Deductible (Per Member) $100 $100 $100 Annual Plan Maximum $1,500 $1,500 $1,500 Preventive Services Exams, Cleanings, Fluoride, X-Rays You Pay 0% You Pay 0% You Pay 0% Basic Services Fillings, Extractions, Endodontics, Crown Repairs You Pay 50% You Pay 50% You Pay 50% Major Services Crowns, Dentures, In/Outlays, Bridges, Implants You Pay 50% You Pay 50% You Pay 50% OUT-OF-NETWORK PPO PREMIER