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   BlueCross & BlueShield of Oklahoma
   Network: DNoA Preferred
   Customer Service: 800 672 2567
   Website: www.bcbsok.com 
   $2,500 per individual, per plan year
   Once reached, Member is responsible for 100% of dental claims for the remainder of the plan year
   $25 per individual, per plan year
   Free, twice per plan year
   Not subject to Deductible
   For Cleaning, Polishing, Bite-Wing X-Rays & Prophylaxis
   15% Co-Insurance after Deductible
   For Fillings, Simple Extractions, Surgical Removal of Teeth & Root Canals
   40% Co-Insurance after Deductible
   For Crowns, Full or Partial Dentures, Bridge Repairs & Occlusal Guards
   $1,500 Lifetime Maximum
   50% Co-Insurance
   For Adults & Dependent Children up to Age 26 Only
   Not Deductible or Waiting Period
   Current & Former Employee Coverage & Rates for the 2025/26 Plan Year, effective 7/1/2025 through 6/30/2026.
   49.76    Member
   26.30    Child
   41.80    Children
   61.46    Spouse
   87.76    Spouse & Child
   103.26    Spouse & Children