Supplemental Benefits" page for details. 
Medicare-covered dental $40 copay 30% of the cost 
Routine dental 
Dental services are subject to our  
standard claims review  
procedures which could include  
dental history to approved  
coverage. Dental benefits under  
this plan may not cover all  
American Dental Association  
procedure codes. Information  
regarding each plan is available  
at  Humana.com/sb .
Out-of-network dentists have not  
agreed to provide services at