Deductible (Single/Family) $50 / $150 Annual Plan Maximum $1,000 Preventive Services Exams, Cleanings, Fluoride, X-Rays 100% Covered Basic Services Fillings, Extractions, Endodontics, Crown Repairs 80% Covered Major Services Crowns, Dentures, In/Outlays, Periodontics 50% Covered Orthodontia Services 50% Covered Orthodontia Lifetime Maximum $1,000