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Benefit
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Milwaukee County Conventional Plan
(Delta Dental)
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Care-Plus (DMO)
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Network of providers
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Services may be performed by the dentist of your choice
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Services must be performed at a Dental Associates, Ltd. Dental Center
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Annual Maximum Benefit
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$1,000 per person
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No Maximum
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Annual Deductible
Diagnostic and Preventive:
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$25 per person
(Maximum of 3 deductibles per family per year)
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None
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- Dental exams and cleanings
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100% of approved charges (1)
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100% of approved charges
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- Bitewing x-rays
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100% of approved charges (1)
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100% of approved charges
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- Full mouth x-rays
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100% of approved charges (2)
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100% of approved charges
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Minor Restorations
(regular fillings: acrylics, amalgams, & composites)
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80% of approved charges
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100% of approved charges
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Major Restorations (crowns, inlays, onlays)
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50% of approved charges
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100% of approved charges3
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Prosthetics
(dentures, bridges)
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50% of approved charges
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100% of approved charges3
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Simple Extractions
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80% of approved charges
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100% of approved charges
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Endodontics
(root canal treatment)
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80% of approved charges
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100% of approved charges
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Periodontics
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80% of approved charges
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100% of approved charges
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Orthodontics
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50% of approved charges with a $1500 life time maximum benefit
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100% of approved charges (includes coverage for adults if
approved by the plan) after $450 maximum patient payment.
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Emergency Treatment
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80% of approved charges
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100% of approved charges at
network provider. All other
providers limited to a $50.00 benefit maximum
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Ancillary Services
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80% of approved charges
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100% of approved charges
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Oral Surgery
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80% of approved charges
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100% of approved charges
(surgeon fee only)
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Notes: This at-a-glance guide is intended as a summary only. For specific terms, provisions, conditions, limitations, or
exclusions, please refer to your Summary Plan Description.
(1) limited to one service per 6 months
(2) limited to 1 service per 36 months
(3) Precious metal (Noble/High Noble) costs are extra and are the responsibility of the patient/insured
*Note: Dental plans are only for active employees and their dependents.
Milwaukee County Conventional Plan SPD
Milwaukee County is an equal opportunity/affirmative action employer that is actively seeking qualified applicants for various positions throughout County government. Milwaukee County does not discriminate based on age, ancestry/national origin, arrest/conviction record, color, creed, disability, marital status, military membership, race, sex or sexual orientation.
If special accommodations are needed, please contact 414-278-4143.
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