Tooth Related)
$0.00
D0473
Pathology Report ? Microscopic Examination of Lesion (Only When Tooth Related)
$0.00
D0474
Pathology Report ? Microscopic Examination of Lesion and Area (Only When Tooth Related)
$0.00
D1110
Prophylaxis (Cleaning) ? Adult (Limit 2 per Calendar Year)
$0.00
Additional Prophylaxis (Cleaning) ? In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year
$45.00
D1120
Prophylaxis (Cleaning) ? Child (Limit 2 per Calendar Year)
$0.00
Additional Prophylaxis (Cleaning) ? In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year
$30.00
D1203
Topical Application of Fluoride ? Child (Up to 19th Birthday) (Limited to 2 per Calendar Year). There is a Combined Limit of a Total of 2 D1203s and/or D1206s per
$0.00
Calendar Year.
D1206
Topical Fluoride Varnish ? Therapeutic Application for Moderate to High Caries Risk Patients ? Child (Up to 19th Birthday) (Limited to 2 per Calendar Year). There is
$0.00
a Combined Limit of a Total of 2 D1203s and/or D1206s per Calendar Year.
D1330
Oral Hygiene Instructions
$0.00
D1351
Sealant ? Per Tooth
$11.00
D1352
Preventive Resin Restoration in a Moderate to High Caries Risk Patient ? Permanent Tooth
$11.00
D1510
Space Maintainer ? Fixed ? Unilateral
$105.00
D1515
Space Maintainer ? Fixed ? Bilateral
$165.00
D1555
Removal of Fixed Space Maintainer
$0.00
RESTORATIVE (FILLINGS)
D2140
Amalgam ? 1 Surface, Primary or Permanent
$0.00
D2150
Amalgam ? 2 Surfaces, Primary or Permanent
$0.00
D2160
Amalgam ? 3 Surfaces, Primary or Permanent
$0.00
4
CODE PROCEDURE
DESCRIPTION
D2161
Amalgam ? 4 or More Surfaces, Primary or Permanent
D2330
Resin-Based Composite ? 1 Surface, Anterior
D2331
Resin-Based Composite ? 2 Surfaces, Anterior
D2332
Resin-Based Composite ? 3 Surfaces, Anterior
D2335
Resin-Based Composite ? 4 or More Surfaces or Involving Incisal Angle, Anterior
D2390
Resin-Based Composite Crown, Anterior
D2391
Resin-Based Composite ? 1 Surface, Posterior
D2392
Resin-Based Composite ? 2 Surfaces, Posterior
D2393
Resin-Based Composite ? 3 Surfaces, Posterior
D2394
Resin-Based Composite ? 4 or More Surfaces, Posterior
CROWN AND BRIDGE
All charges for crown and bridge (fixed partial denture) are per unit (each replacement or supporting tooth equals 1 unit) ? Replacement limit 1 every 5 years.
D2510
Inlay ? Metallic ? 1 Surface
D2520
Inlay ? Metallic ? 2 Surfaces
D2530
Inlay ? Metallic ? 3 or More Surfaces
D2542
Onlay ? Metallic ? 2 Surfaces
D2543
Onlay ? Metallic ? 3 Surfaces
D2544
Onlay ? Metallic ? 4 or More Surfaces
D2740
Crown ? Porcelain/Ceramic Substrate
D2750
Crown ? Porcelain Fused to High Noble Metal
D2751
Crown ? Porcelain Fused to Predominantly Base Metal
D2752
Crown ? Porcelain Fused to Noble Metal
D2780
Crown ? 3/4 Cast High Noble Metal
D2781
Crown ? 3/4 Cast Predominantly Base Metal
D2782
Crown ? 3/4 Cast Noble Metal
D2790
Crown ? Full Cast High Noble Metal
D2791
Crown ? Full Cast Predominantly Base Metal
D2792
Crown ? Full Cast Noble Metal
D2794
Crown ? Titanium
D2910
Recement Inlay ? Onlay or Partial Coverage Restoration
D2915
Recement Cast or Prefabricated Post and Core
D2920
Recement Crown
D2930
Prefabricated Stainless Steel Crown ? Primary Tooth
D2931
Prefabricated Stainless Steel Crown ? Permanent Tooth
D2932
Prefabricated Resin Crown
D2933
Prefabricated Stainless Steel Crown with Resin Window
D2934
Prefabricated Esthetic Coated Stainless Steel Crown ?Primary Tooth
D2940
Protective Restoration
D2950
Core Buildup ? Including Any Pins
D2951
Pin Retention ? Per Tooth ? In Addition to Restoration
D2952
Post and Core ? In Addition to Crown, Indirectly Fabricated
D2954
Prefabricated Post and Core ? In Addition to Crown
D2960
Labial Veneer (Resin Laminate) ? Chairside
D6210
Pontic ? Cast High Noble Metal
D6211
Pontic ? Cast Predominantly Base Metal
D6212
Pontic ? Cast Noble Metal
D6214
Pontic ? Titanium
D6240
Pontic ? Porcelain Fused to High Noble Metal
D6241
Pontic ? Porcelain Fused to Predominantly Base Metal
D6242
Pontic ? Porcelain Fused to Noble Metal
D6245
Pontic ? Porcelain/Ceramic
D6602
Inlay ? Cast High Noble Metal, 2 Surfaces
D6603
Inlay ? Cast High Noble Metal, 3 or More Surfaces
PATIENT CHARGE
$0.00 $0.00 $0.00 $0.00 $85.00 $85.00 $45.00 $57.00 $79.00 $110.00
$400.00 $400.00 $400.00 $460.00 $460.00 $460.00 $490.00 $450.00 $400.00 $425.00 $450.00 $400.00 $425.00 $450.00 $400.00 $425.00 $450.00 $42.00 $42.00 $42.00 $100.00 $100.00 $130.00 $160.00 $160.00 $12.00 $130.00 $12.00 $160.00 $130.00 $91.00 $450.00 $400.00 $425.00 $450.00 $450.00 $400.00 $425.00 $445.00 $450.00 $450.00
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