Plan year 2026

Dental Benefits

DFW offers two dental options through Cigna: a DHMO with network-only copay coverage and a DPPO with deductible and coinsurance coverage.

Dental Benefits

Premiums

Coverage Tier	DHMO	DPPO
EE Only	$5.29	$25.62
EE + Children	$10.01	$47.16
EE + Spouse	$9.36	$46.02
EE + Family	$13.01	$63.42

EE Only

DHMO: $5.29
DPPO: $25.62

EE + Children

DHMO: $10.01
DPPO: $47.16

EE + Spouse

DHMO: $9.36
DPPO: $46.02

EE + Family

DHMO: $13.01
DPPO: $63.42

Covered Services

Feature	DHMO	DPPO
Deductible	$0 annual deductible	For basic and major carePer individual $50Per family $150
Preventive	$5 copayment Office visit$12 copayment Sealant per tooth	$0 (annual deductible waived)Includes checkups, cleanings, X-rays, sealants, etc.
Basic Care	$6 copayment Single tooth extraction$40 copayment Surgical removal of erupted tooth$40 copayment Perio scaling and root planing (1-3 teeth/quad)	20% after deductibleIncludes fillings, oral surgery, periodontal treatment,root canals, crown repairs, etc.
Major Care	$285 copayment Porcelain/ceramic substrate crown$250 copayment Pontic-porcelain bridge fused to high noble metal$260 copayment Two surface metallic inlay$305 copayment Molar root canal$225 copayment Complete upper or lower denture	50% after deductibleIncludes installation of crowns, fixed bridgework,dentures, implants, etc.
Orthodontia	$125 copayment Evaluation and treatment planning$1,608 copayment Orthodontic treatment – children (under 19 years)$2,592 copayment Orthodontic treatment – adults (19 years and above)	50% after orthodontia deductible ($50)until the plan pays lifetime maximum of $1,500,then 100% of any remaining costs.Includes braces for adults and children
Maximum Benefit	None	Per calendar year, per individual $2,000Orthodontics per individual $1,500

Deductible

DHMO: $0 annual deductible
DPPO: For basic and major care Per individual $50 | Per family $150

Preventive

DHMO: $5 copayment Office visit $12 copayment Sealant per tooth
DPPO: $0 (annual deductible waived) Includes checkups, cleanings, X-rays, sealants, etc.

Basic Care

DHMO: $6 copayment Single tooth extraction $40 copayment Surgical removal of erupted tooth $40 copayment Perio scaling and root planing (1-3 teeth/quad)
DPPO: 20% after deductible Includes fillings, oral surgery, periodontal treatment, root canals, crown repairs, etc.

Major Care

DHMO: $285 copayment Porcelain/ceramic substrate crown $250 copayment Pontic-porcelain bridge fused to high noble metal $260 copayment Two surface metallic inlay $305 copayment Molar root canal $225 copayment Complete upper or lower denture
DPPO: 50% after deductible Includes installation of crowns, fixed bridgework, dentures, implants, etc.

Orthodontia

DHMO: $125 copayment Evaluation and treatment planning $1,608 copayment Orthodontic treatment – children (under 19 years) $2,592 copayment Orthodontic treatment – adults (19 years and above)
DPPO: 50% after orthodontia deductible ($50) until the plan pays lifetime maximum of $1,500, then 100% of any remaining costs. Includes braces for adults and children

Maximum Benefit

DHMO: None
DPPO: Per calendar year, per individual $2,000 Orthodontics per individual $1,500

Important Notes

DFW offers two dental options through Cigna: a DHMO with network-only copay coverage and a DPPO with deductible and coinsurance coverage.
Refer to the Cigna DHMO and DPPO Schedule of Benefits on DFWConnected for more details.