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