SMILE. WE'VE GOT YOU COVERED.

Dental Benefits For Everyone.

Which plan is right for you?

Below you can compare coverage for Dominion's plans. For more details, you can view the plan documents at the bottom of the chart. The "Percentages" tab below shows how much each of the plans cover for each of the listed procedures. Click the "Copayments" tab to see a in-network comparison that shows how much you would pay for these procedures for each of these plans.

Benefit Features Discount Program1 Select Plan Basic1 PPO Basic
Office Visit $15 $10 N/A
Deductibles None None $50 per adult (adult max $150)3
Annual Maximums None None $1,000 per insured person
Waiting Periods None None None
Receive Care From Discount Network Dentist Select Plan Network Dentist Elite PPO network dentist (DC, DE, MD, PA, VA), Choice PPO network dentist (GA, NJ, OR) or any licensed dentist
States Available DC, DE, MD, NJ, PA, VA DC, DE, MD, NJ, PA, VA DC, DE, GA, MD, OR, NJ, PA, VA
Procedures and Covered Services     Year 12 
In/Out Network
Year 22 
In/Out Network
Year 32 
In/Out Network
I.  Diagnostic & Preventive          
Comprehensive Oral Exam 100% 100% 100% | 90% 100% | 90% 100% | 90%
Bitewing X-Rays (4 Films) 45% 100% 100% | 90% 100% | 90% 100% | 90%
Teeth Cleaning (Adult) 100% (1 per year) 90% 100% | 90% 100% | 90% 100% | 90%
II. Basic Restorative          
Full and panoramic X-rays 45% 80% 50% | 30% 60% | 50% 80% | 70%
Amalgam filling (silver) 50% 75% 50% | 30% 60% | 50% 80% | 70%
Composite filling (white) 50% 65% 50% | 30% 60% | 50% 80% | 70%
Extraction, erupted tooth 50% 65% 50% | 30% 60% | 50% 80% | 70%
III. Major Restorative          
Crown (Porcelain/Metal) 45% 55% 15% | 10% 25% | 20% 50% | 40%
Bridges 45% 60% 15% | 10% 25% | 20% 50% | 40%
Complete Denture 45% 65% 15% | 10% 25% | 20% 50% | 40%
Relining of dentures 35% 55% 15% | 10% 25% | 20% 50% | 40%
Periodontics (root planing and therapy) 50% 55% 15% | 10% 25% | 20% 50% | 40%
Endodontics (root canals) 60% 70% 15% | 10% 25% | 20% 50% | 40% 
Oral Surgery (extraction of impacted teeth) 40% 55% 15% | 10% 25% | 20% 50% | 40%
IV. Orthodontics
Adults 48% 48% 0% | 0% 0% | 0% 0% | 0%
Children (Kids Plan only) 48% 48% 50% | 0-30%6 50% | 0-30%6 50% | 0-30%6
Plan Document Discount Program

Select Plan Basic

Select Plan Basic Kids

PPO Basic

PPO Basic Kids

 

