Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0325047071[exp0327][xNM] © 2025 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL PLAN SUMMARY Dental Insurance Coverage that can help make it easier to visit a dentist and can help lower your dental costs. Fillings One replacement per surface in 24 months Endodontics Root canal treatment limited to once per tooth per lifetime Space Maintainers Space maintainers for dependent children up to his/her 19th birthday Periodontics  Periodontal scaling and root planing once per quadrant, every 24 months  Periodontal surgery once per quadrant, every 36 months Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year Repairs Once in 12 months Tissue Conditioning Once in 36 months Denture Rebases/Relines Once every 36 months Pulpotomy Apexification and Recalcification Extractions Oral Surgery General Services Type C — Major Restorative Crown, Denture and Bridge Repair/ Recementations Once every 12 months Occlusal Adjustments Once every 12 months Consultations Once every 12 months Denture Adjustments Once every 12 months Implants Replacement once every 5 calendar years Implant Repairs Once every 12 months Bridges and Dentures  Initial placement to replace one or more natural teeth, which are lost while covered by the planDentures and bridgework replacement; one every 5 calendar years  Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed Crowns, Inlays and Onlays Replacement once every 5 calendar years General Anesthesia When dentally necessary in connection with oral surgery, extractions or other covered dental services