All Star Dental for Children

Insure children up to age 19 with no deductible on preventive services like cleanings.

Details below
Girl brushing teeth

All Star Dental for Families

Healthy smiles for the whole family.

Details below
Family smiling

Qualified Dental Plans

For pediatric essential health benefits.

Details below
Girl brushing teeth

Child Benefits (<19)

 

High Option

Low Option

Deductible (Does not apply to Preventive Services) $15 per child $100 per child
Annual Maximum None None
Out-of-Pocket Maximum $700 per child
$1400 maximum for all children
$700 per child
$1400 maximum for all children
 
 

Preventive & Diagnostic Services:

Coinsurance*
INN/OON**

Coinsurance
INN/OON

Routine Exams ( 2 per 12 months) 100% 100%
Prophylaxis ( 2 per 12 months) 100% 100%
Radiographs - Bitewings (max 4 films; 1 per 12 months) 100% 100%
Radiographs - any one of the following per 5 years - FMX D0210, D0277 or D0330 100% 100%  
Adjunctive Pre-Diagnostic Oral Cancer Screening
(max 1 per 12 months for age 40+)
Not Covered Not Covered
Fluoride (child only) 100% 100%
Sealants (child only) 100% 100%
Space Maintainers (child only) 100% 100%
 

Basic Services:

Restorations (Fillings) 80% 50%
Simple Extractions 80% 50%
Resin-based Composite Restorations (Anterior Only) 80% 50%
Emergency Pain (1 per 12 months) 80% 50%
Non-Surgical Periodontics  
-Periodontal scaling & root planning 
-Periodontal Maintenance
80%
80%
50%
50%
Endodontics  
-Pulpotomy/Pulpal therapy 
80% 50%
General Anesthesia (subject to review) 80% 50%
Oral Surgery (surgical extractions & impactions) 80% 50%
 

Major Services:
12-month waiting period (applies to the Adult/Family plan only)

Non-Surgical Periodontics  
-Periodontal scaling & root planning 
-Periodontal Maintenance
See Basic Services above See Basic Services above
Endodontics  
-Root Canals/Apexification
50%
50%
Endodontics  
-Pulpotomy/Pulpal therapy 
See Basic Services above See Basic Services above
Surgical Periodontics 50% 50%
General Anesthesia (subject to review, covered with complex surgery) See Basic Services above See Basic Services above
Oral Surgery (surgical extractions & impactions) See Basic Services Above See Basic Services Above
Repairs:  Crown, Denture, and Bridge 50% 50%
Inlays 50% 50%
Onlays 50% 50%
Crowns, Bridges and Dentures 50% 50%
Emergency Pain (1 per 12 months) See Basic Services Above See Basic Services Above
 

Orthodontia
(24-month waiting period)

Medically Necessary 50% 50%


   

Family

    Child Benefits (<19)   Individual/Adult Benefits (>19)
    High Option Low Option   High Option Low Option
Deductible (Does not apply to Preventive Services)   $15 per child $100 per child   $50 per person $50 per person
Annual Maximum   None None   $1,000 yr1
$1,250 yr2
$1,500 yr3+
$1,000 yr1
$1,250 yr2
$1,500 yr3+
Out-of-Pocket Maximum   $700 per child
$1400 maximum for all children
$700 per child
$1400 maximum for all children
  Not Applicable Not Applicable

Preventive & Diagnostic Services:

 

Coinsurance INN/OON

Coinsurance INN/OON

 

Coinsurance INN/OON

Coinsurance INN/OON

Routine Exams ( 2 per 12 months)   100% 100%   100% 100%
Prophylaxis ( 2 per 12 months)   100% 100%   100% 100%
Radiographs - Bitewings (max 4 films; 1 per 12 months)   100% 100%   100% 100%
Radiographs - any one of the following per 5 years - FMX D0210, D0277 or D0330   100% 100%   100% 100%
Adjunctive Pre-Diagnostic Oral Cancer Screening
(max 1 per 12 months for age 40+)
  Not Covered Not Covered   100% 100%
Fluoride (child only)   100% 100%   Not Covered Not Covered
Sealants (child only)   100% 100%   Not Covered Not Covered
Space Maintainers (child only)   100% 100%   Not Covered Not Covered
 

Basic Services:

Restorations (Fillings)   80% 50%   80% 50%
Simple Extractions   80% 50%   80% 50%
Resin-based Composite Restorations (Anterior Only)   80% 50%   80% 50%
Emergency Pain (1 per 12 months)   80% 50%   See Major Services Below Not Covered
Non-Surgical Periodontics
-Periodontal scaling & root planning
-Periodontal Maintenance
  80%
80%
50%
50%
  See Major Services Below Not Covered
Endodontics
-Pulpotomy/Pulpal therapy
  80% 50%   See Major Services Below Not Covered
General Anesthesia (subject to review)   80% 50%   See Major Services Below Not Covered
Oral Surgery (surgical extractions & impactions)   80% 50%   See Major Services Below Not Covered
 

Major Services:
12-month waiting period (applies to the Adult/Family plan only)

Non-Surgical Periodontics
-Periodontal scaling & root planning
-Periodontal Maintenance
  See Basic Services above See Basic Services above   50% Not Covered
Endodontics
-Root Canals/Apexification
  50%
50%   50% Not Covered
Endodontics
-Pulpotomy/Pulpal therapy
  See Basic Services above See Basic Services above   50% Not Covered
Surgical Periodontics   50% 50%   50% Not Covered
General Anesthesia (subject to review, covered with complex surgery)   See Basic Services above See Basic Services above   50% Not Covered
Oral Surgery (surgical extractions & impactions)   See Basic Services Above See Basic Services Above   50% Not Covered
Repairs: Crown, Denture, and Bridge   50% 50%   50% Not Covered
Inlays   50% 50%   50% Not Covered
Onlays   50% 50%   50% Not Covered
Crowns, Bridges and Dentures   50% 50%   50% Not Covered
Emergency Pain (1 per 12 months)   See Basic Services Above See Basic Services Above   50% Not Covered
 

Orthodontia
(24-month waiting period)

Medically Necessary   50% 50%   Not Covered Not Covered
 

* Coinsurance percentage reflected is the Plan's responsibility.

** INN = In-network provider, OON = Out-of-network provider