Deductible No deductible $25 Annual Plan Maximum $1,250 (Maximum Per Person) Preventive Services Exams, Cleanings, Fluoride, X-Rays You Pay 0% Basic Services Fillings, Extractions, Endodontics, Crown Repairs You Pay 10% You Pay 15% Major Services Crowns, Dentures, In/Outlays, Periodontics You Pay 40% You Pay 45% Orthodontia Services (maximum age limit 18) You Pay 50% Orthodontia Lifetime Maximum $1,250 $1,000 IN NETWORK OUT-OF-NETWORK