Additional Plans

Benefit FeaturesSelect Plan Premium1PPO PlusPPO PremiumElite ePPO Basic1
Office Visit$10NoneNoneNone
DeductiblesNone$50 per adult (adult max $150)3$50 per adult (adult max $150)4 $25 per adult (adult max $75)4
Annual MaximumsNone$750 per insured person$1,500 per insured person$1,500 per insured person
Waiting PeriodsNoneNoneYes5None
Receive Care FromSelect Plan Network DentistElite PPO network dentist (DC, DE, MD, PA, VA), Choice PPO network dentist (GA, NJ, OR) or any licensed dentistElite PPO network dentist (DC, DE, MD, PA, VA), Choice PPO network dentist (GA, NJ, OR) or any licensed dentistElite ePPO Network Dentist
States AvailableDC, DE, MD, NJ, PA, VADC, DE, GA, MD, OR, NJ, PA, VADC, DE, GA, MD, OR, NJ, PA, VADC, MD, PA, VA
Procedures and Covered Services In/Out NetworkIn/Out Network 
I.  Diagnostic & Preventive    
Comprehensive Oral Exam100%100% | 90%100% | 90%    100%
Bitewing X-Rays (4 Films)100%100% | 90%    100% | 90%   100%
Teeth Cleaning (Adult)100%100% | 90%  100% | 90%   100%
II. Basic Restorative    
Full and panoramic X-rays80%100% | 90%100% | 90%100%
Amalgam filling (silver)80%50% | 40%80% | 70%85%
Composite filling (white)70%50% | 40%80% | 70%85%
Extraction, erupted tooth70%50% | 40%80% | 70%  75%
III. Major Restorative     
Crown (Porcelain/Metal)60%0% | 0%50% | 40%   60%
Bridges60%0% | 0%50% | 40%    60%
Complete Denture70%0% | 0%50% | 40%    75%
Relining of dentures60%0% | 0%50% | 40%   70%
Periodontics (root planing and therapy)55%50% | 40%50% | 40%  60%
Endodontics (root canals)70%0% | 0%50% | 40%50%
Oral surgery (extraction of impacted teeth)55%0% | 0%50% | 40%  60%
IV. Orthodontics
Adults48%0% | 0%  0% | 0%   0%
Children (Kids Plan only)48%50% | 0-30%650% | 0-30%650% | 0-30%6
Plan Document   Select Plan Premium

Select Plan Premium Kids

PPO Plus

PPO Premium

PPO Premium Kids

Elite ePPO Basic

1 Approximate percentage of coverage based on the Context4Healthcare's 80th percentile. Based on zip 223. A specific fee schedule applies and will be mailed with your membership card. To view copay schedules for the pediatric plans, go to DominionNational.com/pediatric.
2 Year 1 benefits apply during the subscriber's first 12 months of continuous coverage. Year 2 benefits apply during the subscriber's second 12 months of continuous coverage. Year 3 benefits apply during the subscriber's third 12 months of continuous coverage.
3 Deductibles apply to all services.
4 Deductibles apply to basic care and major restorative care.
5 There are no waiting periods for diagnostic and preventive care. To be eligible for basic care, you must have completed 6 (six) months of continuous coverage. To be eligible for major restorative care, you must have completed 12 (twelve) months of continuous coverage. Waiting period credit will be given for the length of time an insured was covered under each benefit classification under the current employer's prior dental coverage.
6 Medically-necessary orthodontics. 0% Out-of-network coverage for DC, DE, GA, NJ, OR, PA, VA. 30% Out-of-network coverage for MD.

Which plan is right for you?

Below you can compare in-network coverage for Dominion's plans. For more details, you can view the plan documents at the bottom of the chart. The "Copayments" tab below shows how much you would pay for these procedures for each of these plans. Click the "Percentages" tab to see a comparison that shows how much each of the plans cover for each of the listed procedures.

Benefit Features Discount Program Select Plan Basic PPO Basic
Office Visit $15 $10 N/A
Deductibles None None $50 per adult (adult max $150)3
Annual Maximums None None $1,000 per insured person
Waiting Periods None None None
Receive Care From Discount Network Dentist Select Plan Network Dentist Elite PPO network dentist (DC, DE, MD, PA, VA), Choice PPO network dentist (GA, NJ, OR) or any licensed dentist
States Available DC, DE, MD, NJ, PA, VA DC, DE, MD, NJ, PA, VA DC, DE, GA, MD, OR, NJ, PA, VA
Procedures and Covered Services Avg. Cost Without Plan1  You Pay  You Pay You Pay
Year 11,2
You Pay
Year 21,2
You Pay
Year 31,2
I.  Diagnostic & Preventive
Comprehensive Oral Exam $85 $0 $0 $0 $0 $0
Bitewing X-Rays (4 Films) $74 $31 $0 $0 $0 $0
Teeth Cleaning (Adult) $102 $0
(1 per year)
$13 $0 $0 $0
II. Basic Restorative
Filling (3-Surface/Silver) $217 $107 $64 $109 $87 $43
Complete Series X-Rays $161 $66 $26 $81 $64 $32 
III. Major Restorative
Crown (Porcelain/Metal) $1,299 $677 $523 $1,104 $974 $650
Complete Denture $1,785 $895 $697 $1,517 $1,339 $893
Root Canal (Anterior Tooth) $747 $413 $341 $635 $560 $374
Perio Scaling/Root Planing $247 $138 $109 $210 $185 $124
IV. Orthodontics
Adults $7,025 $3,658 $3,658 Not Covered Not Covered Not Covered
Children (Kids Plan only) $6,552 $3,422 $3,422 $3,2766 $3,2766 $3,2766
Plan Document    Discount Program

