Deductible $50 per covered member Annual Plan Maximum $1,250 / person Preventive Services You Pay 0% Exams, Flouride, Sealants, Space Maint. Basic Services You Pay 20% Fillings, Simple/Complex Extractions, Endo/Perio Major Services You Pay 20% Prosthodontics, Implants, Inlays, Onlays, Crowns Orthodontia Services You Pay 40% Orthodontia Lifetime Maximum $500