Optional Benefits - Basic Dental/Vision Plan USNow Basic Dental Plan - No Deductible
- No Waiting Periods
- National PPO Network
- Out of Network claims paid up to the 85th percentile of UCR
- $1,000 per person, calendar year maximum
- Diagnostic and Preventative paid at 90%
- One office visit, exam, one set of bitewing x-rays, and cleaning every six months
- Fillings and Simple Extractions paid at 80%
- One, two, three and four surface amalgams, and simple extractions
Covered
Code | Procedure | DPO | UCR | | In-Network | NonNetwork | | 120 | EXAM - Periodic Oral Evaluation | 90% | 90% | | 1110 | CLEANING - Prophylaxis - Adult | 90% | 90% | | 1120 | CLEANINGS - Prophylaxis - Child | 90% | 90% | | 272 | XRAY - Bitewings - two films | 90% | 90% | | 2110 | FILLINGS - Amalgam - 1 surface, primary | 80% | 80% | | 2120 | Amalgam - 2 surfaces, primary | 80% | 80% | | 2130 | Amalgam - 3 surfaces, primary | 80% | 80% | | 2131 | Amalgam - 4 or more surfaces, primary | 80% | 80% | | 2140 | Amalgam - 1 surface, permanent | 80% | 80% | | 2150 | Amalgam - 2 surfaces, permanent | 80% | 80% | | 2160 | Amalgam - 3 surfaces, permanent | 80% | 80% | | 2161 | Amalgam - 4 or more surfaces, permanent | 80% | 80% | | 7110 | Extraction single tooth | 80% | 80% | | 7120 | Extraction each additional tooth | 80% | 80% | USNow Basic Vision Plan Your Vision is Our Focus
When you take a look at our vision plan, you’ll see for yourself that the Basic Vision Plan offers one of the most comprehensive prevention, examination, and prescription programs available. We focus on value, quality, and affordability, and offer a large network of credentialed private practice and retail chain providers. The Basic Vision Plan includes a routine vision exam (including refraction), as well as preferred pricing on eyeglasses and contact lenses. Features: - Routine vision exam (including refraction) paid in-full after copay
- Preferred Pricing offered on frames, lenses, and lens options at
- private practice providers, and discounts at retail chains
- A network of credentialed private practice and retail chain providers
- Access to discounts on laser vision correction through a nationwide
- network of more than 300 laser vision correction specialists
- 24-hour access to benefit information through www.spectera.com,
- and our toll-free Interactive Voice Response (IVR) line at 800.839.3242
- No claim forms
The Basic Dental and Vision Plan is underwritten by United HealthCare Insurance Company, Hartford, CT (except in New York) or United HeathCare Company of New York, Hauppauge, NY (New York only). Not affiliated with United HealthCare Medical. | 
