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You can receive a list of these participating dentists online at call 1- 800-942-0854 to have a list faxed or mailed to you. What services are covered under this plan? All services defined under the group dental benefits plan are covered. May I choose a non-participating dentist? Yes.

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Metlife Veterans Affairs Dental Plan The exclusions in this section apply to all benefits. Although we may list a specific service as a benefit, we will not cover it unless we determine it is necessary for the prevention, diagnosis, care, or treatment of a covered condition. We do not cover the following:

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Schedule of benefits - MetLife

• Surgical removal of wisdom tooth/third molar for orthodontic reasons only is not covered. D7140 Extraction - erupted tooth or exposed root (elevation and/or forceps removal) $0 D7210 Surgical removal of erupted tooth $0 D7220 Extraction - removal of impacted tooth - soft tissue $0 D7230 Extraction - removal of impacted tooth - partially bony $0

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Dental PPO Summary of Benefits - MetLife

• Your Children, up to age 26, are covered while Dental Insurance is in effect. You, Your Spouse, and Your Children, up to age 26, are covered while Dental Insurance is in effect. • All dental procedures performed in connection with • Payments are on a repetitive basis. • Benefit for initial placement of the appliance will be