Select Plan Basic

Select Plan Basic Kids

PPO Basic

PPO Basic Kids

 

Additional Plans 

Benefit FeaturesSelect Plan PremiumPPO PlusPPO PremiumElite ePPO Basic
Office Visit$10None  None  None
DeductiblesNone  $50 per adult (adult max $150)3$50 per adult (adult max $150)4$25 per adult (adult max $75)4
Annual MaximumsNone  $750 per insured person $1,500 per insured person  $1,500 per insured person
Waiting PeriodsNoneNoneYes5None
Receive Care FromSelect Plan Network DentistElite PPO network dentist (DC, DE, MD, PA, VA), Choice PPO network dentist (GA, NJ, OR) or any licensed dentistElite PPO network dentist (DC, DE, MD, PA, VA), Choice PPO network dentist (GA, NJ, OR) or any licensed dentistElite ePPO Network Dentist
States AvailableDC, DE, MD, NJ, PA, VADC, DE, GA, MD, OR, NJ, PA, VADC, DE, GA, MD, OR, NJ, PA, VADC, MD, PA, VA
Procedures and Covered Services  Avg. Cost 
Without Plan1
You PayYou Pay1You Pay1You Pay
I.  Diagnostic & Preventive
Comprehensive Oral Exam$85$0$0$0$0
Bitewing X-Rays (4 Films)$74$0$0$0$0
Teeth Cleaning (Adult)$102$0$0 $0$0
II. Basic Restorative
Filling (3-Surface Silver)$217$58$109$43$40
Complete Series X-Rays$161$26$0$0$0
III. Major Restorative
Crown (Porcelain/Metal)$1,299$495Not covered$650$570
Complete Denture$1,785$664Not covered$893$560
Root Canal (Anterior Tooth)$747$325Not covered$374$550
Perio Scaling/Root Planing$247$105$124$124$97
IV. Orthodontics
Adults$7,025$3,658Not Covered  Not CoveredNot Covered
Children (Kids Plan only)$6,552$3,422$3,2766$3,2766$3,2766
Plan Document   Select Plan Premium

Select Plan Premium Kids
PPO Plus
PPO Premium

PPO Premium Kids
Elite ePPO Basic



1 Approximate costs and payment amounts based on the Context4Healthcare's 80th percentile. Based on zip 223. A specific fee schedule applies and will be mailed with your membership card. To view copay schedules for the pediatric plans, go to DominionNational.com/pediatric.
2 Year 1 benefits apply during the subscriber's first 12 months of continuous coverage. Year 2 benefits apply during the subscriber's second 12 months of continuous coverage. Year 3 benefits apply during the subscriber's third 12 months of continuous coverage.
3 Deductibles apply to all services.
4 Deductibles apply to basic care and major restorative care.
5 There are no waiting periods for diagnostic and preventive care. To be eligible for basic care, you must have completed 6 (six) months of continuous coverage. To be eligible for major restorative care, you must have completed 12 (twelve) months of continuous coverage. Waiting period credit will be given for the length of time an insured was covered under each benefit classification under the current employer's prior dental coverage.
6 Medically-necessary orthodontics