Cost-Shares - for dates of service through April 30, 2012

A cost-share is the amount you are required to pay for the services rendered. United Concordia pays a percentage of the dentist's usual charge up to United Concordia's allowance for the covered service, subject to limitations.

The percentage of your cost-share depends upon the type of service received (see chart below).

The following chart provides an overview of cost-shares for types of services covered under the TDP. Please note: The TDP provides selected services -  including endodontic, periodontic and oral surgery - at reduced cost-shares for pay grades E-1 to E-4.

Type of Service CONUS
E1–E4 All Other Pay Grades
Diagnostic 0% 0%
Preventive* 0% 0%
Emergency Services 0% 0%
Sealants 20% 20%
Basic Restorative 20% 20%
Endodontic 30% 40%
Periodontic 30% 40%
Oral Surgery 30% 40%
Other Restorative 50% 50%
Implant Services 50% 50%
Prosthodontic 50% 50%
Orthodontic 50% 50%
General Anesthesia 40% 40%
Intravenous Sedation 50% 50%
Consultation / Office Visit 20% 20%
Post Surgical Services 20% 20%
Miscellaneous Services (occlusal guard, athletic mouthguard) 50% 50%

*Space maintainers are fully covered for patients under age 19 when involving posterior teeth. They are covered at a 20% cost-share for patients under age 19 when replacing anterior teeth only. Sealants are covered at 20% as noted above.
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