WELCOME TO YOUR EMBLEMHEALTH DENTAL BENEFITS

to high quality, low cost care. (Continued) EMBLEMHEALTH SILVER VALUE PLANS DENTAL BENEFITS CATEGORY/PROCEDURE BENEFIT LIMITATIONS MEMBER WILL PAY ... Simple tooth extraction Once per tooth per lifetime $35 $35 Surgical tooth extraction Once per tooth per lifetime $35 $35 ORTHODONTICS — Helps restore oral structures, function, and treats ... ................
................