Deductible $25 / person to a max of $75 / family Annual Plan Maximum $1,000 / person Diagnostic Preventive Services You Pay 0% Exams, Cleanings, Fluoride, and space maintainers Basic Services X-rays, filings/crown repair, root canals, extractions, crowns, You Pay 50% relines/repairs to bridges, implants and dentures Major Services You Pay 50% Prosthodontic Services: bridges, implants and dentures Orthodontia Services You Pay 50% Orthodontia Lifetime Maximum $500 PPO Coverage - Offers significant discounts; no balance billing; acceptance of processing policies; and 108,000 dentist locations Premier Coverage - Negotiated fees; no balance billing; acceptance of processing policies; and 186,000 dentist locations Non-Participating Coverage - Balance billing and does not offer discounts